Odontology Often is Final Piece to Grim Puzzle

A man fails to return home after a weekend fishing trip in the mountains. His wife reports him missing, and a weeklong search ensues. Months go by before a hiker stumbles upon some sun-bleached human bones near an alpine stream.

The discovery is reported to authorities, and the county coroner calls in an expert in identification -- a forensic dentist, one of a small cadre of specialized volunteers assisting California's Department of Justice in identifying missing individuals.

Forensic dentists, also known as forensic odontologists, help match nameless human remains with some of the Golden State's approximately 2,000 unidentified victims from as far back as 1959.

Identification is accomplished through studies of dental remains, which include postmortem X-rays, photography, and creation of dental records to catalog unique restorations or other identifying qualities. The postmortem information is sent to Sacramento, Calif., where it is compared with dental records of missing people on file at the Department of Justice.

The identification process is important in forensic odontology and can present substantial challenges depending on circumstances surrounding the case.

"One remarkable case was when a single tooth was found in addition to some pelvic bones that enabled us to determine it was a female," says Norman D. "Skip" Sperber, DDS, a senior forensic odontology volunteer with more than 30 years' experience. "It was a central upper incisor containing a particular restoration. We searched the Department of Justice records of missing women, made a positive identification, and her killer was later identified and apprehended."

Before the late 1970s, solving missing-persons cases was haphazard at best. No coordinated statewide procedure existed, and Sperber thought there had to be a better way. In the first effort by a state to organize dental records to make matching them with unidentified deceased people easier, he and two other forensic dentists convinced a member of the state Legislature that a law was needed. Their work resulted in a statute enacted in 1979 requiring dental records of all missing persons to be sent to the Department of Justice.

The system has worked. Duane E. Spencer, DDS, a pediatric dentist practicing in the East Bay who since 1974 has participated in identifying more than 250 missing people, recalls one case in particular.

"A number of years ago, a case made television's America's Most Wanted show after a man was murdered in Berkeley," Spencer says. "His dismembered body was scattered. Months later the skull finally turned up. The skull and teeth helped us identify the victim, eventually leading authorities to the murderer. He was found guilty and received the death sentence."
Spencer said the identification was relatively straightforward because the victim's dentist had kept good records of his care.

Another volunteer forensic odontologist, James D. Wood, DDS, in Cloverdale, north of San Francisco, also emphasizes the importance of good recordkeeping.

"Without good records, especially good radiographs, there is no way to compare a possible match to a set of postmortem remains. That's the critical feature," Wood says. "The written record is also incredibly important because it documents what was done on a patient. I can't stress enough the importance of not destroying records, and that means X-rays as well. Everyone deserves the dignity of their identity."

California's handling of missing-persons cases has had a nationwide effect, leading to a federal law that mirrors what the state has done, according to Gerald L. Vale, DDS, an associate dean of the USC School of Dentistry.

"Many remains found here came from other states, so working with our own data we won't be very successful," says Vale, a veteran of more than 30 years of forensic dentistry. "We need a nationwide database, and we're moving in that direction with proposed new federal legislation called Jennifer's Law."

"The benefit would be more people identified, and this will benefit families because of the obvious emotional and financial concerns. From the law enforcement point of view, it's tremendously important, because the solution of homicides results from knowing who the victim is."

Vale reminds all dentists of other ways they can help.

"By law, California dentists must put a patient's name or social security number in all full or complete dentures," he says. "We've had cases of bodies identified because of this."

Department of Justice officials welcome the efforts of California's volunteer forensic dentists.

"As a result of dentists who volunteer for us, we've been able to identify five additional unidentified deceased persons in the last year-and-a-half," says Jeannine Willie, supervisor of the Missing/Unidentified Persons Unit, Office of the Attorney General, California Department of Justice. "In each of these cases, if it weren't for the dentists an ID could not have been made. All leads were exhausted. The dentists who volunteer for us are the greatest."

Dentists who want to know more about forensic dentistry can attend a lecture being presented by the California Society of Forensic Dentistry. The next lecture will be Sept. 25, 1998, in San Diego. Vale, Sperber, Spencer, Wood, and six others will make presentations. Contact Rick Cardoza, DDS, at (619) 444-6195 for more information.

Soul-Searching Authors Sought

Chicken Soup for the Dental Soul is looking for authors. On the heels of several "Chicken Soup" bestsellers, including Chicken Soup for the Teenage Soul and Chicken Soup for the Pet Lover's Soul, a new book is in the works about the "soul" of dentistry. Dental professionals are invited to submit one or more true, dentistry-related short stories for the new Chicken Soup for the Dental Soul story contest.

Suitable story subjects might deal with parenting, the Tooth Fairy, kindness, kids at the dentist's office, self-esteem, attitude, overcoming obstacles, perspective, teaching and learning, special moments, and living one's dream.

Contest-winning stories will be selected by the Chicken Soup organization. Author of the first-place story will receive $2,000; the second-place winner will receive $1,000; and the third-place winner will receive $500. Authors of all other stories published in Chicken Soup for the Dental Soul will receive $300. All awards will be paid within two months of publication of the book. Receipt of all stories submitted will be acknowledged by postcard. Entries are due Dec. 1, 1998.

For more information, contact Don Dible at (408) 739-4020 or E-mail at dentalsoul@aol.com.

Find the Target, Hit the Mark

The Internet has greatly increased people's ability to access research material and other information. Search engines are invaluable when it comes to sifting through mounds of information, but sometimes the results can be overwhelming. How can you narrow your search? Following are some suggestions:

• Quotation Marks. Placing words within quotation marks creates a phrase. A match is returned only when the exact word sequence is found. Example: "dentistry in the 18th century."
  
  
• A plus sign. Adding a plus sign (+) directly in front of a word requires that the word be included in all search results. Example: tooth+decay.
  
  
• A minus sign. Adding a minus sign (-) directly in front of a word indicates that the word should not be found in search results. Example: porcelain-teacup.
  
  
• An Asterisk. An asterisk (*) is a wild card. It must be placed on the right-hand side of a word or embedded within a word with at least three characters to the left. Use an asterisk to find various spellings or related words. Example: dent* will return matches of dent, dents, dental, dentist, dentistry, among others.
  
  
• And: Search results must contain all words joined by the "and" statement. Example: restorations and ceramics.
  
  
• Or: Search results must contain at least one of the words joined by the "or" statement. Example: needles or syringes.
  
  
• And Not: Search results cannot contain the word that follows the "and not" statement. Example: crowns and not royalty.
  
  
• Parentheses: Use parentheses to build complex search queries that incorporate other special words and characters. Example: San and (Francisco or Diego) results in lists of sites about either city.
  
  
• Capitalization: Searches typed in all lowercase letters will match for either uppercase or lowercase letters. Uppercase letters in a search word will match only to uppercase letters. Generally, it is better to use lowercase letters in your search phrases.
  

White Smile Equated to Healthfulness

Being perceived as healthier and more attractive may be as simple as flashing a healthy white smile, according to the Crest Extra Whitening Smile study. Conducted in conjunction with Custom Research Inc., and research and psychology experts, the study surveyed 200 male and female respondents of various ages and ethnic backgrounds in eight cities in the United States.

Study participants were asked to rate two photos of the same people before and after their teeth had been digitally manipulated to be whiter. Each participant looked at 20 pairs of photos. Respondents were not informed of the manipulation process, and the tooth color changes were slight.

The results show that a 90 percent of study respondents viewed the people with whiter teeth as healthier and more attractive, regardless of age, sex, or ethnic background.

Communication Can Lead to Complaint Resolution

Many peer review complaints involve communication problems between the patient and the dentist. With direct and specific communication with patients, many misunderstandings can be avoided. Following is a list of suggestions by the Oregon Dental Association to help dentists better communicate with patients:

1. Discuss fees for services to be performed before commencing treatment.

2. Discuss all treatment options and risks with the patient before commencing treatment. Don't simply make a treatment decision for the patient. Document discussions with patients and agreements made in each patient's chart.

3. Pre-authorize treatment to be done with the patient's insurance company before performing the procedure, and share the outcome of prior authorization with the patient before beginning treatment.

4. If a patient is dissatisfied with treatment received, the dentist should communicate with the patient. Staff should not be assigned to attempt to resolve the issue. The patient wants to talk to the dentist. Staff communication with patients in that circumstance often shifts the focus to a billing dispute instead of addressing the patient's discomfort or dissatisfaction with treatment.

5. Suggest peer review if dentist and patient disagree on the quality or appropriateness of treatment you have provided.

6. Communicate verbally with the patient before his or her verbal complaint turns into a written complaint or demand.

7. Discuss office policies with patients before commencing treatment. Document office policies and have the patient sign or initial that they understand these policies.

8. Handle patient problems or concerns immediately. Don't let issues fester. Handle them at the onset.

9. Forward patient records within 14 days when requested either by the patient or another practitioner.

10. Seek help from a colleague or local dental association when dealing with a difficult patient or if treatment is not working out as planned.

Caries Protection Doesn't Come in a Bottle

Some public health officials are concerned about the increased reliance on bottled water and the potential impact it might have on dental caries, especially in young children, says Warren LeMay, DDS, in the April 1998 WDA Journal.

Parents, dentists and other health care providers should consider the consequences of children drinking water with inadequate fluoride levels, LeMay says.

According to LeMay, unlike many community water systems, most types of bottled water lack sufficient fluoride. Says LeMay, "It seems clear that unless an individual uses enough of other sources of fluoride, there is an increased risk for dental caries. Appropriate levels of fluoride in the drinking water can reduce dental caries by up to 30 percent."

Americans drink nearly 3 billion gallons of bottled water a year, reports LeMay. Increased consumption may be particularly significant among consumers with health concerns or with compromised immune systems.

LeMay suggests that dentists and physicians evaluate the fluoride intake of children and discuss with parents the possible need for dietary fluoride supplements, fluoride mouthrinses or more intense professional supervision.

Dentists should also inquire whether a home is equipped with a water filtration system. Two of the most common water filtration systems are carbon filtration and reverse osmosis. Carbon filtration systems do not remove fluoride, but reverse osmosis systems can remove about 95 percent of fluoride from the water. Parents with a reverse osmosis system may be unaware that their system is removing most of the fluoride from their drinking water, LeMay says.

HIV Spread Drops in Some, But Increases in Others

National Cancer Institute researchers report a "striking drop" in the spread of HIV infection among young men through homosexual contact and drug use during the early 1990s.

Published in the June 17 Journal of the American Medical Association, the NCI study found "the best available data indicate an increase in heterosexual transmission to young women, particularly young black women."

The study, conducted by Philip S. Rosenberg, PhD, and Robert J. Biggar, MD, of the National Cancer Institute, is the most detailed yet of HIV infection trends among young adults, Rosenberg said in an NCI news release. He added that it provides some insight into the effectiveness of public health efforts to battle HIV.

Biggar and Rosenberg estimated that 50 percent fewer white men aged 18 to 27 were living with HIV infection in 1993 than in 1988, NCI reported. The number of young minority men living with HIV, though, was about the same in 1988 and 1993. But the number of black women aged 18 to 27 living with HIV infection in 1993 rose more than 60 percent from 1988.

As for the years since 1993, Rosenberg is optimistic that the trends showing declines in new cases of HIV attributable to homosexual contact and drug use have continued.

"If fewer people have the disease, there is less chance of encountering an infected person, which tends to slow the spread of the disease," he says.

He added that it is possible new therapies reducing the viral load may also mean people carrying HIV are not as infectious.

The researchers are particularly concerned by the high rate of heterosexual transmission among young minority individuals.

"Most HIV-infected young people, about two-thirds, are black or Hispanic," Rosenberg says, but those minority groups comprise just 27 percent of the population of the age groups studied.

Upcoming Meetings 1998

Aug. 14-15 Academy of LDS Dentists Conference, Provo, Utah (801) 378-4851
Sept. 11-13 Oral Health 2000 Consortium, San Diego (312) 836-9900
Sept. 12-16 American Academy of Periodontology's Annual Meeting, Boston (312) 573-3210
Sept. 16-19 American College of Prosthodontists Annual Session, San Diego (800) 378-1260
Oct. 1-3 Annual Scientific Session of the Academy of Surgical Research, Nashville, Tenn. (612) 927-6707
Oct. 1-3 Third International Congress on Dental Law and Ethics, London, England (44) (0) 171-935-0875
Oct. 2-3 Society for Advanced Dentistry Inaugural Meeting, New Orleans (317) 290-2613
Oct. 8-12 World Dental Congress, Barcelona, Spain +44 171 935 7852
Oct. 8-10 American Society for Dental Aesthetics International Conference on Aesthetic Dentistry, Chicago (800) 454-2732
Oct. 24-28 ADA Annual Session, San Francisco (312) 440-2500
Oct. 31-Nov. 3 Pacific Coast Society of Orthodontists Annual Session, Palm Springs, Calif. (415) 441-2410
Nov. 19-21 International Dental Showcase, NEC Birmingham, U.K. 01722 335599
1999
Feb. 3-6 Academy of Laser Dentistry's Sixth Annual Conference and Exhibition, Palm Springs, Calif. (248) 548-7171
Feb. 11-13 East Coast District Dental Society Miami Winter Meeting and Dental Expo, Miami (800) 344-5860 or (305) 667-3647
April 8-11 CDA Scientific Session, Anaheim (916) 443-3382, Ext. 4470
April 13-17 International Dental Show, Cologne, Germany, http://www.koelnmesse.de/ids
Sept. 16-18 CDA Scientific Session, San Francisco (916) 443-3382, Ext. 4470
Sept. 17-18 Society for Advanced Dentistry Annual Meeting, New Orleans (317) 290-2613
To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.