Disaster waiting

THERE are surely very few dentists whose jobs require them to keep a bag packed and their vaccinations up to date, ready to dash to Heathrow Airport at three hours’ notice – or whose place of work could be anything from a crumbling mortuary with a fuse box hanging off the wall to a gazebo on the edge of an airfield with no running water.

But for forensic odontologist Dr John Robson challenges like these are routine. Dr Robson is part of a small cadre of specialist dentists in the field of disaster victim identification and a call on his mobile could mean a sudden summons to Colombia or the Congo, Sri Lanka or South Africa, to provide expertise in the aftermath of a plane crash, shipwreck or natural catastrophe.

As with the random nature of disasters, so often is the response. Dr Robson explains: “Each situation is unique and you have to be very adaptable. You don’t know what you’re going to come up against. In one disaster, we had cockroaches running down the mortuary wall. The conditions were dire.”

Over the years he has come up against a wide range of extremely challenging situations, among them the Asian tsunami of 2004, where he led a team of international dentists in Sri Lanka and Thailand in the race to identify thousands of victims, and the Bahrain boating disaster of 2006 in which nearly 60 people were drowned after an Arab dhow capsized.

Dental signatures

Forensic odontology is nothing like the image that springs to mind when you think of dentistry. But for the CSI generation the word ‘forensics’ offers something of a clue. “I did a forensic dental course before most people knew what the word forensic meant,” says the 65-year-old laughing. “It really boils down to the evaluation and presentation of dental evidence in the interests of justice. This may be in a legal report or actually in court.”

Evidence could mean comparing a bite mark on a rape victim’s shoulder to the mouth of the attacker or assessing the age of an illegal immigrant via the growth of their third molar. Or it could mean, as with so much of Dr Robson’s work, the identification of a body, be it decomposed, fire-damaged, infested or worse.

“It is the law of most countries that every effort should be made to identify the body so that a death certificate can be issued,” he says. “It’s also important for reasons of inheritance, re-marriage, life insurance purposes and in homicide cases, where if an ID is done early it gives the police an immediate circle of family and friends, who could be among the first suspects.”

Teeth are the hardest tissue in the human body and are much more resistant to decay or destruction than other body parts – as are dental inserts such as fillings, dentures, bridges and crowns. Dental surgeries the world over maintain – in effect – an extensive antemortem database for purposes of comparison. For this reason a person’s dental status is recognised by Interpol as one of four primary identifiers along with DNA, fingerprints and unique medical appliances such as numbered hip joints and pacemakers.

“Primary identifiers are those which will stand alone with no back-up other than, say, sex and height,” says Dr Robson. In the aftermath of the tsunami in Thailand, dentition was the most significant of the four, with many more positive identifications on dental information alone, compared with fingerprints alone and relatively few on DNA alone.

Never an easy job

But dental identification is no easy task and often this is as much due to the circumstances in which the work must take place. As Dr Robson explains: “You arrive in the country and the first thing you have to do is liaise with whoever’s in charge. It’s usually the chief of police or the coroner, but that can be a problem because what we call a coroner they might call a magistrate, or something else. And sometimes the people you think are in charge aren’t really in charge at all.

“From there, you have to find out where the bodies are, assuming they’re in one place. I once did a job where the bodies were at three different locations: the local hospital, the funeral home and then a hospital in the next town. That makes the investigation much more difficult.”

There’s also the physical and emotional strain. Working seven days a week on a short deployment (“You’re on your feet a lot of the time and you’re concentrating”) and dealing with makeshift facilities, pressure from concerned relatives and what could be thousands of dead bodies can take its toll. “The sights are pretty horrific and the smells are pretty horrific. And the worst thing that everybody dreads is when a small bag comes in with the body of a child in it.”

But there are rewards, says Dr Robson. “It’s such a wonderful feeling when you find somebody. You know you’re going to return this body to the loved ones, who’ve been waiting and waiting – especially in something like a natural disaster. Because most people, once they’ve accepted the death of a loved one, the next thing they want is the body back.”

Confirming an identity is almost always about comparing postmortem with antemortem data, and Dr Robson is keen to point out that the collection of as much dentally related information as possible – charts, radiographs, toothbrushes (“a wonderful source of DNA”), dentures, extracted teeth, even a bleaching tray – is just as important as the investigations at the scene. “A lot of people and authorities tend to lose sight of this,” he says.

It is in this area that all dentists have a part to play through comprehensive and accurate charting and record-keeping. “I’ve worked in general practice myself so I realise that dentists are under a lot a pressure, but we owe it to the patients, morally and ethically, to do a decent chart,” he says. “Any day, a dentist in general practice may have a policeman or a forensic odontologist knocking on their door and asking, ‘Could I have the records for Mr Smith?’ And by records we mean all the available information, including charts, models, bills, radiographs and clinical photographs. Too much antemortem info is better than too little!”

Forget the glamour

While forensic odontology certainly has more to do with CSI than general practice, Dr Robson is quick to play down any sense that this kind of work is glamorous. Nevertheless he admits that it was an interest in detective fiction and true crime books that led him in 1989 to enrol on a postgraduate course in forensic odontology. Prior to that he had worked in general practice before moving into specialist orthodontics.

After finishing his course, he joined the British Association for Forensic Odontology (BAFO), introduced himself around and expressed an interest in going abroad on jobs. “Four or five months later,” he says, “this chap gave me a ring and asked, ‘Would you like to go to Colombia tomorrow?’ I said I didn’t know and he said, ‘Well you’ve got 20 minutes to think about it and ring me back.’”

Since then he’s been deployed all over the world, but until his recent retirement the workload was never enough to allow him to give up his practice work. “It isn’t really a fulltime career. You can’t give up general work,” he says. “I’m quite high up in the profession and the amount I work is about once a month if I’m lucky.”

That he is a past president of BAFO and is currently chairman of the BAFO Disaster Victim Identification (DVI) group is testament to how ‘high up’ Dr Robson has risen. In this latest role, which comes under the aegis of the Home and Foreign Offices, he has shifted from his usual ‘after the fact’ investigation work to policymaking and is currently involved in preparations for potential terrorist attacks in the UK.

“We have been asked to make arrangements so that we can man several disaster sites at the same time,” he says. “So we are getting together a pool of forensic odontologists who can be available for that. These have to be experienced dentists who have a postgraduate qualification in forensic odontology and are members of BAFO.”

But despite his new role, the habits of 25 years are hard to break and he remains committed to attending disaster scenes around the world as and when required. For the foreseeable future, therefore, he will continue to keep a suitcase at the ready and his vaccinations up to date.

For more information contact the British Association for Forensic Odontology at www.bafo.org.uk. The University of West Glamorgan runs a postgraduate course in forensic odontology – contact Dr Catherine Adams.

Profile by Adam Campbell, a freelance journalist and regular contributor to MDDUS publications