Teeth are the most durable parts of the body, and dentitions are as individual as fingerprints. Therefore, individual tooth morphology as well as the restorations that exist in teeth are useful for human identification. Situations involving decomposition and skeletal remains may yield no recognizable facial features or fingerprints. Postmortem (after death) teeth, jaws, prostheses, and appliances can yield a positive identification if accurate antemortem (before death) records are available. Even DNA, a popular and valuable identification tool, relies on accurate and complete antemortem (before death) records. Therefore, accurate, comprehensive, and current radiographs and dental charting are critical to the successful confirmation or elimination of an individual as a victim.

A real test of the value of dental identification is found in the case of John Wayne Gacy of Chicago, convicted of 33 counts of murder. Only five of the human remains found still had soft tissue, making the identification process a challenge. However, 20 of the 33 known victims were identified through their dental records. In another case, a landslide in the State of Washington in 2014 resulted in mass fatalities where 27 of the 43 victims were positively identified using dental records. Several cases were reported at AAFS in 2015 where the morphology of a single tooth was critical to victim identification. Identification of a severe burn victim was made based on the visual similarity of the root canal filling and the dilaceration of the root on tooth #11. The mangled victim of a train collision was identified based on the unique root and pulp chamber morphology of one molar. Yet another identity was confirmed by superimposing antemortem and postmortem radiographs of tooth #32.

One well-publicized case in 2006 involved mistaken identity of two young female college students who were involved in a motor vehicle accident in Indiana. One woman was deceased at the scene, and the other was unable to communicate due to head trauma. Based on physical evidence found near their bodies, the deceased victim was erroneously identified. One family held funeral services for their presumed deceased child while the other family held bedside vigil for their presumed surviving daughter. The error was not discovered for over 5 weeks when the surviving woman recovered enough to confirm her own identity. This situation might have been avoided had a dental identification been utilized for the deceased victim instead of reliance on visual and circumstantial evidence.

Accurate, comprehensive, and current antemortem radiographs and dental charting are critical to the successful confirmation or elimination of an individual as a victim. Several presentations at the Annual Session of the American Academy of Forensic Sciences Odontology Section in 2015 reported on the importance of accurate charting of existing teeth and restorations. As one example, all dental professionals must determine whether the tooth just distal to the second premolar is a first molar or a second molar that has drifted or has been orthodontically moved into that space. As stated earlier in this book, this decision must be based on careful examination of the anatomy of the crown (and the root on radiographs) and patient knowledge of extractions or missing teeth.

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