Dr Gary Berman - Forensic Odontology and DMORT

[Music] Welcome to the People of Pathology podcast. I'm Dunnestrink. I'm this podcast. I speak with the people doing interesting things in pathology, laboratory medicine, and forensic medicine. My guest today is Dr. Gary Berman. Dr. Berman is a forensic odontologist and he's also a member of the disaster mortuary operational response team, also known as demort. Today on the show Dr. Berman will tell us all about his work in forensic odontology. He'll talk about his work with demort including the World Trade Center, Site, and Hurricane Katrina, and he'll talk about his work with the American Board of forensic odontology. All right now here's Dr. Gary Berman. All right so we're going to talk about forensic odontology today and you are a forensic odontologist. So I want to start with kind of a broad definition. Can we kind of give a broad idea of what is forensic odontology? I'm happy to. Forensic odontology, let's start off with the word odontology is just another word for dentistry. I believe it might be an old European word, but so when we talk about forensic odontology it's interchangeable with forensic dentistry and what this is is a branch of forensic medicine which we're applying our dental knowledge to both civil and criminal problems and such. As a forensic odontologist typically we will be working in a medical examiner corner's office, we'll get involved with mass disaster situations, and a small percent of forensic odontology is also work with human abuse organizations. Okay. The whole field of forensic odontology is actually especially of forensic sciences and it's not a specialty dentistry and this decision from the forensic odontology is made way before my time, but we are a forensic specialty recognized by the American Academy of Forensic Sciences just like forensic pathology, forensic anthropology, criminalistics, engineering, Christian documents, et cetera, et cetera. The whole field of forensic odontology we also have a organization called the American Board of Forensic odontologists in which we can achieve specialty recognition in forensic odontology. Okay. But you are a dentist. I mean that's sort of absolutely. Absolutely. Almost every single forensic odontology is at least the United States. They're either in private practice. They might be teaching in the dental school or they might be working full-time as an investigator in a medical examiner cornered office. But as you said, we all consider this our second job. I work full-time as a family dental practitioner. So what sort of training is involved in forensic odontology? Do you cover that in dental school or is that kind of over and above? Let me take it step one step back because I kind of missed this. But what we're doing as a forensic odontologist is probably 95% plus the time. We're doing identification of an unknown decedent using teeth and jaws and cranial facial bones. And typically, again, this is done in a medical examiner's office or a mass disaster situation. Most time what we're doing is verification when we can't visually identify somebody. But the field of forensic odontology because it is considered a specialty of forensics more than dentistry, most dental schools might have one or two lectures on forensic odontology that are given to the dental students. But that's pretty much it. I think there might be one school out in Paswede, New Jersey that actually has a whole course on it. So once we become a dentist, I had to go ahead and find courses throughout the country to go ahead and get my training with it. Presently, there are two part-time fellowship programs that dentists that are interested in forensic odontology can take. One is offered by McGill University. One is offered by University of Texas, excuse me, University of Tennessee. And a program that's been existence for many years with stopped for a couple of years, I believe they're starting up again as at the University of Texas San Antonio. But most dentists, like myself, we had to go around the country taking four and five day courses in forensic odontology in order to get our training with it currently here in Detroit, which is where I live. We have a five-day forensic odontology course that is held every other year at our medical examiner, a medical examiner's office in Wayne County, in which we will get about 40 dentists and dental hygienists that come in that are interested in forensic odontology and we'll be able to train them in the medical examiner's office. So for you, the training that you had about, I mean, because you had to kind of get it when it was available, about how long did that take? I took my first course. Let me go back and talk about how I became interested in this and how progressed into my education. My dental practice is about 10 miles from Detroit Metropolitan Airport. And back in 1987, there unfortunately was a Northwest airline plane crash, like 255. And reading about the dentists that were involved with that time, our state dental team with the identifications got me very interested in this. So back in 1990, I called Dr. Ellen Warnock, who was the team leader for the Michigan Dental Association's forensic dental identification team. And he invited me to come down with him to the Wayne County Medical Examiner's office. And I found this absolutely fascinating. And for that reason, I started taking the courses that were being offered at that time. And most of them were through the Armed Forces Institute of Pathology. And unfortunately, they're no longer being offered. But I went ahead and first took a forensic odontology course from them, which was a five day and some hands-on with specimens. And from there, as I could find other courses around the country, I would go take a course here and there with it. The training was sort of like ongoing every year because you're working full time. I would try to take one five day course or something along that way. And back in 1991, I happened to be taking a course in forensic anthropology from the Armed Forces Institute of Pathology in Beliebos, Elba Kirkki. And I met there a young forensic pathologist just finishing up his training in New York City, Dr. Michael Kaplan. And in talking to him, he said that he was going to be the new forensic pathologist in Washington County, which is Ann Arbor, Michigan, literally 10 minutes from my office. So I happened to got lucky, made contact with the new forensic pathologist. And Dr. Kaplan was wonderful when he started, I started calling me up and I started doing cases in that county. It took me from the time I started, I got my interest starting courses to the point that I had enough education and enough case work to challenge boards about 10 years. So I finally became board certified in 2002. Okay, so there is a board certification for forensic auto. There is correct. As you mentioned, the forensic autoontologist has a role in identification in mass casualties. And this is something that you have quite a bit of experience with. You're a part of the organization called Demort. Correct. Can you tell us what is Demort and what does it do? Okay, let's start with the name Demort means disaster mortuary operations response team. Demort started in the early 1990s, the National Funeral Directors Association made a decision that the funeral directors were going to organize a portable disaster mark that they would be able to move around the country to help when disasters occurred. Back in the early 1990s, the, you know, Directors Association basically combined with the US government's National Disaster Medical System to create these Demort teams. And so Demort became a specialty team within the National Disaster Medical System, which also includes what's known as demats, which are pretty much the emergency doctors, nurses, EMTs, pharmacists that rush into a disaster to help out it with the living. There's also a second group of veterinarians there there to help the search and rescue dogs and any animals that might be left behind as pets. But the Demort team pretty much is we're there to help recover and identify the deceased in a disaster and get the deceased back in with their families. So what happened with Demort was in 1997, there was a federal law that was created, the law basically directed the National Transportation Safety Board to coordinate the, all the resources for any type of aviation type, I'm excuse me, any type of transportation accident where we need victim identification. And the NTSB then signed an agreement with this National Disaster Medical System that Demort teams will now be caught upon for that. Now after 9/11, the Demort teams kind of bounced around. First, we are part of Homeland Security and then we became part of the Department of Health and Human Services a couple years later. Currently, Demort is still part of the National Disaster Medical System and which is part of the Public Health Service which is part of the Health and Human Services. Now the Demort teams we're here to be pretty much provide various levels of assistance to the local communities, the medical examiners with it. So the medical examiners or the corners in each state and county are still in charge but the Demort team will come in with all their resources and I'll talk about that in a second to help the local community in the disaster and again the recovery and the identification of these unknowns. Now Demort teams are made up of many individuals but including forensic pathologists, forensic anthropologists, forensic odontologists, DNA experts, fingerprints, x-ray technicians, computer specialists, a whole bunch of support personnel including a lot of funeral directors, law enforcement, mental health specialists, and they have, Demort has currently three portable morgues that can be loaded onto trucks or put in airplanes and flown around the countries so Demort is able to pretty much come in to help out, set up their own morg, get their own personnel in there, get their own computer networks up there, and then be able to help the local community with whatever level of help they pretty much need. You're also part of the Michigan, do you say M.I. Mort? Yeah, we're just going to get the M.I. Mort. So what pretty much happened was the Katrina was a different type of disaster in that the Demort had to go and help in two different locations. They had a, they were helping in Mississippi, they're helping in Louisiana. So Demort actually set up two different disaster morgues and it allowed a Demort person that were members went through helping out when we replied to Demort, they're normally two week rotations. And so here in Michigan, a bunch of us that were in Demort after we were back in Michigan, we started realizing you know if there's a problem in which Demort is pretty much stretched because the disaster could be in multiple locations throughout the country. We realized that Demort may not always be available to respond. So back in 2005, a couple of the forensic pathologists, Dr. DeYoung and Dr. Markey and myself, Dutch Nye who was a funeral director and Dr. Norm Sauer who was a forensic anthropologist, we decide that we're going to try to form a state disaster team that would be able to integrate into Demort. And that was the beginning of our MyMore team. So we tried to have our team so that we could respond first and then if we're overwhelmed, we would be able to call Demort and Demort would be able to come in and integrate because all our procedures and our software and everything else would pretty much be interchangeable. And starting in 2006, the state of Michigan were able to get from the federal government some aspirer type grants. That's the office of assistant secretary of preparedness and response. And the state got very, very active and the state currently is very, very supportive. We have monthly meetings of our MyMore team and currently we're part of the Michigan Department of Health and Human Services Bureau of the MS trauma and preparedness. But they, we are state team. We believe that, you know, God forbid we have a disaster in Michigan, we'll be able to have our state team come in and be able to respond at least for the first few weeks. And then if need be, Demort will be requested and through the proper protocol to help out. And we're now not the only team like this. There are several teams throughout the country. Florida has one Ohio has one Wisconsin has one. Good New York said New York does and a lot of this was because we realized that Demort might be overwhelmed at some point. So with the support of federal grants, we were able to form state teams that integrate with Demort. Got it. Okay. Now Demort is organized into regions around the country. Is, is MyMore kind of organized the same way throughout Michigan? No. MyMore we basically have a statewide team and we have members throughout Michigan being quite large like many state. We do have members throughout the state with it. Demort, Michigan's part of a region five, which is Michigan, Ohio, Indiana, Illinois, Wisconsin, and Minnesota. But our state team again is just one entity with all our portable morgue equipment being housed at our state capital in Lansing with it. And our state team actually, unfortunately, we got activated during this, this COVID crisis that we are currently still in. And our state team, we went ahead and we set up it. One of the airports and one of the hangers, we actually had to set up our ability to, we were requested to help the hospital overflow. The hospitals were having unclaimed COVID victims and the hospitals were running out of room. And Michigan, the state was not allowing funerals. They're allowing, you know, you have a grave site funeral with less than 10 people. And what the hospitals were finding were families were not ready to claim the disease knowing that they couldn't have a funeral. And the hospitals became overwhelmed. So our MyMore team was able to set up in a, in a hanger, our, our equipment that will allow us to go ahead and transport these individuals from the hospitals into a secure environment housed in the airplane hanger with the proper cooling equipment and everything. While we were able to contact the families and allowed them to make arrangements to have their funerals, the MyMore team for this. So we weren't involved with any type of identification. We knew who all these individuals were. It was just more of a mess. The task was just ran out of room. We were up for almost two months. And fortunately, here Michigan, the number of deaths, you know, went way down. The hospitals were back to normal. And after a little under two months, the MyMore team was able to break down their equipment and store it again. And we hope not to have to set it up again. This was the first time, this was the first time since 2005 that our MyMore team actually responded to a type of disaster. Other than that, we just pretty much been having trainings, hands-on trainings every two years and yearly conferences, that sort of thing. So it wasn't exactly what we envisioned when we formed the team, but it was wonderful that MyMore team was able to help out the local communities. Yeah, absolutely, absolutely. Now, you mentioned, so it's forensic pathologists, forensic dentists, forensic anthropologists, various computer personnel. What are other types of positions are there on teams like that? Like other lab personnel, are they dental hygienists? Okay, so let's start talking about Dennis because being a dentist. Our dental team in the state, and also in Deemorth, but when we talk about our dental team, the dental team is made up of dentist, dental hygienist, and dental assistants. And we always believe that as in our dental office, the dental auxiliary is that being the dental hygienist and dental assistants, probably can you take better x-rays than the dentist can in many cases. And so we kind of always work in teams and when we work out of a deceased individual, we're working three or four people at a time while we're doing our work up. And dental assistants and dental hygienists have been incredibly important both in Deemorth and on our state team in the helping the dentist process and do what we do with the individuals with it. In the state of Michigan, my more team, I believe a third of our dental team members are actually dental hygienists and you know, probably five to ten dental assistants. The Deemorth team also because this is a self-contained group that when we went down, for example, down to Katrina, there was no electricity, there was no water, there was no, you know, cell phone coverage. Besides the forensic specialists for the morgue, we need to have everybody else around that will allow us to do our jobs. So we have, you know, safety experts. We always have an EMT of some sort in case somebody gets hurt. Like I mentioned, mental health specialists because this can be very psychologically trying at times. We have, we have the individuals that we can then set up a morgue and both physically and, you know, set up the generators that we have power, that sort of thing. The computer networking is just amazing watching these guys do it. But again, you know, X-ray technicians, fingerprint experts, DNA specialists and so on. So it really is a very encompassing team. And we also have administrative people because we have to have people knowing when to rotate in and rotate out. And when Deemorth, when we go for Deemorth, we actually become temporary federal employees of the federal government pretty much we get military pay. So we need administrative people that can help monitor that. Our state, my more team, we're all volunteers. So everybody that responds from state level wise, we're all volunteers with the state disaster team. When there is like a national disaster and the Deemorth team has to get called up, if it's outside of your region, like you mentioned Katrina, how does that work? How does your region get called to another region? Okay. The typically what will happen is Deemorth will try to keep people within a region if it are possible. But often because the region, when the states got hit pretty hard, they're not the people that are actually going to be able to respond because they got their own problems going on there. So Deemorth will go ahead and via an email or a phone call or text message nowadays, go ahead and ask for our availability for everybody. And we will go ahead and respond and say, I'm available from August 1st through August 30th. We're making a two-week commitment that will be available to go. Often they'll give us 24 hours notice before we have to go somewhere. And what would the Deemorth hire up people in the command, what they're trying to do is they're trying to get these different specialists, whether it's a Francisco d'Intelges or pathoges or a computer person from around the country, knowing that this might go ahead and take longer than necessary. I believe Deemorth now is about 800 people. So it's not this gigantic organization. So almost always when Deemorth needs to come in, they're asking other regions for help. And we'll have people from different regions coming in. That's 800 nationwide. Yeah, Deemorth still a very small organization, yes. Which is why the government's been so supportive of states going ahead and forming their own teams so that Deemorth doesn't have to be the first choice. Oh sure, that makes sense. Can we talk a little bit about a couple of the sites that you've been to I know in 2001, you were at the World Trade Center site and then you were also at Hurricane Katrina in 2005. Sure. What we did was very similar, but the situations are totally different. So I'll be talking first about my experience with the World Trade Center. Okay. Like like many people, I was actually at work when the airplanes crashed into the Trade Center. And that night, I actually got a phone call from Deemorth requesting that, am I available? And if so, we were going to be meeting the next day in Chicago at 7 a.m. Now Chicago is about a five hour drive from Michigan. And I say drive because remember at that point, all the flights were canceled. There was nothing flying. So yeah, so about 2 a.m. myself, Dr. Warnick, we got in a car and we actually drove to Chicago. And we all met at the airport outside the airport actually. The region five people. So people had driven from Minneapolis and other areas around our region five. And there was about, I think, a little under 40 of us. And we were flown later that day. I think we were one of, you know, only a handful of flights that were actually in the air. But we're we're flown on a military jet to Stewart Air Force Base, which was north of New York City. And that was sort of like the holding area for all the Deemorth team people coming in. And for the World Trade Center, we ended up staying in a hotel near the airport, near La Guaria. And we were working two 12 hour shifts, 7 a.m. to 7 p.m. and 7 p.m. to 7 a.m. And depending on what your specialty in Deemorth was, that's sort of what you did. So I was actually there for three weeks. And we were pretty much helping the forensic dentist. I was that were, you know, in the part of the Medical Examiner's office and working under them. And then I went back for about two weeks over Christmas that year. They ran 24 hour seven, the World Trade Center. I believe into about the first year, in which case, they ended up just having to do 12 hour shifts. That was a difficult type of mass disaster because one, nobody knew what was going on. We everyone we had we all had questions as to what's really happening. Why are they telling us which turn out to be nothing? Why is there so much security? And, you know, everyone was, you know, very scared cell phones were just beginning back then and they didn't work very well. It was hard to communicate with their families. And if you remember back the people that saw, they would have posters all over the walls throughout the city. And so the people that were missing, people that died, very much in your face. It wasn't like you can ignore and just do your job because you're totally inundated by all these individuals that have passed away in the attack. But we were staying in hotels and we had food. So it wasn't a rustic type deployment. It was just a very psychologically hard deployment while we went ahead and did our things. Katrina was quite different because the hurricane went ahead and destroyed the infrastructure. What happened with Katrina is the National disaster medical system had us doubted Memphis the day before the hurricane. So we were pre deployed them knowing that there was going to be a bad situation. And we were in Memphis as the hurricane went through and the next day we got into trucks and cars. And my group drove down to Gulfport, Mississippi. And the other group went toward New Orleans. We took over D-Mart. We took over a hinger at the Gulfport airport there. And that's where we set up our temporary warring and such. But here there were no hotels. There was no water. There was no electricity. There were no sewers. There were no cell phones at all. We actually took showers at a military base nearby. And we were sleeping in the normally we'll bring in refrigerated trucks like they carry food in. And those are converted to hold the deceased. And so we can keep them cool. At that point we had nowhere to sleep because there were no hotels. So we were sleeping on the floors in the refrigerated trucks, not with that individuals. We were sleeping on floors in there. And we were eating on MREs. And such. While FEMA and everybody was trying to get equipment down there for us. So unlike the road trade center where we had hotels, here was very rustic. But we kept telling us so. We're still in so much better shape than the people that survived the hurricane down there. That it was no problem. It offered us. And eventually we were able to get washer and dryers and water trucks and tents and cats and sleeping bags and everything else down there. The actual process of the forensics in the morgue is very similar in hot disasters. We're going to be bringing the individual in and they're going to go through the different pathology, anthropology, forensic or ontology stations and everything. It's going to be documented. And for Katrina, the difficulty for the dentist were actually getting dental records because all the dental offices were closed. So we had. Yeah. So we had to wait for dental offices to open up. And there were some dental offices that were right along the Gulf of Mexico. And some of the dental offices in Gulfport actually got destroyed. The other team that went to help Norellines were got stationed in St. Gabriel, which is about an hour away from Norellines. And their infrastructure was up. So they were able to set them up and they were sleeping in sleeping bags and cats in a elementary school. And they had at least all their infrastructure going up. And they had a little bit of an easier time getting dental records. But the numbers of deceased individuals in Norellines was five times that of Mississippi. I think Mississippi was somewhere between two to 300 people that passed away that deemarts saw in the Norellines dead or maybe 12, 1400. Oh, okay. Wow. You know, I was just thinking if someone wanted to get involved with deemarts or their state organization, how would they go about doing that? Okay. So deemarts being the federal organization, deemarts will go ahead and as they have in the last couple of years, they will open up the application process for different type of specialty. One of the and then they just need to go into a, I believe it deemort either dot gov or deemort dot com. But they can go on there and see, you know, what specialties areas that deemort is looking for. From a dentist standpoint, the dentist responded very quickly to deemort back in the 1990s. And their deemort is not basically open up for dentist since 2001. They feel they've had enough dentist in there. So from a dental person, dental hygienist and assistant standpoint, it's difficult to become a member of deemort. However, a lot of the states have state dental teams. And for their, you know, and that's really easy. I mean, in state of mission, we'll love anyone that wants to join higher state dental team, which is part of my mort. We hope we know we we we we we we we welcome with open arms. And for us, in the state of Michigan, you can either we go into the my my mort.org website or contact in the state of Michigan. Our dental team is through the Michigan Dental Association and contact the Michigan Dental Association. And they'll lead you to the right contact people. And like I said, a lot of a lot of states all have dental teams that have been set up over the years. They may not have a statewide my mort type team, but a lot of the states have dental teams that are available to help in a disaster. Yeah, I'm going to put links to those organizations in the show notes if anybody's interested in checking that out and maybe joining. I want to take a short break right here and introduce you to another podcast that I recommend. Hey, everyone. I'm Nicole Kruem and I'm Jordan Taylor. And we're both pathology residents and the host of Deadman, Do Tell Tales. A podcast about forensic pathology related topics. We've talked about everything from CSI and bones reality versus fiction to natural disasters and poisonous plants. It's been a great learning experience. And we kind of taste a lot of really good whiskeys along the way. Oh, and don't forget about the beer and other mixed drinks too. So if you want to hear more about the science behind autopsies and MD's role in death investigation or your favorite mixed drink, you should hop on over and take a listen. You can find us on Apple podcasts, Spotify, Cast Box, and probably a few others that we don't even know about. Thanks, press for that. Talk to you all soon. And now back to the show. You've served as the president of you mentioned the American board of forensic odontology among other roles you've had in that organization. Can you talk a little bit about that experience? What was that like? So yeah, the American board of forensic odontology pretty much was formed to the object was to basically set standards of qualifications for people that practice forensic odontology around the world. And to be a way to certify those people that have achieved certain levels of competency in there. And our American board of forensic odontology is accredited by the forensic specialties accreditation board as a forensic specialty or offering board certification. The currently I believe we have a little under 100 board certified forensic dentists in North America because we have some Canadian members. And I was I was present back in 2003. It's an organization of an incredibly dedicated, you know, individuals. This is all dentists. I'm the board. And actually, I think now it's present. I'm trying to think no, no, so the American board of forensic odontology, I was the president in 2015. So the board meets yearly. We have a business meeting yearly. We piggyback on to the American Academy of forensic sciences meeting in February that bounces around the country. The American board of forensic odontology offers workshops dental defecation, human abuse, courtroom testimony, dental aging. As part of these meetings and every year, they're different workshops. We don't offer off for the same time. The organization like I said, we're there basically to help practicing forensic dentists, even if you're not boarded, by establishing these guidelines and recommendations and standards that can be used around the country. And because it's a small organization, you know, at times we're very efficient and very can respond to things very quickly and other times because we're a small organization. And we all have, I tell people primary jobs, which aren't being the forensic odontologists. It's sometimes things take a long time to get achieved and approved, but it is truly a wonderful organization. And something that hopefully off forensic odontologists strive to achieve to be able to challenge the board and become board certified. You mentioned the workshops that you give. Do you teach any of those? Not anymore. The workshops basically the chairman of that group from the board. So let's say dental identification. The chairman of that group will get members of his committee to go ahead and teach the workshops. So when I say not anymore, for many years I was involved with quite a few of the different workshops, but as we have membership go through different layers of office and involvement, we try to rotate who teaches at these courses, at least these workshops. What I am involved with is the five day forensic dentistry course held here from the University Trade Mercy at the Wayne County Medical Examiner's office. And we hold this course every other October. So the next course it will be October of 2021. And what's truly unique for this course is that it's actually held in the medical examiner's office. So those people that are interested, at least seeing whether this is something they want to pursue, they are not just getting the training of a forensic odontology. We're able to offer them. They can go ahead and see how a medical examiner's works. I mean we have wonderful forensic pathologists at our office that they can come in and observe autopsies and many lectures from the forensic pathologists there about non-denial things. So that in the five days we can go ahead and expose them to all areas of forensic science, including forensic odontology. Do you have a specific area or two that you'd like to do like specific topics within forensic odontology that you like to teach yourself specific interest? I pretty much have been teaching a lot of over the years, master's-aster and such, that yeah. In a master's-aster situation, the basically what a forensic dentist is doing is exactly what we do in a medical office or a coroner's office. But instead of a single body, we have unfortunately many more. And what I personally found over the years that I've gotten very involved with the logistical aspect of this. From the MyMore team, I'm actually the more operations chief. So I'm overseeing everything that is happening from all the forensic specialties in the morgue. So I've actually taken a step away from the forensic dentist. But we have wonderful Dr. Lishon, Dr. Brian Murphy, our wonderful team leaders for our dental team. So I've been able to take a step away from that and help oversee everything. So over the over the last 20 years, myself and Dr. Warnock, we've given many lectures throughout the country to dental teams mostly in setting up master's-aster teams. You know, how do you do it? What kind of equipment, what kind of training and everything, almost like that. And it's been very enjoyable. A lot of exercises, hands-on, pretend exercises in master's-aster. And I believe that because of this, many, many state teams around the country were prepared if needed to go ahead and respond. You've also done a fair amount of writing, also. You've contributed to the manual of forensic or ontology. Can you tell me how did you get involved with that? So one of the dental organizations is the American Society of Forensic Oden Tougies. So in Forensic Oden Tougies, there's pretty much three different organizations. We have the Forensic Oden Tougie group that's part of the American Academy of Forensic Sciences. And that's the Big Unbredal group containing all the forensic specialties. The two smaller other organizations is one, the American Board of Forensic, the American Board of Forensic Oden Tougie, which is the Board Certification Group. And the other organizations called the American Society of Forensic Oden Tougie. Now, American Society of Forensic Oden Tougie is open to anyone that's interested in forensic oden Tougie Forensic Dentistry. And it's a, we like to say our membership includes lawyers, our membership include laboratory people, anyone that has an interest. And like the American Board, the American Society of Forensic Oden Tougie piggybacks onto this yearly American Academy of Forensic Science meeting. And they have a four day class workshop lectures during the week of the Academy meeting. So anyway, so I was present back in 2003. And one of the things that society has been doing for literally since the beginning was trying to promote textbooks in forensic dentistry because there were not very many. And so every few years the American Society of Forensic Oden Tougie would go ahead and publish a new edition of their textbook, which is the Manual of Forensic Oden Tougie. I believe they're working on this sixth edition right now. And so for two of the edition, the third and fourth edition, I was one of many authors asked to write chapters for the textbook. The last textbook, the fifth edition, I was one of the co-authors for the chapter on dental identification and on the chapter on disaster victim identification. So it truly stopped for a dentist to get involved in writing because I became a dentist because I didn't like my English classes. So go ahead and become a textbook writer. It stretched my abilities. Let's just leave it at that. Sure. So you've been involved in the forensic fields for quite a while now. What are some ways that field has changed over the years? I've known what it's in recent maybe the last decade or maybe two digital x-rays in dentistry have become kind of the norm, which I imagine is a major job a lot easier. But what are some other things that have changed over the years? Yeah, well let's start with the digital and the portable stuff. So the equipment has changed tremendously, which made our lives so unbelievably easy. Digital x-rays because for people that aren't familiar, dentistry, if you think about normally we had little film. We put in some ice mouth and we shot an x-ray and then you had to go put it either hand-processed in dip tanks or run it through a machine that would go ahead and process the x-ray film. So when doing a dental identification on a deceased individual, we're taking dental x-rays so that we can compare those dental x-rays to the dental x-rays that we got from the dentist. And what we're looking for is basically are things the same or if things change in a logical direction. What I mean by that is did he smothling get larger? If a tooth had a filling when the person was alive and you're looking at the tooth and the deceased individual and there's no filling in there, it probably is not that individual teeth don't miraculously heal themselves in the filling's go away. But so the difficulty in the past was we had to take these x-rays and then we had to go ahead and process them and many medical examiner's offices did not have the equipment to process them. So we'd take the x-rays, go back to your dental office and develop them and hope that the x-rays you took were good enough. The use of digital now, we have a digital sensor that's hooked up to a laptop which makes it very portable and our digital sensor is instantaneous. Along with that, in the dental office you always have those x-ray machines attached to the wall, which made it difficult because not all medical examiner's offices had that sort of equipment. So often we were dependent on medical x-rays to compare to dental x-rays, but for the last probably 10 to 15 years there are handheld portable dental x-ray units. So I'm talking about the thing that's attached to the wall right now. These things look like just very large gun and they actually would take the x-rays, you take the x-ray and you shoot it at a sensor and literally in three seconds you have your dental image to look at. So working on deceased individuals, we get instantaneous x-rays that I can go ahead and say, you know, that's good, but the angle from the x-ray from the dentist is different. I can change that x-ray and so I can get even a better shot of that. So it's made our life really easy. And then getting the antimoron, the before death of records from the dentist, which is what we need to compare with when the dentist offices and more and more are becoming digital, can email them to us, we can get their records instantaneously instead of waiting days for mail or, you know, next day for, you know, FedEx. And the quality is truly much better. The old philmex rays would over time got worse. And so the quality of the philmex rays sometimes were less than ideal. And digital basically, you know, is great. And truly in my mind, the most important thing is it's easy to store these x-rays. It's not digital. So we know long enough to cop in office and say, do you have dental records? And they go, oh, they haven't been here for 14 years. And after 10 years, I destroyed the dental records because it's a digital media, which means people with the dentist are going to be storing these dental records pretty much forever. So we're no longer going to have to worry about dental records being destroyed. It's just a question of being able to find out which dentist they had gone to. So the field has changed tremendously because of all this. And because of all this, with the digital transfer of information and stuff, the American Dental Association under Dr. Ken Ashheim out of New York, have been working on standard regarding digital transfer of forensic dental information. Teeth are numbered differently depending on what country you're from. So they're working on all these standards so that we're going to be able to seamlessly export information overseas if somebody passes away there in the dental records or here or vice versa. And this has been a lease of five year project, but it's incredibly exciting. And I believe that they're almost done with it. Oh wow. Is there some sort of like, you know, like with fingerprinting, you've got sort of a national database? Is there something like that for dental records? There isn't for people that are living like for you and me. Okay. And there's always been from the population privacy, you know, issues with that. But what there is is that when we have an unknown, maybe with a street person or we don't know who this person is. So typically in Wayne County, we'll go ahead, we'll take dental x-rays, we'll compare that to the dental x-rays of all the people reported missing in the community. And if it's none of those people, the Department of Justice has a group called NAMIS, N-A-M-U-S. NAMIS is interesting. NAMIS will go ahead, we can go ahead and put our dental information from our unknowns into NAMIS, which is a national wide information. And NAMIS will also have dental information from missing people in there. And the NAMIS group will go ahead and try to run through the computers, match these individuals up. So we will go ahead and we put all our unknowns into this NAMIS program. And we'll get, you know, emails from them said, well, it's possible it's these people. We'll go ahead and double check. And we'll go ahead and double check to see if it is. NAMIS also has a DNA registry. So not only do we send them our dental records NAMIS, we'll send them something that they can run DNA on. So they have the DNA of the unknowns also. Okay. This has been fascinating. Is there anything I haven't asked you that you wanted to mention? I could not have asked for a better second career. I love being a dentist, but the, our ability to help families, you know, because every time I go in there and identify somebody that's deceased that can't be visually identified. I'm helping a family. I'm helping a family be able to have a funeral, get closure, and all this sort of legal aspects as far as, you know, the state settlement and everything else like that. And when we go ahead and able to identify, whether it's decomposed or scultry mains, that someone's been missing for four to six months, I find it so exciting because the closure, the ability to help the family, the community is wonderful. It's a great profession. Yeah. I can definitely hear the excitement in your voice. Dr. Burman, thank you so much. This has been great. You're welcome. Big thanks to Dr. Gary Burman and also thanks to Dr. Lockman's son from the Wayne County Medical Examiner's office and Detroit's daily docket podcast for connecting you with Dr. Burman. As always, the links to everything that we talked about in this episode will be in the show notes, which are at the website, peopleofpathology.podbean.com. You can also follow the show on Twitter at people of path. Don't forget to subscribe to the show on Apple podcasts, Spotify, Google podcasts, and pod bean. And if you like this episode, share it with someone you know. And together, let's inspire the next generation of pathologists and laboratory professionals. I'm a member in the CFO of the American Association of Pathologist Assistance. This podcast is not necessarily representative use of the AAPA and receives no financial support from the AAPA. Thank you very much for listening. And I will talk you next time on the people of pathology podcast. [Music]