Denture marking for identification

Denture marking for identification

C L IN IC A L D e n tu r e m a r k in g James D. W oodward, f o r R EPO R T S id e n t if ic a t io n DMD, M Ed A n id e n tific a tio n stri...

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C L IN IC A L

D e n tu r e

m

a r k in g

James D. W oodward,

f o r

R EPO R T S

id e n t if ic a t io n

DMD, M Ed

A n id e n tific a tio n strip w ith th e p a t ie n t ’s n a m e c a n e a s i l y b e i n c o r p o r a te d in to d e n tu r e s d u rin g th e p a c k i n g p r o c e d u r e s . T his m a y s e r v e a s a m e a n s o f id e n tific a tio n o f e d e n tu lo u s p e r s o n s s h o u ld th e n e e d a rise.

he im portan ce o f de n ta l fin d ­ ings and the oral stru ctu re in id e n ­ tific a tio n o f deceased persons has lo n g been recognized. The oral structures, bo th hard and soft tis ­ sues, are w e ll protected and h ig h ly resistant to damage fro m exposure to fire and the natu ra l elements. The co m bin atio ns o f fin d in g s th a t m ay be present in a person are alm ost lim itle s s w h en co nsid era tio n is g ive n to the num b e r o f teeth present, restorations in n a tu ra l teeth, re­ placem ent o f m is sin g teeth, b o n y form ations such as to ri, and ra­ d io g ra p h ic fin d in g s o f the u n d e rly ­ in g structures. U sing the oral c a v ity as a means o f id e n tific a tio n is m ore d iffic u lt i f the person is edentulous. M o st ed e n tu ­ lous persons have com plete den­ tures; but, i f the dentures are n o t m arked in any m anner, the m ost in ­ fo rm a tio n th a t can be obtained m ay be the m o ld and shade o f the teeth used. H aines1 reports th a t in h is ex­ a m in a tio n o f 380 v ic tim s o f e ig h t a ir disasters, 50 v ic tim s (13.2%) had com plete dentures and 47 v ic tim s

(12.4%) had p a rtia l dentures. F rom these figures, i t can be expected that a p p ro x im a te ly 25% o f the v ic tim s o f a mass disaster c o u ld be w e a rin g e ith e r com plete o r p a rtia l dentures. P rosthetic appliances, therefore, are a s ig n ific a n t part o f evidence in id e n tific a tio n after a mass disaster and sh o u ld be p ro p e rly m arked to give as m u ch in fo rm a tio n as p ossi­ b le to the investigators.

Review o f the literature M a n y m ethods o f denture id e n tific a ­ tio n have been described in the lite r­ ature. The m ethods m ay be d iv id e d in to tw o classes, engraving o r in c lu ­ sion. E ngraving m ethods can in ­ clu d e m a rk in g the im p re ssio n o r the cast, o r s crib in g on the fin is h e d den­ ture w ith a b u r or v ib ra tio n -ty p e en­ graver. H e n ry 2 describes a “ f u ll u p p e r g o ld pla te m o u n te d w ith nat­ u ra l teeth and iv o ry m o la r blocks w h ic h had been m ade fo r a p a tie n t o f p u b lic em inence w h o d ie d in 1852. T h is pla te had been p u nched w ith a ro w o f v e ry sm a ll figures, such as g o ld sm ith s use, in s id e the casing o f a w atch. T h e y w ere stam ped in the palate near the m o la r re g io n w ith tw o sets o f num erals. Between them there is an oblong p u n c h m a rk .” Several in c lu s io n types o f m ethods have been described in the lite ra ­ ture. C h m ie le w s k i3 advocated the use o f a m etal tag. H arvey4 m entions the use o f stainless steel o rth o d o n tic band m a te ria l, m a trix band m a te ria l, and sh im steel m a te ria l. H a rve y5 also w rite s about the use o f n y lo n ,

lin e n , fiberglass, o n io n s k in paper, clear in k s th a t g lo w u n d e r u l­ tra v io le t lig h t, and p in k to ile t tissue m arked w ith a b a llp o in t pen. H arvey c o n clu de d th a t the la tte r was best because “ the a v a ila b ility , consis­ tency, and cost are a ll c o n v e n ie n t.” W hat typ e o f m a rk in g sh o u ld be used and w h a t in fo rm a tio n sh o uld be in clu d e d ? There is m u c h v a ria ­ tio n in the lite ra tu re . Lose6 suggested the use o f the p a tie n t’s last name, the m o ld , and shade o f the teeth used. H arvey4 advocates the use o f the d e n tis t’s re g is tra tio n num ber, the date, and the case num ber. Jerman7 w o u ld use the pa­ tie n t’s Social S e c u rity num ber. Carlsen8 suggested th a t the d e n tis t’s name and a n u m b e r be used. In Sweden, the m o n th and year o f b irth and the n a tio n a l re g is tra tio n nu m b e r o f the p a tie n t are m arked on the tis ­ sue side o f the dentures. T h is is re­ q u ire d b y la w in Sweden. The p a tie n t’s name, ra th e r th a n a num ber, is preferred because th is avoids the need to re fe r to registers th a t m ay be lo s t o r out-of-date. There is also chance o f d u p lic a tio n o f num bers w h e n several agencies get in v o lv e d w ith setting up re g is tra tio n procedures and lis tin g s . It c e rta in ly is unfeasible to use the d e n tis t’s reg­ is tra tio n num ber, as th is w o u ld en­ ta il the ke e p ing o f a separate n u m ­ bered lis t b y each d e n tis t and the chance o f th is g e ttin g lost, o u t o f se­ quence, and g e n e ra lly unm anage­ able is assured. H a in e s1 had c o n sid ­ erable d iffic u lty in o b ta in in g the names to id e n tify several bodies J A D A , V o l. 9 9 , J u ly 1 9 7 9 ■ 5 9

Fig 1 ■ Identification strip placed on m ois­ tened acrylic resin after trial packing.

w hose v a lid passport num bers w ere kn o w n .

Denture marking technique

My choice (used with all patients treated), for materials and simplicity, is thin paper. Onionskin paper, or the paper that separates the pieces of base plate wax, may be used, as this is avail­ able in the laboratory. The method for inserting this strip is uncomplicated. Directions for placement of the identi­ fication strip should be included on the work authorization form sent to the den­ tal laboratory. The procedures are identi­ cal to the normal processing procedures to the point of final closure of the flask during the packing process. The steps in the procedure are: First, make a trial pack as usual. Then, type the patient’s last name and first ini­ tial on thin paper and cut a piece of tin­ foil to measure IV2 x V2 in. Moisten the acrylic resin with monomer where the name is to be placed. (For maxillary den­ tures, the area used is the region of the posterior palate anterior to the posterior palatal seal, or the area of the posterior ridge under the teeth. For mandibular dentures, the area used is the posterior lingual flange, or the area of the posterior ridge under the teeth.) Place the strip of identifying paper on the moistened sur­ face (Fig 1); moisten the strip of paper with monomer. Then, place the strip of tinfoil over the paper (make sure it com­ pletely covers the paper), close the flask, and press with the desired pressure for the final trial pack. Open the flask; re­ move the strip of tinfoil; moisten the area with monomer; and place clear acrylic resin over the strip of paper to fill the void that was created when the tinfoil was removed (Fig 2). Finally, close the flask and process as usual; then re-cover and finish the processed denture. The identification strip is covered by a window of acrylic resin that the patient 6 0 ■ J A D A , V o l. 9 9 , J u ly 1 9 7 9

Fig 2 ■ Identification strip covered with clear acrylic resin.

cannot feel, yet the identification strip is visible and protected (Fig 3). The inclu­ sion in the resin does not affect the strength of the finished denture. Because the identification strip is located toward the tissue surface of the denture, the esthetic appearance is not impaired. If the denture is rebased, the palatal area can be removed and a new identification strip can be included when it is pro­ cessed. In a commercial dental laboratory in which many dentures are made, the pos­ sibility of a mix-up at the deflasking stage is limited with an identification strip in the dentures. The identification strip w ill also assure that the correct den­ ture is delivered to the patient; but, most important, the identification strip can provide a possible means for later iden­ tification if the patient should die in a plane crash, explosion, or fire. Summary A m ethod fo r in c lu d in g the p a tie n t’s name in the denture base m aterial fo r id e n tific a tio n purposes has been described. T h is s im p le procedure takes lit tle tim e , has alm ost no cost, and is effective.

Dr. W oodward is an associate professor, de­ partm ent of reconstructive dentistry, and is di­ rector of removable prosthodontics, School of Dentistry, Oral Roberts University; he is a

Fig 3 ■ Finished dentures with identification strip showing through processed clear acrylic resin.

diplom ate of the Am erican Board of Forensic Odontology and is a fellow of the Am erican Academ y of Forensic Sciences. Address re­ quests for reprints to Dr. W oodward, Associate Professor, Director of Removable Prosthodon­ tics, School of Dentistry, Oral Roberts U niver­ sity, 7777 S Lewis, Tulsa, Okla 74171. 1. Haines, D.H. Identification in mass disas­ ters from dental prostheses. Int J Forensic Dent 1:11-15, 1973. 2. Henry, C.B. Marks on old dentures, letter. Br Dent J 123(9):411, 1967. 3. Chm ielewski, J.K. M arking of dentures for identification purposes, letter. Br Dent J 131(7):296,1971. 4. Harvey, W. Marking on dentures, letter. B rD ent J 128(3}:111-112, 1970. 5. Harvey, W. Identity by teeth and the m arking of dentures. Br Dent J 121:334-340, 1966. 6 . Lose, F.M. Denture identification. J Prosthet Dent 8:940-941, 1958. 7. Jerman, A.C. Denture identification. JADA 80:1358-1359, 1970. 8 . Carlsen, A. Taenderne Som Identificeringstegn. Tandlaegebladet 35:411, 1931.