Forensic Dentistry: What It Is, My Journey Through It, and How Do You Get Involved

In Diagnostics by Mary BushLeave a Comment

On February 9, 2021 I became the first woman to win the Reidar F. Sognnaes Award of Excellence in Forensic Odontology from the American Academy of Forensic Sciences. In a traditionally male dominated field, this was a milestone. Before I begin my story, I want to discuss what forensic dentistry is, and address one of the most frequent questions I am asked: How do I become a forensic dentist?

Forensic dentistry, simply put, is dentistry as it applies to the law, and there are three main areas: Victim Identification, Age Estimation, and Bitemark Analysis. Let’s take a brief look at each.

Victim Identification is used to confirm the identity of an unknown individual from dental records. This can be in a case of a single person, or many people; as in mass disasters. A mass disaster is defined as a situation in which there are more fatalities than local resources can manage. In these circumstances, forensic dentists become part of a Disaster Mortuary Operational Response Team (DMORT). DMORT is government run and they create teams based on geographic region that get deployed to the disaster site. Members have to join to be part of DMORT. They also have to participate in training activities. If this is of interest to you, information can be found at: https://www.phe.gov/Preparedness/responders/ndms/ndms-teams/Pages/dmort.aspx.

Age estimation is used when the teeth are needed to estimate age. Sounds easy but after the dentition has completed its development, this becomes tricky, and there has been a spike in cases when an individual’s age must be determined. These cases usually occur in situations when an individual is not US born, and over or under eighteen must be established to determine adult status or not. Third molar development is typically used in these situations. As dental professions, we know it is impossible to determine age with absolute certainty, though. There will always be a range. Unfortunately, some do try to pinpoint this with certainty and it’s here that problems arise.

The last category is Bitemark Analysis. This is used in circumstances in which someone is bitten and the teeth of a suspected assailant are compared to a wound on a victim. Bitemark analysis has had a controversial past and it seems it will have a more tainted future. Though this type of forensic analysis has been used as a courtroom staple since the 1970’s, and was instrumental in getting a conviction against notorious serial killer Ted Bundy, it is so unreliable that more than thirty wrongfully sentenced individuals, some of who have spent time on death row, some who have spent more than thirty years of their lives behind bars for a crime they did not commit, are bringing an awareness to the fact that this is junk evidence by their exonerations. I should mention that I have been on the front line of making the problems of bitemark analysis be known. I’ve testified in capital murder appeal cases on behalf of the wrongfully accused (DNA evidence pointing to another suspect), and even testified on Capitol Hill about the need for scientific rigor in the courtroom.

Maybe it’s now that I tell you more about me. My entry into the world of forensics was fairly atypical. I had just been hired at SUNY at Buffalo School of Dental as a full-time faculty member on a tenure track. What this means is that I had to do independent research. I chose forensic dentistry. Fast forward a couple of years and I had published papers on how you could use dental materials as an aid in victim identification. Resin composites and root canal sealers stay around, even after being exposed to cremation conditions and can be identified by brand name! In high temperature situations, the teeth fracture, shrink by about 25%, and they dislodge from the jaws, creating difficulty for standard radiographic techniques. Using the written chart to compare brand of material placed adds another piece to the puzzle to confirm identity when few clues remain.

One area we said we would never get involved in is bitemark analysis. It was very contentious. Still is. But I was working with a dental student who very much wanted to do a research project on bitemarks. So, we did. Long story short, every bite we created, with the same set of dental models, under the same conditions, left a different imprint in the skin (we used un-embalmed cadaver skin). Some of these imprints didn’t even look close to the set of teeth that created them, leading us to see that bitemarks do not reliably transfer to the skin. The establishment of a strong research team, several grants and a number of publications later…well the results were damning and we were not well liked by the Bitemark examiners.

As this was all going on, I was invited to testify on Capitol Hill about the need for scientific rigor in the courtroom. Next, my husband and I gave a presentation before the Texas Forensic Commission, who in the end, declared a moratorium on bitemark analysis. Finally, we presented before the President’s Council of Advisors on Science and Technology (this was President Obama’s council). Every scientific agency we spoke to concluded the same thing about bitemark analysis: It shouldn’t be used, and that it does rise to any level of scientific validity. The legal community is very different from the scientific one though, and today, bitemark cases are still admitted in a court of law. We are still fighting the fight.

Now, how do you get involved in forensic dentistry? There are a couple of ways. The most common is to take continuing education courses that train you on how to do this, and I’ll list the best sources to find courses below. My biggest bit of advice is to take an introductory course to see if this is really for you. Watching TV shows which features the medical examiner’s office is very different from being in the morgue yourself, and this is the best way to see if this is really for you. If all goes well, take some more involved five-day courses that give hands on training. After you’ve completed your education, the next step is to become affiliated with the medical examiner’s office in your area, and contacting the medical examiner in your town is the best place to start. If they have a forensic dentist on staff, they should direct you in his/her direction.

My next strong bit of advice is to definitely become involved in organizations: Networking is key. Getting to know people in the field can open doors and create opportunities. Here are some of the best ones:

The American Society of Forensic Odontology (ASFO). This is an entry level organization and anyone with an interest in forensic odontology can join. https://asfo.org. The website for the ASFO has a thorough list of all courses offered and this is a great resource to find educational opportunities. And conferences too!

The American Board of Forensic Odontology (ABFO). This is an organization that credentials board certification and there are a number of requirements in achieving this. Information, along with a number of resources can be found at https://abfo.org.

Finally, there is the American Academy of Forensic Sciences (AAFS). This is a credentialing organization and they have entry levels of membership as you work towards full membership. There will be a certain amount of education and casework necessary to move up the ranks and this is all described in the website. They have a large yearly conference and this is a great place to learn all about forensics, and meet people too. https://www.aafs.org

I have been involved in forensic dentistry since 2006 and love every minute of it. I’m a fellow of the AAFS and past President of the ASFO. I’ve lectured nationally and internationally about my research which is in 30+ journal articles and 9 textbook chapters. Now, I write crime novels based on my forensic experiences. I wish you the best of luck in your forensic endeavors!



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