Journal of Forensic and Legal Medicine 51 (2017) 45e49

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Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Stabilisation of dental structures of severely incinerated victims at

disaster scenes to facilitate human identication
John Berketa*, Denice Higgins
Forensic Odontology Unit, University of Adelaide, North Terrace Campus, Adelaide, South Australia, 5005, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Fatalities due to re events such as bushres, domestic and industrial res and vehicle accident related
Received 20 April 2017 incineration, leave victims with limited prospects of being accurately identied. Due to their morphology
Received in revised form and anatomical position teeth are uniquely protected in incineration cases and via comparison to dental
16 July 2017
records often provide the only scientically valid means of identication. However, extreme heat and
Accepted 24 July 2017
direct exposure to ame can render the teeth extremely fragile and vulnerable to damage and loss
Available online 25 July 2017
especially during collection and transportation to the mortuary. Here we highlight the advantages of
forensic odontology assistance at the scene of such events and discuss techniques and protocols applied
Keywords:
Forensic science
to actual cases in which these processes were used to facilitate the identication of incineration victims.
Identication 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Incineration
Odontology
Protocol

1. Introduction
Identication of deceased victims is required for legal and
ethical reasons.1 In the case of severely incinerated victims iden-
tication is especially problematic as re destroys physical evi-
dence such as facial appearance, clothing, documents, tattoos,
ngerprints, and hair.2 Fire can also completely destroy soft tissues
limiting available DNA and at very high temperatures DNA in
skeletal elements can also be severely degraded.3 Past history re-
veals that identication by dental comparison can be successful in
these circumstances4e8 however; the effects of heat also compro-
mise dental postmortem information. Extreme heat can leave teeth,
especially those in the anterior dentition, in an extremely fragile
state susceptible to crumbling from only minor forces.9,10 To
maximise the collection of dental data and hence increase the
likelihood of positive identication in these cases, the attendance of
a trained odontologist at the scene prior to transportation of the
body to the mortuary is advised. The odontologist is able to identify
fragmented and displaced dental structures, stabilise fragile re-
mains and in the case of extreme fragility perform examination and
data collection prior to transportation. However, odontologists
* Corresponding author.
E-mail addresses: john.berketa@adelaide.edu.au (J. Berketa), denice.higgins@
adelaide.edu.au (D. Higgins).
often receive little training in preparation for scene attendance and
there is no or scant information in the published literature with
regards to appropriate operating procedures. This paper discusses
the potential effects of incineration on oral structures, methods to
improve stabilisation of remains, and presents standardised oper-
ating procedures (SOP) developed for casework addressing pres-
ervation and collection of remains and health and safety for the
attending odontologists.
2. Discussion
The effects of re on teeth are particularly evident on the
anterior dentition, which has less protection from soft tissues. The
enamel crown of a tooth may separate from the body of the tooth if
exposed to extreme temperatures11 and surviving structures can
become extremely fragile and susceptible to crumbling from even
minor forces.9,10 In the 2009 Victorian (Australia) bushres, the
res were still burning after 4e5 h12 and even after 24 h the
temperatures recorded on some bodies were still at 600e700  C.13
Separation of tooth crowns lead to a loss of information for com-
parison with antemortem dental records. In these cases, root
morphology placement and angulations, bony features, including
sinuses, and anomalies provide the only information for compari-
son. Posterior tooth crowns while less likely to be lost often frac-
ture, and may dislodge becoming wedged against the neighbouring
or opposing crowns (Fig. 1). Loss of anatomical structures and

http://dx.doi.org/10.1016/j.jm.2017.07.020
1752-928X/ 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
46 J. Berketa, D. Higgins / Journal of Forensic and Legal Medicine 51 (2017) 45e49
Fig. 1. Posterior tooth crowns fractured and wedged against the neighbouring or
opposing crowns.
dental restorations can occur not only during the re event but also
during lifting of the head, removal of the body from the immediate
scene to the body bag and subsequent transportation to the mor-
tuary.10 In the 2011 Christchurch (New Zealand) earthquake, where
incineration events occurred, a forensic odontologist was deployed
with the police disaster victim identication (DVI) scene teams to
assist with locating, securing and preserving dental and facial
material for this very reason.14
Recommendations arising from the 2009 Victorian (Australia)
bushres, suggest that recovery procedures should not be
commenced until after consultation with forensic medical/scene
specialists, especially where comingling is a possibility.15
Frequently, media and community pressure to recover all remains
as quickly as possible occurs, but rushing the process of careful
retrieval can often be self-defeating as evidence may be lost or
damaged. Searching for the separated material and reconstruction
for radiographic analysis at the mortuary creates delays for the
relatives and increases doubt (as an opinion is now required on
how this information is reconstructed).
Wrapping of the head of incineration victims prior to trans-
portation can help retain and protect dental structures. When using
plastic wrap for protection of the head, Hill et al. observed that less
damage was sustained to the dental evidence and any dislodged
remains were conned within the wrapped area.16 Grifths and
Bellamy also suggested that the head should be protected with a
shock-absorbent layer during transportation.17 This however does
not completely stop damage due to transportation or the pressure
of the wrapping itself if it is not applied appropriately.
To improve the retention of dental material, stabilisation
methods applied directly to the oral structures can be
employed.18,19 A number of methods for stabilisation have been
reported in the literature,20,21 including the application of a cement
such as cyanoacrylate.17 While this method is useful, cement is
difcult to apply and it sets extremely rigid making separation of
the jaws at examination difcult. Reviewing other methods of
stabilisation, Grevin advocated the use of a glue gun 22; Fairgrieve
advocated the use of PVA water based glue 23; whilst Mayne, Cor-
reia and Beattie suggested soaking bone fragments in diluted PVA
for 1 min.24 An adhesive that is safe to spray can more easily cover
large areas. Fauzi highlighted the use of commercially prepared
clear enamel gloss in a spray can (Dulux, Melbourne, Australia),25
however, volatile vapors emitted from the petrochemical spray
may compromise a scene if testing for accelerants is required.
Clag paste (wheat paste) has also been advocated; it can be
diluted and applied as a spray.26 This mixture is simple to use,
readily available, non-toxic, easily portable, inexpensive, non-
compromising to dental/radiographic examination and free of
volatiles.26 A study by Mincer et al. examined a number of different
stabilisation methods and reported that in all cases, whatever
materials was used, treated remains were better preserved than
untreated remains.18
Since 2015 in South Australia, odontologists have been routinely
deployed to the scene of severe incineration deaths. During the
period 2015e2016 our odontologists attended a total of eight
incineration scenes involving thirteen victims. Six of these scenes
were vehicle accidents, one was a bushre and the eighth case was
self-immolation in a motor vehicle. Positive identication was
facilitated by dental comparison for all but one of these victims. For
the victim that was unable to be identied antemortem dental
records were not available so dental comparison could not be
performed despite the availability of substantial postmortem data.
To facilitate routine attendance at scenes our team has developed a
standard operating procedure (SOP), addressing occupational
health and safety issues (OH&S), the selection of a stabilising agent
and optimal workow. These considerations are discussed below
with reection on the scenes attended. The SOP developed by our
team is presented in Table 1.
2.1. Standard operating procedure (SOP)
Without training it is unlikely that all scene respondents would
operate in the most efcient and coordinated way. A detailed SOP
acts as a plan to maximise efciency and ensure safety of all scene
attendants. All members should read and understand the SOP
before being placed on an oncall roster.27 As with all forensic
casework preservation of chain of evidence is vital. To facilitate this
we advocate that a document outlining all events and consider-
ations or issues (a running sheet) be created at the time of initial
notication as memory lapses may occur. This also establishes a
pattern of orderly behaviour.28 The maintenance of a fully stocked
scene bag including the premixed stabilising agent of choice
considerably reduces preparation time, ensures that all items
required are collected, and facilitates prompt arrival at the scene.29
Scene bags need to be readily available so they could be stored both
at home and at the forensic ofce. It is prudent where possible for
odontologists to work in pairs for assistance in both physical and
mental tasks.27 If this is not possible then police or emergency
personnel can be enlisted to assist with documentation and
placement of necessary tools. Documentation of departure time
and transport details can also assist in the debrief stage to discuss
improvements in any delays that might have occurred.
Upon arrival at the scene consultation with the scene com-
mander, (noting the commanders' name and time of arrival for the
record) allows a brief of the situation and safety issues present to be
undertaken and a plan to be developed. An overview of the scene
and the designated paths of foot trafc will aid in forming a search
and retrieval plan. It is important that the commander is aware of
who and where personnel are at all times to control the situation.30
Assistance with photography by attending police with specic
training in scene photography frees the hands of the odontologist
for stabilisation and retrieval tasks and allows the collection of all
photographic records in one place.30 A high resolution portrait
image of the head taken before the body is moved can prove
extremely useful for comparative analysis with ante mortem pho-
tographs and dental data, as well as assisting in assessing if material
has been lost during collection and transport.27
Following stabilisation and retrieval of remains, a revisit to the
head site in some cases reveals further information including loose
teeth, implants, and facial piercings.31 Ensuring that all dental and
circumstantial evidence is recorded, collected and protected will
 J. Berketa, D. Higgins / Journal of Forensic and Legal Medicine 51 (2017) 45e49 47

Table 1
Standard operating procedure.

Examination/documentation OH&S Stabilisation Evidence collection

Create running sheet at initial notication
Call second odontologist for team support
Note time of departure and transport
details
Upon arrival report to ofcer in charge,
note name and time
Ask attending police for photographic
assistance
Document and photograph visible teeth
before attempting to spray or move
head
Re-examine teeth and photograph
Document and photograph subsequent
objects before placement within body
bag
Clearly mark head end of body bag with
permanent marker and label as
FRAGILE
Document events and people involved at
the scene before leaving. Note time of
departure
Document report of events when well
rested or following day/s.
Select appropriate clothing including Collect premixed Clag or wheat Collect scene bag
respite clothing
Take water, food and coffee
Question safety concerns and safe
access to victim/s
Assess the scene
Don full PPE
Place knee mat next to head for
protection from sharps, glass and hot
embers
Be aware of water contact with
electrical connections
Request police to remove body
Dispose of protective gear, wash
hands, refresh with liquids and food
Scene debrief and discuss concerns.
Rest if necessary before travelling
back
Full debrief of all concerned Restock stabilising mixture
paste for stabilisation
Prepare spray bottle of
stabilisation solution
Spray mixture using ne mist
spray onto all teeth till
saturated
Wait till dry or apply non-LED Clear retrieval access by directing the removing of
light till dry
Further application of spray and Revisit scene, collect any articles around where the
setting with light may be
required
Assess if oral structures are intact
Search scene for evidence and carefully remove
covering debris
objects such as doors.
Supervise body retrieval maintaining protection for the
head
head was, including loose teeth, dental prostheses, and
piercings
Wrap the head with bubble wrap, and place paper bag
over the entire wrapping to conne contents.
Place a stiff board under body bag for lifting to
transport van.
Remind transporter of the fragility of the remains
Restock scene bag

maximise identication efforts and eliminate the need for a revisit
to the scene.16,32 When collecting these objects, documenting and
photographing is important (for quality assurance) before place-
ment within the body bag.33 Individual separated teeth should be
sealed in a clearly labelled specimen container with cotton gauze to
limit damage. Photographic record of items placed within the body
bag decreases the potential for items being overlooked at the
postmortem stage. It may be benecial for the odontologists to
supervise movement of the body bags into the transport vehicles. A
stiff board placed beneath the body bag prior to moving will sup-
port the remains minimising the shifting of structures towards a
low point during lifting.34 Highlighting to the body transporters the
fragility of the remains of burnt victims is important as they may
not have experience or understanding of the necessity to avoid
sudden forces on incinerated bodies. Clearly marking the outside of
the body bag with warnings of fragility will alert the receiving
mortuary technicians to which bodies are fragile requiring special
care.
Prior to departure from the scene, all personnel must report to
the scene commander. While the details are still fresh, notes should
be made of all relevant information, including departure time.
Before leaving, dispose of protective gear, thoroughly wash hands
and refresh with liquids and food. An assessment should be made
as of your own physical and mental wellbeing prior to embarking
on the return journey especially if self-transportation is likely.
Scene bags should be restocked as soon as is practical as a further
call out is unpredictable. On the following days, gather all docu-
ments and images together so as not to miss important details, to
formulate a report and for the eventual debrief of the incident.30
Creation of a scene report should also include details of any dif-
culties encountered so as to facilitate improvements in protocol at
subsequent scenes.
2.2. Stabilisation
After extensive research, we selected diluted Clag paste
(wheat paste) as the stabilising agent for routine use.26 One
consideration was that it is difcult to predict if testing for volatiles
is required. Even in a vehicle collision incident non accidental death
may need to be considered. At one scene, the remnants of a gas
bottle were found within the compartment of the car. Other sta-
bilising agents may be more practical to use such as acrylic spray if
it is denite that the area is not a crime scene.16e18, 35, 36 Once
dental structures are discovered, by carefully removing covering
debris, an initial assessment of what is present is noted and pho-
tographed before any further action is taken. Initial spraying of
structures within reach, will provide support against movement
which may occur when gaining access to the remains for retrieval
(especially when the jaws of life are utilised). A ne mist spray
should be utilised as any pressure applied to the structures would
be self-defeating.26 One initial setback encountered when using the
water based stabilising spray was that the mixture took quite some
time to set fully due to moisture in the air. This problem was
overcome in subsequent cases by utilisation of a non LED oodlight,
(generated by the police or re brigade's portable generators)
placed in close proximity to the sprayed surfaces. This produces
sufcient radiant heat to set the material in most cases within
thirty minutes. During setting steam can be seen emanating from
the surface.
Once the body is moved away from the immediate scene,
photography of the dental structures not obtained earlier due to
limited access can be taken. Areas of the head that weren't acces-
sible directly can be resprayed to add further rigidity, before
transportation to the mortuary. Once the stabilising spray is fully
dried, the head should be wrapped with some form of cushioning
such as bubble wrap (Sealed Air Corporation, Charlotte, USA),17
48 J. Berketa, D. Higgins / Journal of Forensic and Legal Medicine 51 (2017) 45e49
and a paper bag can be placed over the entire wrapping to conne
the contents.35 A cardboard box with one end removed might also
aid in protection if available. Otherwise, further buffering around
head should be added to limit movement. The use of aluminium foil
might also be useful.
2.3. Health and safety issues
Attendance of our odontologists at actual scenes has highlighted
a number of important OHS considerations. A call out usually oc-
curs without prior warning and often in the middle of the night.
Hence a major potential hazard is fatigue including driving without
adequate sleep both before and after attendance. Provision of
transportation by a third party, likely police, needs to be considered
especially if the scene is some distance from the ofce. Personal
provisions of water, coffee and convenient food snacks are sug-
gested to maintain alertness as it is unlikely that these items are
going to be readily available at the scene.
In South Australia, the police are in charge of the scene of these
incidents and will make every endeavour to make the area safe for
all personnel present including the attending specialists. Upon
arrival at a scene, an odontologist should report to the ofcer in
charge for a brief of the incident.30 At this time, concerns with
regards to trafc risk, dangerous substances, fumes, compromised
structures within the area and a safe access path to the victim
should be addressed.30, 37, 38 Individual assessment of likely dan-
gers also should be undertaken as there may be task specic dan-
gers and any adjustments to the area to make it safer should be
discussed with the scene commander. Physical hazards that may
present to the odontologists include: unstable or sloped terrain;
sharp objects, including bone; unstable structures; residual heat;
residual carbon monoxide/carbon dioxide; falling debris; passing
trafc and dangerous wildlife.37, 38 Chemical fumes, ne dust and
ember particles might also be airborne, which can cause lung and
eye irritation.37, 38 All of these hazards mandate the use of appro-
priate personal protective gear including: sturdy, thick soled work
boots; long trousers and long sleeved shirts made of a thick non-
synthetic material; facemasks; safety glasses; high visibility vests
and hard hats if required.37, 38 When entering a burnt-out structure
or vehicle wearing of a disposable personal protective suit is often
helpful as this will not only lend protection to clothing from soot
but also limit contamination of the scene if trace testing is to be
performed. The use of a head lamp, not only at night but also in
conned areas, allows good vision not only for the job at hand but
also to identify and avoid hazards. As the stabilisation agent con-
tains water, surveying of electrical dangers should be assessed in
that immediate area. It is our experience that there is often debris
around the victim including sharp metal, hot surfaces and broken
glass. Hence, the wearing of heavy duty gloves initially is recom-
mended to minimise the dangers to hands together with the use of
a kneeling mat which will help in insulation from residual heat or
sharp debris. Fine examination gloves can subsequently be used to
pick up ne fragile evidence once the overlying debris is removed.
The retrieval of the body, once the oral tissues have been sta-
bilised, may require heavy lifting in a conned area such as an
upturned car. Thus, several Police or Emergency Services personnel
may be required to undertake the task safely. It is benecial that the
odontologists do not perform the lifting of the body, but supervise
the careful preservation of the head. In many motor vehicle cases,
we found it benecial for the re ofcers to remove some of the
doors and struts rst to allow easier access for body retrieval.
Before leaving the scene, assess if rest is necessary, as fatigue
might set in where there has been an adrenaline rush after an
intense concentration event. A micro nap may be a hazard on the
drive home. If an appropriately rested driver is not available a
sufcient period of respite in an appropriate facility close to the
scene is recommended. The psychological well-being of personnel
also needs to be considered, symptoms of stress can occur at any
time. A debrief following the incident is suggested and any con-
cerns need to be discussed with appropriate psychological assess-
ment.28, 39
In many jurisdictions, the attendance of odontologists/anthro-
pologists at the scene is not a common occurrence. In most in-
stances the thoroughness of scene ofcers allows appropriate
retrieval of remains. However, the lack of postmortem evidence and
the need to maximise information for identication in severe
incineration cases requires the attendance of experts in their eld
to ensure a timely and reliable identication of the deceased.10 The
identication of partial charred crowns or dental implants could be
crucial to the outcome of identication efforts. However, it is
important that attending specialists remain within their own eld
of expertise and stay under the direction of the Scene Comman-
der.40 A list of suggested materials and equipment that we have
found useful for our odontologists is include in Appendix A.
3. Conclusion
At severe incineration incidents, extreme heat and direct
exposure to ame can render the teeth extremely fragile and
vulnerable to damage and loss especially during collection and
transportation to the mortuary. The attendance at the scene of
experts in their eld such as odontologists to implement protocols
to stabilise and maximise the post-mortem information may lead
to greater certainty in the identication of re victims.
Conicts of interest
None.
Funding
This research did not receive any specic grant from funding
agencies in the public, commercial, or not-for-prot sectors.
Appendix A.
List for scene kit equipment
Glasses for reading and close up analysis.
Protective goggles which can t over close up glasses.
Rubber examination gloves and thick industrial gloves.
Foam mat or knee pads for knee protection.
Face masks.
Clag paste or wheat paste, water and spray bottle.
Head torch.
Flood light (non LED).
Masking tape.
Pen, Permanent marker pen.
Paper documents erunning sheet, PM sheets, scratch pad, pens.
ID and documentation.
Specimen containers e large and small (for evidence collection
and mixing).
Mixing sticks.
Dental mirror, probe and tweezers.
Scissors.
ABFO scale ruler.
Gauze.
Small paint brush.
Large paper bags, Zip lock plastic bags.
Bubble wrap.
 J. Berketa, D. Higgins / Journal of Forensic and Legal Medicine 51 (2017) 45e49 49

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