Roger D Metcalf DDS, JD

 

Forensic Odontology

and Some Other Stuff

 

 

 Odontologists--remember we need basic, foundational research in all areas of our discipline.  Are our procedures scientifically valid and reliable? 

 

 

Critically examine everything we've been taught.  Question the scientific basis of every standard, guideline, best practice, or principle followed.

 

 

Keep in mind  the quote often attributed to W. Edwards Deming: "Without data you are just another person with an opinion."  I would add, if you use incorrect data, you are commit forensic malpractice, because, after all: "First, do no harm."

 

 

We insist on evidence-based treatment in health care, why not in forensics?

 

 

Merely saying "we're following the science" without verifying that the "science" being followed is actually true is the same thing religions and cults do.

 

Roger D Metcalf DDS, JD
PO Box 137442
Fort Worth, TX 76136-1442

ph: +1-817-371-3312
fax: +1-817-378-4882

metcalfdds@gmail.com

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Post 3

   Ok...so some folks are asking me, in essence: "Well, since you've done a 180 degree turn from your previous beliefs, and are now pontificating and smugly telling us we're all wrong and that you're so smart, what is so wrong with the things we're doing in odontology*?" Fair question.

   Some of the systemic problems I have personally observed and experienced, and these may not be universal, seem to be:

   1) Very nearly all forensic odontologists practice the discipline on a very limited part-time basis. There is only a *very* small pool of jobs in the US for full-time odontologists, and I was very fortunate to have had one of those--and even then, my duties were not 100% odontology (when you work at a government agency as head of a department, you spend a lot of time filling out paperwork!)


   2) Only a fraction of odontologists in the US have been through a formal, university-based training program. There's a number of reasons for that: it's not required, it's not financially rational--one will likely never make enough income from forensics to defray the cost of the program, and, there's only a couple of programs in the US at this time (and one of those is relatively new while the other is slowly fading away).


   3) The training in even the university programs is based on methods and procedures that have been passed down through generations of odontologists as received knowledge without critical examination of the underpinnings.


   4) In the US one becomes a forensic odontologist simply by declaring "I'm a forensic odontologist." No training required. No requirements to fulfil. No license to obtain.  Just print up some business cards.  You can eventually become board-certified if you wish, but you don't have to.


   5) Bitemark analysis, in particular, "seems" like it ought to work. It has been used to send some pretty bad dudes off to their eternal reward--Ted Bundy, for example. But because a method "seems" to work certainly doesn't mean it actually does in every case--it could mean, and likely does, that the odonts got lucky and were involved in a very high-profile case where all the cards fell in their favor. Odontologists may mean well, but as the old saying goes "the road to Hell is paved with good intentions."


   6) When one thinks about it--why are DENTISTS interpreting patterned injuries? We are not trained in evaluating cutaneous injuries. Who looks at such injuries all day long? Forensic pathologists, and physicians and nurses in pediatric ER units....nurses in our local children's hospital tell me they see bitemarks all the time. So why do we dentists think WE should be the experts evaluating these injuries? I don't recall ever seeing a bitemark on a patient in my 27 years of general dental practice--so, no practical experience there.  Pediatric nurses and ER docs may be mistaken at times about the injuries they see, but I can't dispute that, in any case, they do see a LOT more real bitemarks than I do.

   So, what do we need? A scientific basis for what we do, IMHO--supporting research, for example, as to the characteristics needed to even classify an injury as a bitemark. Supporting research for the idea that two odontologists can be trained to reliably evaluate an injury and reliably agree and conclude that it is or is not a bitemark. Research into whether or not a real bitemark can reliably be "matched" to a biter (spoiler alert, I don't think that's ever going to happen--human skin is simply a miserable impression material.)

More, but I'm out of space. Just my opinions. Your mileage may vary.

 

*"Odontology"--what the heck is that?  Well, just a fancy way of saying "dentistry."  Some say there is a distincition between forensic odontology as being our discipline applied to the deceased vs. forensic dentistry which is our discipline as applied to the living (i.e. some bitemark cases, age guesstimation for immigration or other legal purposes, malpractice cases).  I don't really care one way or the other--I'm just glad that in the US we don't call ourselves "odontostomatologists" as some Europeans do because I have a heck of a time spelling that.



© Copyright 2013, 2019 Roger D Metcalf. All worldwide rights reserved.  No reproduction without permission.  Neither the Tarrant County Medical Examiner's District, Tarrant County, the American Board of Forensic Odontolgy, the American Society of Forensic Odontology, the Royal College of Physicians, Oklahoma State University, nor any other organizaion mentioned here necessarily supports or endorses any information on this website.  Any opinions, errors, or omissions are my responsibility, and mine alone.  This site DOES NOT REPRESENT the official views of any of these--or any other-- organizations.  Similarly, those other organizations may not fully represent my views, either.

 

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Roger D Metcalf DDS, JD
PO Box 137442
Fort Worth, TX 76136-1442

ph: +1-817-371-3312
fax: +1-817-378-4882

metcalfdds@gmail.com