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A b s t r a c t
The Cedar Fire burned a large area of
San Diego County in October 2003.
By the time it was extinguished in mid-
November, it had consumed more
acres than any fire in California’s his-
tory. Fifteen people lost their lives
because of the fire. Forensic dentistry
played a prominent role in the identifi-
cation of the victims.
n Saturday, Oct. 25, 2003, a lost hunter lit a signal fire hoping to be rescued. Instead, he started a mas- sive wildfire. When it finally was extin- guished weeks later, it had consumed more acreage than any fire in California history. The hunter was in an area called Cedar Creek, just east of the community of Ramona in San Diego County, deep within the hills of the Cleveland National Forest. The area was generally inaccessi- ble due to the rough terrain and 30 years of underbrush growth. In San Diego County, the average rainfall is nine inch- es per year. However, the average rainfall had been well below normal the past sev- eral years. As a result, the dead brush had a moisture content of 2 percent to 3 per- cent compared to paper, which has a moisture content of 10 percent.^1 The fire began at sunset under fairly calm wind conditions. However, because of the extremely dry brush, it spread very rapidly and covered much ground. Air tankers were not allowed to respond that evening due to night flight restrictions and firefighters could not reach the fire’s Ground Zero. The fire grew rapidly in size, moving west toward Ramona. Suddenly, in the early evening, the Santa Ana winds increased and shifted direction. The front of the fire increased to a width of five miles and moved rapidly toward eastern Ramona, the
Barona Indian Reservation, and Wildcat Canyon/Muth Valley. As the fire grew in size and ferocity, it grew into a force of incredible destruction. Raging through Wildcat Canyon, its speed approached 60 miles per hour. The fire consumed 33,000 acres in one hour, equal to nine acres per second. At that point, all rescue personnel could do was to focus on saving lives. “A hundred fire engines would not have been enough. The crews were there to rescue people.”^2 By 9 a.m. the next morning, the fire had consumed more than 150, acres and traveled almost 20 miles west through the communities of Ramona, Barona, Wildcat Canyon/Muth Valley, Lakeside/Eucalyptus Hills, Poway (south), and into Scripps Ranch mov- ing up to and over the 10-lane Interstate 15. By Sunday night, the Cedar Fire raged south and east through the communities of Santee (north), El Cajon (east), Crest, Harbison Canyon, and Alpine. In its first full day,
AUGUST. 2004. VOL. 32. NO. 8. CDA. JOURNAL 689
Dental Forensic
Identification in the
2003 Cedar Fire
Anthony R. Cardoza, DDS
Author / Anthony R. Cardoza, DDS, maintains a private practice of general dentistry in El Cajon Calif., and is a forensic dental consultant for the San Diego County Medical Examiner, the Imperial County Coroner, and the California Department of Justice in Sacramento. He currently is the Southern Regional Director of California DIT. Acknowledgements / The author wishes to recog- nize and thank the following individuals for their assistance and support: Drs. John Berk, Leon Dychter, Duane Spencer, Norman Sperber, Glenn Wagner, and James Wood. Also, Michael Ellano, Gretchen Geary, Robert Sutton, and the entire staff of the San Diego County Medical Examiner.
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Method of Dental Identification Forensic dental identification is most often accomplished by comparing the radiographs of the teeth of the decedent (postmortem) with the dental radi- ographs obtained from the dentist of the suspected victim (antemortem). Ideally, the antemortem radiographs furnished should be the original full mouth series. Often this is not the case. Children’s radi- ographs are typically bitewings only unless they have orthodontic records as well. Frequently, duplicate radiographs, rather than originals, are sent and they often have been either poorly duplicated and/or are not labeled right and left for
tooth, but also the morphology of the roots, pulpal chamber, and their rela- tionship to their surrounding structures (i.e. sinus proximity, mandibular canal proximity, interproximal bony trabec- ular patterns etc.). If dental restora- tions are added, the unique combina- tion for any given individual can factor into the millions. There are numerous important rea- sons for identifying the deceased.^5 A legal certification of death is necessary to consummate legal matters such as life insurance, wills, etc. There are fami- ly and personal reasons as well, includ- ing closure. In criminal investigations,
it became the largest fire in San Diego County’s history. Three days later, the Cedar Fire earned the distinction of being the largest fire in California’s his- tory consuming, more than 233, acres at an average of 6,000 acres per hour. 3 The fire overran the entire com- munity of Lake Cuyamaca, destroying 90 percent of the homes and devastat- ing the surrounding state park. On Wednesday, the fire headed back toward Julian to the north and Pine Valley to the east. The fire raged for several more days and was not fully contained until Nov. 16, 2003. The Cedar Fire ultimately burned more than 270,000 acres, destroying 2,232 homes. The fire was fought by 877 fire engines and 5,203 firefighters from 325 departments. 4 The fire claimed 15 victims, including a fire- fighter from Novato, Calif.
Purpose of Dental Identification Forensic dental identification spe- cialists typically are the last convention- al option for postmortem identification. DNA is also now utilized, but due to its high cost and the extensive time required for analysis, it is used sparingly or when no other option exists. This was seen recently in the identification of the remains of Laci Peterson, whose body was recovered headless and hand- less. Other forms of postmortem identi- fication include visual, personal effects, fingerprints, scars, marks, tattoos, and medical radiographs. Forensic dental identification has been successful because of the nature of the human dentition. Enamel is the hardest substance in the body and the only exposed portion of the skeletal sys- tem. Teeth are resistant to thermal dam- age and blunt force trauma. Therefore, the dentition remains stable during tis- sue decomposition. In addition, the dentition is unique to a specific individ- ual. This includes not only the mor- phology of the coronal portion of the
it is important to establish the identity of the victim in order to proceed with the criminal investigation and to iden- tify the suspect.^6 In a blaze such as the Cedar Fire, the bodies often are burned beyond visual recognition. Personal effects are also destroyed or lost in the fire. Even if the personal effects are recovered, they may not be considered reliable due to the typical calamity surround- ing a fire. A forensic anthropologist can examine the remains of the skele- tal system and often can determine age, race and sex of the victim. Positive identification is best per- formed by examination of the surviv- ing dentition by the forensic odontol- ogist. However, in cases such as the Cedar Fire, where the temperatures were at times very high (1000°C), even the dental remains may be destroyed. Crowns may fracture or explode leav- ing only the roots. The bone may also be completely consumed leaving only scattered roots with no bony sockets for reference.
orientation. In addition, the antemortem radiographic image may be of poor qual- ity due to improper operator technique (cone cuts, overlapping interproximals, elongation/foreshortening, etc,) or poor processing (contrast, burned images, etc.). When poor antemortem radi- ographs are compared to an ideal post- mortem radiograph, the two may not appear consistent. This could seriously hamper the identification effort. In forensic dental identification, it is emphasized that good quality, properly mounted and labeled original ante- mortem radiographs be sent for com- parison. In addition, copies of the vic- tim’s dental treatment progress notes should be submitted as well. This allows the forensic dentist to verify dental treatment that was performed subse- quent to the date of the radiographs.
Identification of the Cedar Fire Victims The majority of the Cedar Fire vic- tims died the first night in the Wildcat Canyon/Muth Valley area. This was
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Enamel is the hardest substance in the body and the only exposed portion of the skeletal system.
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dentist. While he no longer had any of his treatment records concerning the decedent, he did recall placing the bridge. The Mexican dentist signed a sworn affidavit at the U.S. Consulate in Tijuana, Mexico, certifying he placed the bridge five years earlier. Though this identification was not ideal, the medical examiner and the author had a high enough degree of confidence to com- plete this case.
Discussion Fire often plays a role in mass dis- asters, and the identification of the victims of the Cedar Fire once again illustrated the significant role forensic dental identification plays in a mass disaster. When one looks at the enor- mity of the Cedar Fire, the number of victims who perished could have been much greater if not for the heroic response of all emergency personnel. The author experienced these heroics firsthand the second night of the fire. Authorities instructed the author to evacuate his family to a safe area. The fire came within 300 yards of his resi- dence. During the evacuation, the author witnessed several neighboring homes burning on the hillside. Several
almost completely missing except for select posterior molars. It was fortunate that in both cases the antemortem radi- ographs furnished were complete full mouth series. Identifications were com- pleted for both. The author’s final dental identifi- cation of the fire victims was one that involved international cooperation. On a set of remains that was nearly fully cremated, the medical examiner investigator was able to recover some dental root fragments and a three-unit porcelain fused to metal bridge ( Figure 5 ). The victim’s family stated the dece- dent’s dental treatment was performed in Tijuana, Mexico. The medical exam- iner investigator spent nearly 10 weeks pursuing the leads in this case and finally was able to get the name of the decedent’s dentist in Mexico. Meanwhile, the author determined the bridge was a maxillary right posterior bridge with teeth Nos. 4 and 6 the abutments and No. 5 the pontic ( Figure 6 ). With the name of the Mexican den- tist, the author contacted Leon Dychter, DDS, chief forensic odontologist for the Courts of the State of Baja California, Mexico. Dychter met with the Mexican
Mexico after the last bitewing X-rays were taken, but the medical examiner investigator was unable to obtain any of those records. Fortunately, the local dentist also furnished copies of all the treatment progress charts. The dece- dent’s subsequent treatment performed in Mexico was extensive, e.g., multiple extractions, full mouth porcelain fused to metal crowns and long span bridge- work, ( Figure 4 ) and upon initial com- parison to the bitewings, it appeared the postmortem radiographs were not consistent with this individual, except for evidence on the bitewing of an endodontic fill on No. 13. In the treat- ment notes, the local dentist had previ- ously taken a full mouth series of radi- ographs. The author then contacted this dentist and he personally delivered the additional radiographs the same evening. The endodontic restoration was consistent and the identification was completed. This illustrates the importance of furnishing all the records on file. With the following two cases, the decedents had suffered very extensive thermal damage, again almost to com- plete cremation. Only a small portion of the cranium remained, the jaws were
Figure 5. The dental fragmented remains of a fire victim. The remains were almost fully cre- mated but a crown and a three-unit bridge remained intact.
Figure 6. The intact three-unit bridge which was used for the identification.
Figure 4. The resected jaws of a fire victim. Note the extensive crown and bridgework.
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patient records on file and continually update them, including the radi- ographs. The records may be needed for postmortem dental identification.
To request a printed copy of this article, please contact / Anthony R. Cardoza, DDS, 266-B Avocado Ave., El Cajon, Calif., 92020.
References / 1. Los Angeles Times Dec. 28, 2003, p A31.
2. Fisher MA, Paradise Lost, Readers Digest 102- 11, February 2004. 3. San Diego Union Tribune Oct. 29, 2003, p A1. 4. San Diego Union Tribune Jan. 29, 2004, p B8. 5. Standish SM, et al., Identification of Human Remains by Comparison of Frontal Sinus Radiographs: A series of four cases, J Forensic Sci 36(6):1765-72, November 1991. 6. Spencer DE, Berk JK, Identifying Fire Victims: The East Bay Fire Storm, J Calif Dent Assoc 20(2):52-7, 1992.
of the author’s patients, friends and colleagues lost their homes in the Cedar Fire. It is safe to say that every- one in this community was affected in some way.
Summary In conclusion, it is noted California is well represented with dentists experi- enced in forensic odontology. California has the highest number of certified forensic odontologists com- pared to other states in the nation. In addition, we now have the California Dental Identification Team as a statewide resource. To maximize the effectiveness of our forensic resources, it is important for practicing dentists to keep complete
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