Dental Tribune U.S. Edition

ClINICal Hygiene Tribune U.S. Edition | May 2012D2 Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com ViCe President glObal sales Peter Witteczek p.witterczek@dental-tribune.com Chief OPerating OffiCer Eric Seid e.seid@dental-tribune.com grOuP editOr & designer Robin Goodman r.goodman@dental-tribune.com editOr in Chief dental tribune Dr. David L. Hoexter feedback@dental-tribune.com editOr in Chief hygiene tribune Patricia Walsh, RDH feedback@dental-tribune.com managing editOr Robert Selleck r.selleck@dental-tribune.com managing editOr shOw dailies Kristine Colker k.colker@dental-tribune.com managing editOr Fred Michmershuizen f.michmershuizen@dental-tribune.com managing editOr Sierra Rendon s.rendon@dental-tribune.com marketing manager Anna Kataoka-Wlodarczyk a.wlodarczyk@dental-tribune.com sales & marketing assistant Lorrie Young l.young@dental-tribune.com C.e. direCtOr Christiane Ferret c.ferret@dtstudyclub.com Dental Tribune America, LLC 116 West 23rd Street, Suite 500 New York, NY 10011 Phone (212) 244-7181 Published by Dental Tribune America © 2012 Dental Tribune America, LLC All rights reserved. Dental Tribune strives to maintain the utmost ac- curacy in its news and clinical reports. If you find a factual error or content that requires clarification, please contact Managing Editor Robert Selleck at r.selleck@dental-tribune.com. Dental Tribune cannot assume responsibility for the validity of product claims or for typographical er- rors. The publisher also does not assume responsibil- ity for product names or statements made by adver- tisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune. editOrial bOard Dr. Joel Berg Dr. L. Stephen Buchanan Dr. Arnaldo Castellucci Dr. Gorden Christensen Dr. Rella Christensen Dr. William Dickerson Hugh Doherty Dr. James Doundoulakis Dr. David Garber Dr. Fay Goldstep Dr. Howard Glazer Dr. Harold Heymann Dr. Karl Leinfelder Dr. Roger Levin Dr. Carl E. Misch Dr. Dan Nathanson Dr. Chester Redhead Dr. Irwin Smigel Dr. Jon Suzuki Dr. Dennis Tartakow Dr. Dan Ward Tell us what you think! Do you have general comments or criticism you would like to share? Is there a particular topic you would like to see articles about in Hygiene Tribune? Let us know by e-mailing feedback@dental-tribune.com. We look forward to hearing from you! If you would like to make any change to your subscription (name, address or to opt out) please send us an e-mail at database@dental- tribune.com and be sure to include which publication you are referring to. Also, please note that subscription changes can take up to six weeks to process. The Rhode Island fire of 2003 was the fourth deadliest in U.S. nightclub history. Ninety-six people perished on the night of the fire, four more in the hospital later on. The staff of the local medical examin- er’s office was completely overwhelmed. The services of many dentists were need- ed to help bring peace and closure for the families of the victims. Without a standing local identifica- tion team, matching dental records was a monumental task. The state of Con- necticut took note of this tragedy and quickly formed the Dental Identification Response Team or DIRT for short. I was encouraged by my boss, Dr. Tom Brady, to become a member of the American Society of Forensic Odontology. Dr. Brady had many years of service as a police constable to add to our response team knowledge base. Each year, as members of one of the three teams (antemortem, postmortem, comparison), we continue our education in disaster preparedness. The annual American Society of Foren- sic Odontology meeting is routinely held the third week in February and attracts dental professionals from around the world. During a course entitled “Beyond IDs and Bitemarks,” I had the privilege to be seated next to the only forensic odon- tologist from the nation of Senegal. This particular dentist, an army colo- nel, had made the trip for continuing ed- ucation for the past five annual meetings. I noticed that several of his uniform in- signias were against a purple velvet back- ground. They reminded me of the purple velvet ribbon that graced my nursing cap from the Fones School of Dental Hygiene. I suppose some things dental are univer- sal. During lunch I found myself sitting between a doctor who works hand-in- hand with the Canadian Mounted Police and a woman dentist from Korea. While my focus was on community preparedness, there were other areas cov- ered at the meeting as well. These special- ties included preparation for court testi- mony in civil litigation, child or spousal abuse evidence and professional fraud. The director of our state forensic team is on call 24/7 and works closely with the medical examiner. The initial response team is responsible for assessment, site evaluation and personnel planning. The substrata of individual teams are trained, but may or may not have experience in forensic dentistry. We are available on 48- hour notice. We need to be capable of aug- menting or relieving the initial response team during mass disaster. Training includes a familiarization of the WinID (www.winid.com) or standardized chart- ing system used by the medical exam- iner’s office. It is not vastly different from those seen in any U.S. dental office. Most dental professionals catch on quickly. The software can be downloaded for home study. The Katrina response was the first time digital radiography was used by a U.S. identification team. A 12-pound, handheld radiation source, the Aribex Nomad, enabled easy access to victims. Its initial implementation by other teams was after the 2004 Indian Ocean tsu- nami. The manufacturer has responded to the needs of dental teams by making modifications. It has reduced the over- all weight of the unit to five pounds and increased the battery life. The American Dental Association is currently working on a common “language” to facilitate the translation of our routine Dentrix chart- ing to the WinID system via a centralized computer base. There is federal mandate that all dental and medical records be computerized by 2017. This will greatly assist forensic teams in the future when comparison matches need to be made. Winnie Funari, a forensic dental hygien- ist who frequently lectures about her 9/11 experiences, was on the ADA committee charged with developing these important changes. She is immensely proud of the fact that 50 percent of the post-9/11 iden- tification team members were dental hy- gienists. Typically when dental remains are used in forensic identification via DNA, it is the molar that is used because of its large pulp. A noncarious molar is preferred to minimize compromised DNA. In a cata- clysmic event, the molar is most likely protected by thick cheek tissues, thus less likely to have been damaged by extremes in temperature. The molar is the tooth class richest in DNA and the root body is the anatomical region with the highest concentration of DNA. Standardization of dental charting greatly increases the likelihood that re- mains can be identified. Hygienists play a critical role in the documentation of a patient’s unique permanent oral charac- teristics. Meticulous record keeping and up-to-date quality radiographs are essen- tial to assist law enforcement or disaster response teams. Beyond the charting of missing and existing dentition, dental hygienists need to document what makes each and every patient truly “different.” Is it their cusp of carabelli, rotated bi- cuspid, peg lateral or large tori? Is there an oddly positioned impaction, macro- dontia or microdontia? Hygienists can ease the burden of those working long hours, often in a difficult environment, by simply doing their day-to-day job well. Mass casualty situations are emotion- ally tiring and difficult times. Response teams should not have to waste precious hours trying to understand chart nota- tions or searching for good radiographs. A decrease in the use of amalgam only augments the need for detailed patient records. Hygienists are ideally suited for assisting authorities with antemortem (predeceased) information on dentures, ortho appliances, or dental photographs. All persons possess an identity during their lifetime, and the dignity of con- firming and maintaining this identity after death is a strong compelling soci- etal need. Hygienists, as compassionate health care workers, are ideally suited to play an integral role in forensic organiza- tion and record keeping. We are already trained, well-educated observers of the human condition. Hygienists wishing to learn more about forensics can go to the following sites: • American Society of Forensic Odon- tology (www.asfo.org): Continuing educa- tion credits; membership open to all den- tal professionals. • American Board of Forensic Odontol- ogy (www.abso.org): Membership limited to dentists. • Center for Education and Research in Forensics (www.utforensic.org): Weeklong training courses. • Disaster Preparedness Response (www. ada.org/2390.aspx) • National Disaster Medical System (www.phe.gov/preparedness/responders/ ndms/Pages/default.aspx) ˙ References 1. CSDA DIRT manual 2007, Freeman, Mar- shall. 2. www.circle.ubc.ca/handle/2429/12029, The effect of individual characteristics on fo- rensic DNA evidence from human teeth, Gaytmenn. 3. Forensic Dentistry and Dental Hygiene: How can the dental hygienist contribute?, Canadian Journal of Dental Hygiene, July 2008, Fergusen, Sweet, Craig. HYGIENE TRIBUNE Hygienists help in forensics RDHs critical in documenting patients’ unique, permanent oral characteristics By Patricia Walsh, rdH, Hygiene Tribune editor in Chief PaTriCia WalSH, rdH, BS, has been a clinical dental hygienist for more than 20 years. She is a graduate of the Fones School of Dental Hygiene, University of Bridgeport in Connect- icut. She has an exten- sive history in interna- tional volunteer work in oral health, includ- ing The Thailand Dental Project, a volunteer program onproviding educational, preventive and restorative dental care to children in a tsu- nami affected region of Thailand. She may be contacted at pwalshrdh@uberhygienist.com. Left, a typical WinID examination chart used in medical examiner offices in the United States. Right, example of remains needing identification. Below, X-ray documenting unique dental characteris- tics. Photos/ Provided by Dr. Adam Freeman