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 Table of Contents  
FORENSIC ODONTOLOGY SECTION: REVIEW ARTICLE
Year : 2017  |  Volume : 29  |  Issue : 4  |  Page : 371-373

Role of Dentists during Mass Disasters: A Review


1 Private Practice, Hyderabad, India
2 Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Khammam, Telangana, India
3 Department of Oral Medicine and Radiology, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
4 Srinivas Institute of Dental Sciences, Mangaluru, Karnataka, India
5 Faculty of Dentistry, AIMST Dental Institute, AIMST University, Semeling, Bedong, Malaysia

Date of Submission22-Sep-2017
Date of Acceptance06-Jan-2018
Date of Web Publication15-Feb-2018

Correspondence Address:
Dr. Kotya N Maloth
Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Khammam, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_91_17

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   Abstract 


Mass disasters cause damage, ecological disruption, and loss of human life on a massive scale. The reasons for these ranges from natural causes such as volcanic eruptions and earthquakes to secondary human causes like wars. Such massive disruption of life demands help from people belonging to various sectors of healthcare, providing pre-identified, structured, and systematic aid to the victims of the disaster. This review article highlights the role of a dentist in such massive disasters. The dentist not only provides first aid to the victims but also aids in the identification of human remains.

Keywords: Dentist, forensic odontology, mass disasters


How to cite this article:
Vallamchetla K, Maloth KN, Chappidi V, Goyal S, Ugrappa S, Kodangal S. Role of Dentists during Mass Disasters: A Review. J Indian Acad Oral Med Radiol 2017;29:371-3

How to cite this URL:
Vallamchetla K, Maloth KN, Chappidi V, Goyal S, Ugrappa S, Kodangal S. Role of Dentists during Mass Disasters: A Review. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2019 Aug 21];29:371-3. Available from: http://www.jiaomr.in/text.asp?2017/29/4/371/225570




   Introduction Top


Disasters are as old as human history, but the dramatic increase and the damage caused by them in the recent past have become a cause of national and international concern; almost all of them resulting in high incidence of morbidity and mortality. Mass disasters are highly unexpected events that cause alarming loss of lives. A “disaster” can be defined as “any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a massive scale sufficient to warrant an extraordinary response from outside the affected community or area.”[1] Major emergencies and disasters have occurred throughout the history and the incidence of disasters has increased in the recent past owing to the rise in the world's population.

Mass casualty situations occur in an unpredictable manner with serious consequences. Disasters may be man-made or natural which include, earthquakes, cyclones, floods, tidal waves, land-slides, volcanic eruptions, tornadoes, fires, hurricanes, snow storms, severe air pollution smog, heat waves, famines, epidemics, building collapse, toxicologic accidents (e.g., release of hazardous substances), nuclear accidents, and warfare.[2] It is also caused by human activities such as mishaps involving mass transport by land, sea or air, and other causes include war, boundary disputes, ethnic, or religious conflicts.[3],[4]

The Federation Dentaire Internationale (FDI) defines forensic odontology as that branch of dentistry, which, in the interest of justice, deals with the proper handling and examination of dental evidence and with the proper evaluation and presentation of dental findings. Based on the major fields of activity, Avon classified forensic odontology into civil, criminal, and research. The civil field is the one concerned with mass disasters.[5]

Following mass disaster, identification of an individual victim by dental means, is one of the most reliable methods. In severe burn situations and/or following severe disintegration, visual recognition of facial features and fingerprints is often impossible due to extensive soft tissue destruction; this situation ensures the use of hard (calcified) tissue such as human dentition and jaw bones for human identification as they sustain severe form of insults with minimal loss of identification details. People who have been diseased for some time before death and those drowned accidentally in water also present unpleasant conditions with difficulty in identification of the victim.[6] Because of the lack of a comprehensive fingerprint database, dental identification continues to play a vital role in mass disaster.[7]


   Role of Dentists during an Emergency Top


The role of dentists in national emergencies has its origin since the inception of forensic field. During periods of intense military activity in Korea, as well as in World War II, dentists in conjunction with medical fraternity participated in the emergency care of the injured. The assignment of a specific role to an individual dentist depends on the state of organization of the Emergency Health Services at the community level. However, it is considered that the immediate needs in terms of professional personnel will be more critical in relation to primary treatment services, irrespective of the fields they are concerned with.[8] Apart from the routine duties, additional functions for dentists under mass casualty conditions would comprise of [Figure 1]:
Figure 1: Role of dentists during mass disasters

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  1. First-aid, including artificial respiration, emergency treatment of open chest wounds, relief of pain, treatment of shock and the mobilization of casualties towards the disastrous events
  2. Control of hemorrhage
  3. Attainment and maintenance of patent airway, and intra-tracheal intubation including tracheotomy
  4. Proper and adequate cleansing, debridement, and treatment of wounds
  5. Bandaging and splinting
  6. Triage of facial and oral injury cases
  7. Administration of anesthetics under medical supervision
  8. Assisting in surgical procedures apart from oral procedures
  9. Insertion of naso-gastric tubes for lavage, as instructed
  10. Administration of whole blood and intravenous solutions, as directed
  11. Administration of parenteral medication
  12. Urethral catheterizations
  13. Administration of immunizing agents to avoid future complications as directed.



   Role of a Dentist in Identification of Human Remains Top


The important role of dentists in the identification process is reflected from the event where high percentage of victims were identified via dental examination (61%) in the Tsunami disaster of 26th of December in 2004, north of Sumatra Island.[9] Forensic dentists usually have a leading role in the forensic team when dental structures are the only source of information for the identification of human remains. The resistance of teeth and their supporting tissues, even to fire and decomposition, makes them extremely useful for identification purposes.[10],[11] For the identification of human remains, anything that distinguishes one person from another, such as a tattoo, or a variation from normality, becomes very important to the forensic team, greatly assisting the identification process.[12] These variations, analyzed by dental examiners, can potentially lead to a positive identification.[13]

The most frequent investigation performed, is the comparative examination used to establish with certainty that the remains of the deceased and the person represented by ante-mortem dental records are of the same individual. In most of the developing countries, comprehensive fingerprint data base and complete ante-mortem dental records are not maintained properly, thus making comparative dental identification sometimes critical. The second investigation is for cases without previous ante-mortem records and no clues of positive identity exist. Under these circumstances, postmortem dental profiles completed by the forensic dentists suggesting characteristics of the individual result in narrowing the search of the ante-mortem material.[14]

The advent of advanced analytical computer with inbuilt software packages, dental biometrics (the matching of ante-mortem and postmortem dental radiographs for human identification) has come into existence in situ ations where information regarding fingerprint or facial features is unavailable.

The American Board of Forensic Odontologists [15] recommends only four conclusions when reporting dental identification:

  1. Positive identification: the ante-mortem and postmortem records match in details with no unexplainable discrepancies
  2. Possible identification: ante-mortem and postmortem data have consistent features but due to poor quality, identity cannot be positively established
  3. Insufficient evidence: available information is insufficient to form basis for the final conclusion
  4. Exclusion: the ante-mortem and postmortem data are clearly inconsistent.


Quality of ante-mortem dental records was categorized as follows:

  • Grade 0: No information
  • Grade 1: Information without written records
  • Grade 2: Written records only
  • Grade 3: Record combined with unsystematic radiograph
  • Grade 4: Record combined with bitewings
  • Grade 5: Record combined with full mouth survey or an orthopantomograph.



   Postmortem Dental Profiling Top


Postmortem dental profiling is the process by which forensic dentists limit the likely population to which a deceased belongs, in the absence of ante-mortem dental records. Postmortem dental profile will provide information on age of the deceased,[16] ancestral background,[17] sex, and socioeconomic status.[18] Age of children (including fetuses and neonates) can be determined by analysis of tooth development and subsequent comparison with developmental chart; accuracy is ±1.5 years.[19] Periodontal disease progression, excessive wear and multiple restorations, extractions, bone pathology and complex restorative work may indicate an older individual; accuracy of these highly variable markers is ±10 to 12 years. Some forensic dentists claim accuracy of ±4 years using aspartic acid racemization. Scanning Electron Microscope/Energy Dispersive X-ray Spectroscopy (SEM EDXS), is also used to examine restorative materials including resin in relation to age determination in cases where dental status of victims cannot be determined due to damaged dentition.


   Other Methods of Dental Identification Top


Other methods of dental identification include dental biometrics [20] and genetic finger printing.[21] Dental biometrics automatically analyzes dental radiographs to identify the deceased individual. Dental radiographs provide valid accurate and reliable information about the identity of an individual. The method used in dental biometrics is the matching of unlabelled postmortem radiographs against the labeled ante-mortem radiographs. If the set of teeth in a postmortem radiograph sufficiently matches the teeth in an ante-mortem radiograph, the identity of the deceased in the postmortem radiograph is obtained.

The present day DNA fingerprinting is based on polymerase chain reaction (PCR) that undergoes genetic amplification of Short Tandem Repeats (STR) of selective, highly polymorphic regions of DNA. This allows for comparison of DNA from teeth, jaws, and other parts of unidentified individuals with a known ante mortem sample from clothing, stored blood, hair brush, cervical smear, or biopsy specimen.[22] The success rate of dental identification will vary considerably depending on the nature of the accident, the degree of dental injury, the incidence of dental treatment and the availability of adequate dental records, which is a function of the nationality and country of residence of victims.


   Conclusion Top


The role of a dentist during mass disaster is well-defined in other developed countries as compared to India. The role has to be identified, delineated, and assigned along with proper training to be provided to the dentist, with effective planning, education, and training, dentists can play a significant role in responding to mass disaster or other unforeseen events.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bhat PK, Badiyani BK. Are dentists ready for the invincible disasters? Journal of Health Sciences and Research 2011;2:33-6.  Back to cited text no. 1
    
2.
Park K. Textbook of Preventive and Social Medicine. Disaster Management. 21st ed. Bhanot; 2011. p. 736-43.  Back to cited text no. 2
    
3.
Fadeyibi IO, Omosebi DT, Jewo PI, Ademiluyi SA. Mass burns disaster in Abuleegba, Lagos, Nigeria from a petroleum pipeline explosion fire. Ann Burns Fire Disasters 2009;22:97-103.  Back to cited text no. 3
    
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Jain R, Rajoo KM. Mass disaster management: Forensic aspect. Journal Ind Acad Forens Med 2009;31:234-392.  Back to cited text no. 4
    
5.
Shamim T, Shameena PM, Sudha S. Forensic odontology: A new perspective. Medicolegal Update 2006;6:1-4.  Back to cited text no. 5
    
6.
Valenzuela A, Marques T, Exposito N, Bohoyo JM. The application of dental methods of identification to human burn victims in a mass disaster. Int J Legal Med 2000;113:236-9.  Back to cited text no. 6
    
7.
Sharma G, Kumar R. Role of forensic odontologist in disaster victim identification. Journal Indo-Pacific Academy of Forensic Odontology 2011;2:31-2.  Back to cited text no. 7
    
8.
Aberdeen C, McCabe E. The dental practitioner's role in emergency health services. Canad Med Ass J 1967;96:192-5.  Back to cited text no. 8
    
9.
Rai B, Anand SC. Role of forensic odontology in tsunami disasters. Internet J Forensic Sci 2007;2:1540-2622.  Back to cited text no. 9
    
10.
Oliveira RN, Daruge E, Galvao LC, Tumang AJ. Collaboration of forensic odontology for identification postmortem. Rev Bras Odontol 1998;55:117-22.  Back to cited text no. 10
    
11.
Brkic H, Keros J, Kaic Z, Cadez J. Hereditary and environmental dental findings in identification of human remains. Coll Atropol 2000;24:79-83.  Back to cited text no. 11
    
12.
Kanchan T, Shetty M, Nagesh KR, Menezes RG. Lumbosacral transitional vertebra: Clinical and forensic implications. Singapore Med J 2009;50:85-7.  Back to cited text no. 12
    
13.
Warnick A. Mass disaster management: The organization of a mass disaster dental identification team. Alpha Omegan 2002;95:25-37.  Back to cited text no. 13
    
14.
Stavrianos C, Stavrianou I, Dietrich E. Kafas P. Methods for human identification in forensic dentistry: A review. The Internet J Forensic Sci 2009;4:413-21.  Back to cited text no. 14
    
15.
Body identification guidelines. American Board of Forensic Odontology (ABFO). J Am Dent Assoc 1994;125:1244-6.  Back to cited text no. 15
    
16.
Mincer HH, Harris EF, Berryman HE. The A.B.F.O. study of third molar development and its use as an estimator of chronological age. J Forensic Sci 1993;38:379-90.  Back to cited text no. 16
    
17.
Guo L, Sun DL, Ren L, Shen J, Pan KF, Shen J, et al. A comparative morphologic study of Carabellicusp between Chinese and Japanese students. Shanghai Kou Qiang Yi Xue 1995;4:66-7.  Back to cited text no. 17
    
18.
Slavkin HC. Sex, enamel and forensic dentistry: A search for identity. J Am Dent Assoc 1997;128:1021-5.  Back to cited text no. 18
    
19.
Adachi H. Studies on sex determination using human dental pulp. II. Sex determination of teeth left in a room. Nihon Hoigaku Zasshi 1989;43:27-39.  Back to cited text no. 19
    
20.
Chen H, Jain AK. Dental biometrics: Alignment and matching of dental radiographs. IEEE Trans Pattern Anal Mach Intell 2005;27:1319-26.  Back to cited text no. 20
    
21.
Signer EN, Dubrova YE, Jeffreys AJ. Wilde C, Finch LM, Wells M, et al. DNA fingerprinting Dolly. Nature 1998;394:329-30.  Back to cited text no. 21
    
22.
Kolude B, Adeyemi BF, Taiwo JO. The role of forensic dentist following mass disaster. Ann Ib Postgrad Med 2010;8:111-7.  Back to cited text no. 22
    


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