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Forensic Odontology Section: Review Article

Role of Dentists during Mass Disasters: A Review

Kiran Vallamchetla, Kotya N Maloth1, Vani Chappidi2, Stuti Goyal3, Sridevi Ugrappa4, Srikanth Kodangal2
Private Practice, Hyderabad, 1Department of Oral Medicine and Radiology, Mamata Dental College and Hospital, Khammam, 2Department of Oral Medicine and
Radiology, Sri Sai College of Dental Surgery, Vikarabad, Telangana, 3Srinivas Institute of Dental Sciences, Mangaluru, Karnataka, India,
4
Faculty of Dentistry, AIMST Dental Institute, AIMST University, Semeling, Bedong, Malaysia

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

Introduction of justice, deals with the proper handling and examination of

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
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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]
Address for correspondence: Dr. Kotya N Maloth,
Department of Oral Medicine and Radiology, Mamata Dental College and
Hospital, Khammam, Telangana, India.
E‑mail: dr.kotyanaik.maloth@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com
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.
Received: 22-09-2017  Accepted: 06-01-2018  Published: 15‑02‑2018

© 2018 Journal of Indian Academy of Oral Medicine & Radiology | Published by Wolters Kluwer ‑ Medknow 371
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Vallamchetla, et al.: Role of dentists in mass disasters
Role of Dentists During an Emergency
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]:
(a) 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
(b) Control of hemorrhage
(c) Attainment and maintenance of patent airway, and
intra‑tracheal intubation including tracheotomy
(d) Proper and adequate cleansing, debridement, and
treatment of wounds
(e) Bandaging and splinting
(f) Triage of facial and oral injury cases
(g) Administration of anesthetics under medical supervision
(h) Assisting in surgical procedures apart from oral procedures
(i) Insertion of naso‑gastric tubes for lavage, as instructed
(j) Administration of whole blood and intravenous solutions,
as directed
(k) Administration of parenteral medication
(l) Urethral catheterizations
(m) Administration of immunizing agents to avoid future
complications as directed.
Role of a Dentist in Identification of Human
Remains
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
372 Journal of Indian Academy of Oral Medicine & Radiology  ¦  Volume 29  ¦  Issue 4  ¦  October‑December 2017
Figure 1: Role of dentists during mass disasters
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 situations 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.
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Vallamchetla, et al.: Role of dentists in mass disasters
Postmortem Dental Profiling
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
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
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,
Journal of Indian Academy of Oral Medicine & Radiology  ¦  Volume 29 ¦ Issue 4 ¦ October‑December 2017
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.
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