NWD: While the focus of our discussion is what draws someone to become a forensic odontologist, we need to set the stage. Is that the correct term?

Both: Yes.

Dr. Rumreich: Forensic dentist also works.

Dr. Norrlander: I usually define it as Òthe art and science of dentistry applied to matters of the law.Ó

Dr. Rumreich: WeÕre talking about that application as used in the identification of individuals, examination and evaluation of injuries to oral structures, and examination and evaluation of bite marks that might occur in sexual assaults or personal defense situations.

Dr. Norrlander: Or pattern injuries in general Ñ trying to sort out what are bitemarks and what arenÕt. Some people also get involved in civil litigation, helping malpractice attorneys and assisting insurance companies in evaluating the legitimacy of claims against dentists. Tom and I donÕt do a lot of that, but some of our colleagues do. Another area is evaluation of child abuse cases.

NWD: What is the course of training?

Dr. Norrlander: ThatÕs really variable. The area of forensic dentistry is not recognized as a specialty by the ADA. While we are a specialty in the eyes of the Department of Justice and attorneys, there is no move to do that at the ADA simply because there is not enough need. Forensic odontology was actually boarded because the Department of Justice wanted to be able to ensure there would be people with a certain level of experience attorneys could call upon. In the mid-70s, they actively encouraged people in the American Academy of Forensic Sciences (AAFS) to set up the American Board of Forensic Odontology (ABFO), the American Board of Forensic Anthropology, and one or two more.

People from within the Academy put together the Board, which was a credentialing organization, in 1976. The ABFO currently has approximately 90 members from the U.S., Canada, and Puerto Rico.

In terms of education, because we are not recognized by the ADA, there are really no standard programs offering a MasterÕs in forensic odontology. Where that leaves us is a smattering of courses offered throughout the country. The Armed Forces Institute of Pathology offers a week-long course, as does the University of Texas/San Antonio. There are multiple- and single-day classes all over the country throughout the year.

As for getting practical experience, you have to become associated with a Medical Examiner (ME) or SheriffÕs office, and then do some cases. What really helps is to get a mentor of some sort. ThatÕs a difficult thing for a lot of people because many forensic odontologists are very territorial, and there is not that much work to go around. And, of course, the ME wants someone who knows what he or she is doing on a case.

Dr. Rumreich: For me, the most important aspect of the training is that one-to-one mentorship, and mine has been with Dr. Norrlander. Ann took me under her wing 15 years ago because I had expressed an interest in the work as we worked together in a group. That was fantastic training, and there is just no substitute for it.

Dr. Norrlander: Once you have all that under your belt and feel you have satisfied the requirements for the Board, you take the exam. You pass or fail. If you fail, you know what you have to do next. The problem there is there are few well-established textbooks on the subject so even putting together a comprehensive reading list is difficult. So you basically chart your course toward the test, attend meetings, read the literature, ask for help, and try to get as much practical experience as possible in your area of interest. 

The cases we get are all different: The victims are unidentified,or not readily identifiable. I have been involved in cases where there was no one locally I could talk to, but because of my involvement with the national organizations I could call people I knew had done the same or similar casework to get some suggestions. IÕm thinking specifically of an exhumation case. I was supposed to take impressions on the deceased because the police wanted to compare his teeth to a bitemark on an assault. I had never been present when they opened a casket, and I had no idea what to prepare for, even what to bring. I needed someone to ask, ÒCan you tell me what IÕm going to see?Ó One call to a friend prepared me: ÒThis aspect will be different, so plan to do this, this, and this.Ó When we did the Wellstone air crash, a friend in Chicago had worked with the same type of aircraft crash. He told me that type of plane burns very hot. That was invaluable; it was critical that I had talked with him so I could be properly equipped and prepared. [Pause] Just to be able to call someone and say ÒhelpÓ is so important. My friends in the community have gone out of their way to help me when I asked for it.

NWD: When and how did each of you become interested and involved? Where are you now within the specialty?

Dr. Rumreich: In 1986, Ann was heading up a group of dentists we called the Minnesota Disaster Team. Our objective was to train ourselves to be able to deal with a mass identification situation, such as an air crash or hotel fire or similar mass fatality, where remains are Òco-mingled,Ó probably burned, to the point where they cannot be readily identified. I found this so fascinating that I approached Ann. I knew she worked with the Hennepin and Ramsey County Medical ExaminersÕ offices, so I asked if I could tag along. Which I did for a couple of years, and then she turned me loose. ThatÕs where I am now. Most of our calls go through Ann, and if a case isnÕt one she can or wishes to do, it goes to me or to Dr. Ed Bick, the other forensic dentist who works in this area. I occasionally get involved in the bitemark cases. Recently, I had a case go to trial involving bitemarks on a six-week-old child who, it turned out, had been killed by her father. [Quiet]

Dr. Norrlander: Not easy cases.

NWD: Even as the most objective presentation of fact,it is breathtaking to hear these things. Ann, since you mentored Tom, we need to know how

you started. You seem to be the source of all forensics here. [Laughter]

Dr. Norrlander: In 1985, we had a situation in Reno, Nevada where a plane with a lot of Minnesotans on board went down. There was a call for records and information from family members. At that point, with a little nudging from my husband, I decided to contact the MEsÕ offices to see if they needed any help.

That crash was the real impetus for me. IÕd had a little exposure to forensics in dental school, but the idea of becoming involved was becoming increasingly interesting. I talked with Dr. McGee at the Ramsey County ME office, Dr. Garry Peterson at Hennepin, and then went to the Biomedical Library at the U and

did a search, coming up with lots of information including the American Society of Forensic Odontology. I called its president, Dr. Skip Sperber, who invited me to their national meeting.

Usually I am not too outgoing, but for those two days I just picked peopleÕs brains. I found out most everybody had a private practice and did this on the side, and that was reassuring. I got advice on how to talk to other people in forensics, where to acquire experience and classes to attend.

Back home, I went to see Dr. McGee. He actually had a case waiting there for me, so I did my first case. Funny thing, that is one of the only people I have never gotten identified. The case was a suicide. The man obviously wanted no one to identify him. There were no labels in his clothing, nothing on his person to give us any clue to where he came from or who he might be. He was found in an abandoned building next to some railroad tracks. We did a facial reconstruction, took every imaginable X-ray, entered it into every forum we had in law enforcement and the forensic community, and never got a hit. He was buried as, and remains, a John Doe.

At that time there was enough work for one person through the two county offices and police agencies. I lectured at the Bureau of Criminal Apprehension (BCA) and various police organizations, so I got my name out there, and authorities started calling me on other cases. Like any practice, one in forensic dentistry also builds slowly. Now with the growth of the area around Ramsey and Hennepin into Anoka, Dakota, Scott and more, we really cover the state. Cases from less affluent counties go into counties that have forensic pathologists to do the more complex forensic autopsies and therefore we are called to occasionally assist on identification issues.

Dr. Rumreich: WeÕve had a fair number of cases also come over from western Wisconsin.

Dr. Norrlander: A little from the Dakotas. I am the only board certified forensic odontologist in the state. Tom is pretty close to be able to challenge the examination. There are two boarded odontologists in Wisconsin, two in Illinois, none in the Dakotas. Then there is nobody west until Montana. But there are a lot on the coasts.

Dr. Rumreich: Ann does a lot of lecturing, and I supplement my forensic work with teaching. I teach forensic dentistry and photography to police detectives at Chippewa Valley Technical College in Wisconsin.

IÕve done a fair amount of crime scene photography. This started in 1995 with a class in ÒThe Medico-Legal Aspects of Death InvestigationÒ at the Miami/Dade Medical ExaminerÕs office. Their photography program is touted to be the best in the country. I took their two-week certification course Ñ absolutely fabulous. I met a number of police detectives who now bring me down once a year for a one-week internship on crime scenes. Proper photographs of evidence are absolutely essential if we are going to use photos in courtroom presentation.

Dr. Norrlander: Because we canÕt get involved on a case until called by the MEÕs office, we have to approach the casework kind of backwards. We need to make the various offices understand how much we can help them before the case becomes something they need us for. The same is true of forensic anthropologists, the people who examine the entire skeleton, estimating stature, gender, race,

even right- or left-handedness, for clues to cause of death.

Dr. Rumreich: We really do operate at the behest not only of the ME but also the legal system. For instance, if a police department wants impressions in a bitemark case, we canÕt do that until they get us a search warrant.

NWD: Do you keep a list, the number, of your cases?

Dr. Norrlander: I have a list in my basement... A number? In the hundreds for identifications; bitemark cases are much less frequent, probably 20 to 25, at all stages from ruling something out as a possible bitemark to going all the way to court.

Dr. Rumreich: IDs Ñ probably around 60. Six bitemark cases, but I have never had to testify. People think it is much more common than it really is.

NWD: What were your most memorable or instructive cases?

Dr. Norrlander: My initial case was the unidentified man. Second was an ID case that came in at Hennepin when I was observing autopsies, so they called me over. Because the victim was decomposed, the technicians had pushed the X-ray cassette under the unopened body bag, and without appropriately positioning the head. With superimposition of all the overlapping surfaces, it looked like there were a number of silver fillings, but I could tell these were just enamel surfaces overlapping. The antemortem records were of one with a lot of fillings; the victim had none. The victim was finally identified by fingerprints, but I kept them from interpreting the dental in a direction that would have potentially allowed the inexperienced residents to make incorrect assumptions.

Dr. Rumreich: This work takes so many unusual twists and turns. Last year Ramsey County had a case of an individual pulled from the river. They had a photo of who they thought it was. Both photo and body had virtually identical curly red hair in a receding hairline pattern. The antemortem films showed no wisdom teeth, but my X-rays on the deceased showed, you guessed it, four. It would be so easy to accept circumstantial evidence, but you canÕt, ever. Another complication is that often individuals in advanced states of decompostion are cremated. Once that occurs, the evidence is gone forever.

My first case was one Ann gave me. It was from Hennepin. A young man had set fire to the interior of his van, then shot himself. While the body was very badly burned, the case wasnÕt that difficult to do. The reason I recall it so vividly is that when I got home that night, my wife said, ÒWeÕre grilling ribs tonightÓ! And I said, ÒI donÕt think so.Ó And the work is just like that. Even the humor is unexpected.

NWD: What is your arrangement with the county offices today?

Dr. Norrlander: I am primarily the forensic odontologist for Hennepin and Ramsey Counties; I have a signed contract with the former and a verbal agreement with the latter. Tom works mostly with Ramsey, Ed Bick with Hennepin, both due to proximity, but each has occasionally worked with both offices. We are paid: Ramsey per case; Hennepin hourly. ItÕs not a lot of money, considering how much time it takes. Once a case goes beyond the MEÕs office, we bill on an hourly basis to attorneys, police departments, and private attornies.

NWD: What were your most high profile cases?

Dr. Rumreich: The abduction and murder of Katie Poirier by Donald Blum. It was a fascinating case. Before I even knew I would be involved on this case, I had gone on some of the search parties. And, of course, we didnÕt find her. But when Ann asked me to join her, that really wrapped me up in it. It was a very emotional case for me because I had met her parents during the search. That made the case more difficult for me. It was also my most interesting case, because there were so many experts from other specialities. The case developed over a yearÕs time. Periodically we would sit down with the BCA and the FBI to review evidence.

Dr. Norrlander: The questions we asked were: is there anything else we can look at, something weÕre missing, another test, another specialist. The reason I had Tom come in was because I really wanted another dentist looking at the evidence with me, someone to brainstorm with.

Dr. Rumreich: We would spend hours looking at those X-rays, wondering ÒIs there something else, something we havenÕt seen?Ó

I should mention the excellent charting that had been done by two of KatieÕs previous dentists. It was absolutely instrumental in giving us direction, and those dentists are to be complimented. You cannot overemphasize the importance of accurate charting and good X-rays.

Dr. Norrlander: While I was called initially, Tom arrived within the first couple of weeks. I never went to the scene, but I was called when they were excavating the fire pit. I first saw the tooth when an FBI agent brought it to my office. Then more fragments kept surfacing. Then more trips to the BCA, involvement with the forensic anthropologist, chemists at 3M and the BCA, and Dr. Jorge Perdigao, the nationally and internationally renowned dentin-bonding specialist at the U.

Dr. Rumreich: There were people who did spectography on the filling material...

Dr. Norrlander: This case involved the development of dental evidence greater than we are usually able to do. Typically our IDs are based solely on comparison of X-rays. Here we were able to carry examination to another level because

of the charting and all of the things that had been done to this tooth. Lots of different chemicals had been laid down, materials placed, and we were able to find evidence of all of them, going back years. We had just this one tooth, plus the fragments of other teeth and bone, and we had to make it speak. We were fortunate this tooth had that much work done on it.

NWD: When the trial resulted in a conviction, can I ask how the two of you felt?

Dr. Rumreich: I felt relief that this whole thing was over. We donÕt go into these situations trying to get somebody convicted. Our role was to determine whether or not this was the tooth of Katie Poirier. Aside from his confession, which he later recanted, I believe the tooth was the other primary reason he was convicted. I felt that we had done a darn good job analyzing the remains we had to work with, and I was proud of that. I believe we gave the jury the information they needed to make a proper decision.

Dr. Norrlander: As a forensic specialist in whatever field, all you are doing is trying to assist the trier of fact, be it jury or judge, in assessing all the information given them. You have to work carefully to try not to be biased in any way. With such a high profile case as this one, I didnÕt even read its newspaper coverage.

I wanted to keep myself unbiased.

My other high profile case was the Wellstone air crash, which I worked on with Ed Bick. Ed is now the head of our statewide Disaster Team, and he really needed to be there to experience an air crash firsthand. Here we dealt with co-mingled burned remains. We went to the scene in Eveleth to assist in recovery of remains. This was my first time for that.

NWD: LetÕs talk about the work itself. What are you looking at, and what are you looking for, when you examine evidence?

Dr. Norrlander: On the Wellstone case, we recovered at the scene, bagged everything, and brought it back. We were actually in one teeny little room, spilling over into a hallway where the autopsy room was Ñ all in a very small space up in Hibbing. They had the janitors add more curtains to keep passersby from watching us. But you work where you need to work. You take and handle X-rays pretty much the same way you do in your office. I try to keep remains out of my office at all costs. ItÕs not like the ÒCSIÓ on TV. Yes, Dr. Perdigao used his scanning electron microscope on the Poirier case, but most often itÕs your X-ray machine, viewbox, and camera. And then, your interpretation of the data you have collected. Then you produce a report for the ME or the attorneys Ñ the requesting authority. If your part goes to testimony, that is usually at the attorneysÕ request, by subpoena. That doesnÕt happen often Ñ IÕve testified in court in probably four ID cases.

As for what youÕre looking at and for, youÕre looking at teeth, either via X-ray or visual exam of the mouth, and at markings potentially made by teeth.

NWD: Within some history on the art and science of forensics, what are its goals?

Dr. Norrlander: The goals are to assist the trier of facts, to assist authorities to understand dentistry as it applies to a particular case. As a dentist, you have a piece of the puzzle.

The history in America dates to the Revolutionary War and Paul Revere, who did some dentistry. A General John Warren was killed at the Battle of Bunker Hill in Boston. He was stripped of all clothing and ID and buried. When the body was recovered, Paul Revere identified the General based on a gold wire bridge he had placed. There were a smattering of cases over the years, but it was in the last 40 to 50 that it came to the fore. Some of our practices and techniques have changed now with DNA testing, and our role may actually dwindle as DNA technology supplants the need for dentists to evaluate dental evidence.

Dr. Rumreich: When time is an issue, identifying an individual dentally is certainly more expeditious. DNA is definitely the method of choice for bitemarks because bitemarks are not as definitive as fingerprints.

NWD: What are the para-meters, the pressures, and the responsibilities of this kind of work?

Dr. Rumreich: I have found it difficult on occasion when doing an ID case to have a police officer leaning over my shoulder constantly asking, ÒIs it him?Ó Time is a pressure. Families, MEs, and law enforcement want answers. Working conditions arenÕt always the best: maggots, decomposition, things that donÕt

look very nice or smell very good. But do less than a complete job and the consequences of an error would be horrendous. And we need to come to conclusions that are irrespective of a desired or expected outcome by law enforcement.

Dr. Norrlander: There is a fatigue issue whether itÕs an extended case or multiple cases. You need to build into your system a way to double- and triple-check the evidence youÕre putting down. You need your colleagues looking over your shoulder to be sure everything is being noted correctly so that your conclusions will be based on correct evidence. It is your responsibility to make sure you have untainted accurate data.

NWD: What is the best part? What is the worst/most difficult?

Dr. Rumreich: For me, one of the most gratifying aspects is knowing there are people who trust us to do this work accurately knowing how horrible the consequences of a mistake would be. It feels good to know someone trusts me to make those decisions. It is a good feeling as well to know that you have come to a conclusion that is in some way going to be helpful to someone. It may not be what they want to hear, but it can bring closure. And there is no question it is interesting work.

Dr. Norrlander: For me, another best part is the relationships that have developed within the forensic community - not just dentists. I have found common ground with a larger group of friends and acquaintences. I have colleagues all over the country now, and they are a very supportive group of individuals.

Dr. Rumreich: We are privy to information not available to the general public, such as meeting the O.J. Simpson case investigators. The exchange of information is just incredible.

NWD: How do you handle this work emotionally?

Dr. Norrlander: The worst cases for me involve the death of a child, a helpless individual, or walking into the post room in the morgue and seeing someone my own age, my own circumstances... Those are the cases that haunt you. Both Tom and I have very supportive families Ñ you lose yourself in your family. And you can always talk to your friends in the forensic community. Tom and I certainly talked during the Poirier case about psychological issues. You really have to have somebody who knows what you are going through to understand fully what it

is youÕre dealing with. ItÕs a very strong connection.

Dr. Rumreich: For me, the child abuse cases are the most troublesome, especially where the child is deceased. I am asked to photograph cases where the child is not deceased and those are even a little harder for me, because the child more often than not is going to go right back to the situation he or she has just come from. The injuries these children present are absolutely horrific Ñ more than just bitemarks. There was a child who wouldnÕt stop crying, so her mother poured pepper down her throat. She died from it.

NWD: What kind of a commitment is this?

Dr. Norrlander: ItÕs so variable. ThatÕs why itÕs good to have more than one of us who do this. In a court situation, you are at the mercy of the court and that can cause havoc with your office schedule, but at least you donÕt get called in the middle of the night, usually.

Dr. Rumreich: Now that IÕm retired, at least I donÕt have patients to reschedule. But that too is part of the commitment, as is your commitment to pursuing every detail of the case before you come to a conclusion. Cases that look obvious from the beginning are the ones that will throw you. It takes some resilience to get psyched up and stay psyched up for each part of it.

NWD: For people who might be interested, offer some advice.

Dr. Rumreich: People need to go into this with the understanding there is very little actual work available. Joining the organizations Ann mentioned is essential. YouÕll have access to all that information and experience. We also find that the MEs are doing more and more of their own dental identification of late. This is a bit problematic for us. This is something I just donÕt feel they should be doing. The recognition of the dental restorations and the comparisions post- and antemortem cannot be done accurately from the type of X-rays they generally are using. As we see more composite and fewer metallic restorations, these identifications are going to get pretty doggone difficult.

Dr. Norrlander: The American Society of Forensic Odontology is the entry level organization. It includes the full range of interest and experience. Anyone can join; you donÕt even have to have a dental background. It costs about $40 a year. The next level is the Odontology Section of the AAFS. For the Academy you need the credential of working for and being affiliated with a law enforcement agency. For the Odontology Section you need a D.D.S. or D.M.D. from an accredited school. Next is the American Board of Forensic Odontology, individuals involved in forensic odontology who have met a certain level of expertise and experience, proved by casework and exams. So there is a structure of various supportive organizations, but you will evolve within it as your experience dictates.

NWD: This field brings together such differing elements. How does it all

add up?

Dr. Norrlander: ThatÕs true. It is a fascinating area and one I have always enjoyed, although there are certainly aspects I donÕt like. I like a good mystery, being involved in these cases, and meeting the people who are also involved.

Dr. Rumreich: It is incredibly fascinating because things arenÕt always what they seem to be. One of the greatest benefits has been to meet people who are truly famous in their respective fields of expertise in the forensic sciences: criminology, pathology, anthropology...

Dr. Norrlander: But it isnÕt romantic.

Dr. Rumreich: [laughs] It has brought a small change in the rules of our household. When I come home from work in the morgue, all clothing has to be left in the garage. [Ann laughs]  

Dr. Norrlander: And my daughter insists I take a shower!