Dental Charting and the Postmortem Dental Record

A dental chart organises the dentition into a spatial representation. The most common format is a two-row diagram, upper arch on top and lower arch below, each tooth represented either as a schematic crown view (occlusal for posterior, labial for anterior) or as a box assigned to a quadrant-and-position number. Examiners annotate each tooth position with codes, colours, and symbols that encode its current state.

• Present and unrestored: An unannotated tooth position indicates a tooth is present and has no recorded restoration or pathology.
• Missing (extracted): Marked with an X or a cross through the tooth box. In FDI notation, the tooth number is retained but flagged as absent. A missing tooth is as informative as a present one: its absence, the socket condition, and any prosthetic replacement are all charted.
• Restored surfaces: The tooth diagram is divided into surfaces. A surface involved in a restoration is shaded or marked with the restoration type (A for amalgam, C for composite, G for gold). A restoration spanning mesial, occlusal, and distal surfaces is a three-surface MOD restoration.
• Crowns and prosthetics: A full crown is usually indicated by circling the tooth outline or using a C with the material type. A bridge is shown by lines connecting abutment teeth with a box or triangle marking the pontic. Implants are marked separately, often with a different symbol, and the crown on the implant is noted.
• Pathology: Caries on specific surfaces, periapical lesions (usually visible radiographically), bone loss from periodontal disease, and root remnants all have chart annotations. A periapical lesion on a specific root of a multi-rooted tooth is located by root name (mesial root, distal root, palatal root).

The forensic value of a restoration is proportional to its specificity. A single-surface occlusal amalgam on a molar is a class-level feature shared by many patients. A four-surface gold inlay on a specific tooth in an otherwise unrestored dentition is approaching individual-level evidence. The chart must capture both dimensions, the surface locations and the material, precisely.

Material type matters because it has different radiographic appearance and different durability. Amalgam (silver-mercury alloy) appears radiopaque (bright white) on radiographs and is highly durable. Composite resin is radiolucent or only slightly opaque, depending on filler content, and its presence may not be obvious on a film without additional clinical notes. Gold restorations are distinctively radiopaque and often have a distinctive marginal adaptation visible on radiographs. Tooth-coloured ceramic crowns appear similar to natural tooth structure unless they have a metal coping.

Prosthetic dental appliances are sometimes the single most distinctive feature in an identification. Partial and full dentures are fabricated to fit a specific patient's ridges and may carry the patient's name or a laboratory case number embedded in the acrylic base. Bridges are precision-cemented to specific teeth. Implants are placed surgically at specific bone positions and are recoverable from calcined bone. Each of these features is charted and, when present postmortem, compared against the ante-mortem record.

• Fixed bridge: Record the abutment teeth (the teeth to which the bridge is cemented) in FDI notation, the pontic position, and the material (porcelain, gold, porcelain-fused-to-metal). Bridges are anchored to specific teeth and the gap they span is a fixed anatomical fact, so the combination of abutment positions plus pontic position is highly individualising.
• Dental implants: Record the FDI position, the implant system if identifiable (Branemark, Straumann, Nobel, and others have distinctive thread patterns visible on radiograph), and the crown type. Implant fixtures are titanium and survive fire. Their serial numbers or lot numbers are sometimes recoverable and traceable to specific surgeries and patients.
• Removable partial denture: Record the teeth replaced, the clasp teeth (which teeth the denture clips onto for retention), and the material of the base and teeth. Some jurisdictions require dentures to carry patient identification; check the base for an embedded name or number.
• Full denture: Record the presence and, if identifiable, the laboratory or manufacture details. Full dentures are found separated from remains in many decomposition scenarios because they were not in the mouth at time of death. In mass-casualty events, dentures should be bagged and labelled with scene location data.

The postmortem dental examination follows a structured protocol regardless of the condition of the remains. The two main references are the INTERPOL DVI Guide and national protocols such as those of the American Board of Forensic Odontology (ABFO), the British Association for Forensic Odontology (BAFO), and equivalent bodies in Australia, Canada, and Europe. The core steps are broadly shared across these frameworks.

1. Scene and body documentation
   Photograph the remains and the perioral area before any manipulation. Record any dentures, bridges, or appliances found in proximity to the body. Document the condition of the lips, gingiva, and alveolar bone before tissue manipulation.
2. Access to the dentition
   In decomposed or charred remains, soft tissue may need to be reflected or removed to access the teeth. In burned skeletal remains the mandible may be detached. The method of gaining access is documented. In some jurisdictions a specialist pathologist or odontologist performs jaw disarticulation; in others the odontologist proceeds within defined authority.
3. Visual examination and charting
   Each tooth is examined and its state recorded on the postmortem dental form: present, absent (whether the socket indicates ante-mortem loss or postmortem loss must be assessed), restoration status, crown condition, and any anomalies. The examiner notes whether absence is confirmed ante-mortem (remodelled socket) or potentially postmortem (fresh socket, no bone remodelling).
4. Radiographic examination
   Periapical radiographs, a full mouth series, and a panoramic film (if equipment is available) are taken. Radiographs reveal root morphology, bone levels, periapical pathology, and restoration details not visible on the crown surface. A postmortem radiograph taken at the same angulation as an ante-mortem film allows direct overlay comparison.
5. Dental impressions and additional recovery
   In some cases impressions are taken for study models. If a tooth requires removal for DNA, age estimation via cementum annulation, or material analysis, this is documented and the tooth is retained in evidence.

The INTERPOL DVI dental form is the international standard for recording and comparing dental data in mass-casualty identification. The form comes in two versions used at the comparison table: the postmortem form (printed on pink paper) completed by the forensic odontologist at examination of the unidentified remains, and the ante-mortem form (printed on yellow paper) completed by a dentist or an INTERPOL liaison using records supplied by the missing person's family or treating dentist.

Both forms use FDI notation and share an identical tooth grid layout. The comparison examiner places a pink form alongside the matching yellow form and works tooth by tooth through the grid, noting: concordant features (same tooth, same state in both records), discrepancies that require explanation, and features present in one record but absent in the other because the record predates a later procedure.

The DVI form also records orthodontic appliances, implants, and dentures. Special features such as an unusual root morphology, a rare anomaly, or a distinctive crown shape are captured in a free-text box. These special features often accelerate the comparison: an examiner who spots an ante-mortem note for a dens in dente on tooth 22 and finds the same feature on the postmortem form has a strong candidate before looking at any restoration.

Standard charting captures the expected states of a dentition. Anomalies are the exceptions, and in forensic comparison they often carry disproportionate weight. An anomaly present in the ante-mortem record that is also present in the postmortem record at the same tooth position constitutes strong corroborating evidence. Conversely, an anomaly present ante-mortem that is absent postmortem requires explanation before the comparison can proceed.

• Supernumerary teeth: Extra teeth, most commonly a mesiodens in the midline or distomolar behind the third molar. Their presence at a specific position is charted in FDI notation. They are congenital and do not change after their developmental period.
• Congenital absence (hypodontia): Missing teeth with no evidence of extraction. The socket is never formed and the alveolar bone at that position is continuous. Third molars and maxillary lateral incisors are the most commonly absent teeth.
• Dens in dente (dens invaginatus): An invagination of the enamel organ during development creating a tooth-within-a-tooth appearance on radiograph. Almost always affects maxillary lateral incisors. Its radiographic appearance is essentially unique.
• Taurodontism: Enlarged pulp chambers and short, apically displaced root furcations visible on radiograph, producing a rectangular rather than tapered root trunk. Seen in isolation or associated with some syndromes.
• Gemination and fusion: Gemination is attempted division of one tooth bud into two, producing a double crown on a single root. Fusion is the union of two adjacent tooth buds, producing one large tooth where two were expected. Both produce distinctive crown shapes.