Obtaining and Interpreting Antemortem Records

The first task in obtaining AM records is building a complete picture of where the deceased person received dental care. Families are the starting point: they know the name of the regular dentist, whether orthodontic treatment occurred, and whether there was any recent specialist referral. This information should be collected systematically at the earliest opportunity, preferably before the postmortem examination is complete.

• General dental practitioners: the richest source, especially for adults with a long-standing relationship with one practice. Hold clinical charts, radiographs (in various formats including film and digital), and treatment notes spanning years or decades.
• Specialist practitioners: endodontists, oral surgeons, and periodontists hold records of their specific procedures, often including high-quality periapical radiographs not duplicated in the general practice file. Orthodontists hold panoramic radiographs and study models that are especially useful for younger individuals.
• Dental schools and hospital dental departments: teaching clinics and hospital units see complex cases and maintain detailed records. They often hold radiographs and study models for years beyond the minimum retention period.
• Military and prison dental services: uniformed-service and correctional dental records are often comprehensive and well-preserved, because dental examination is routine on entry and re-entry. INTERPOL Disaster Victim Identification (DVI) protocols explicitly direct investigators to military dental archives for this reason.
• Dental laboratory records: if the person had a crown, bridge, or full denture made, the laboratory that fabricated it may hold the prescription, the shade records, and the articulator model. These describe the prosthetic in measurable detail.

Dental records are personal health information, and their release is regulated. In life, access requires patient consent. After death, the investigative framework changes what is available and on what basis. The route depends on the jurisdiction and the nature of the investigation.

In most common-law countries, a coroner or medical examiner has statutory authority to access records relevant to a death investigation. A coroner's warrant or equivalent authorises the treating dentist to release records without requiring family consent, which is important when family relationships are disputed or when families are unavailable. In civil law countries, the investigative magistrate or public prosecutor's office often holds equivalent authority.

International cases, increasingly common in disaster and migration contexts, require engagement with the INTERPOL DVI framework. INTERPOL's yellow form (AM dental, missing persons) and pink form (PM dental, unidentified human remains) standardise data collection across borders. The legal mechanism for cross-border record transfer depends on whether a mutual legal assistance treaty is in force, but in practice most dental offices release records to an official investigative authority without delay when the request is properly framed.

When contacting a dental office, the request should be comprehensive rather than selective. Asking only for the clinical chart misses the radiographs, which are usually the most forensically useful items. A complete request covers:

• All radiographs: periapical, bitewing, and panoramic films or digital image files, with the date each series was taken. Digital files should be requested in DICOM format where possible, or in the original proprietary format with accompanying software information.
• All clinical charts and treatment notes: the complete treatment record from the first visit to the last, not just the most recent chart. Earlier records document teeth that were subsequently extracted, crown preparations before they were covered, and pathology that evolved over time.
• Study models and photographs: if made. Plaster or digital models of the occlusion are valuable where crowns are present and occlusal morphology can be compared.
• Laboratory prescriptions and correspondence: for any prosthetic work, the prescription documents design details not always recorded in the clinical chart.

Receiving the records is not the end of the problem. Clinical charts are written for the treating dentist's own use, in whatever notation system that practice uses, with abbreviations that may not be universally recognised. The forensic odontologist must read that record accurately, translate it into the notation system they are using for the PM chart, and flag anything that is ambiguous before beginning the comparison.

Beyond tooth numbering, surface abbreviations vary. One dentist writes MO for a mesio-occlusal restoration; another charts MOD for mesio-occlusal-distal. One marks a crown as C or Cr; another uses the full material abbreviation PFM for porcelain-fused-to-metal or GC for gold crown. These are translatable, but each step must be made explicit and documented.

Antemortem records are rarely perfect. Common problems include records from only part of the person's dental history, radiographs taken long before death that do not reflect later treatment, charts that document treatment planned but not yet completed, and records destroyed when a practice closed.

• Old radiographs: a radiograph series from ten years before death is still useful for root morphology and bone patterns, which change slowly. It is less useful for restoration comparisons where significant subsequent treatment occurred.
• Partial records: a record covering only the front teeth or one quadrant limits the comparison to that region. The rest of the comparison is treated as insufficient rather than concordant or discordant.
• Records from multiple practices: if the person moved or changed dentist, records from two or more offices may be needed to cover the full history. Earlier records document treatments no longer visible; later records reflect the current state.
• Digital versus film: digital radiographs can be transmitted electronically in minutes and allow image enhancement. Film radiographs must be physically retrieved or digitised. Both can be compared with PM radiographs; the format affects logistics but not the identification value.

When records are sparse, the conclusion must reflect that honestly. Possible identification or insufficient evidence are legitimate outcomes, not failures. A positive identification built on ambiguous records is far more dangerous than an honest possible, because a misidentification can send a live person's documentation to the wrong death certificate and leave the real deceased unnamed.

When formal dental records are unavailable or insufficient, investigators sometimes turn to other sources of information about the deceased's dental appearance. These sources carry lower evidential value but can support a possible identification or narrow the field when direct records are absent.

• Photographs: a clear photograph showing the anterior teeth can document crown morphology, visible restorations, spacing, rotations, and prosthetics. Smiling photographs from social media or family collections are increasingly used as a first-pass screen.
• Medical radiographs: orthopantomograms taken for jaw or sinus investigations, lateral cephalometric radiographs from orthodontic records, and CT scans of the head all show dental structures. A hospital radiology department may hold images a dental office has never seen.
• Prosthetic identification marks: some full dentures carry the patient's name or an identification number embedded in the acrylic base, a practice encouraged by several national dental associations and mandated in some military services. A denture found with the remains or listed in a property inventory should be checked for a mark before it is treated as anonymous.