Quality Assurance in Forensic Odonto-Stomatology

General

Quality assurance implies measures to ensure that work is performed to at least a minimum standard. The goal is that the quality should be improved by working with these standards. In the industry, where products can be tested and measured, this may be easier.

In dentistry and forensic work the products include a certain degree of individual assessment and art. Thus quality assurance in these fields is more difficult to define and to implement. It might even prevent general development and personal improvement if rules that are too rigid are set.

The following chapters attempt to suggest steps to be observed during casework and in the subsequent reports. Established protocols benefit both forensic odontologists and general dental practitioners, who are involved in forensic casework only from time to time.

Education in forensic odontology is often tutor based. This has many benefits but what you did not learn from your tutor, you may never consider important. IOFOS is the only world wide forensic odontology organization. In our opinion, we have a general responsibility for standards and especially to avoid large variations from one country to another.

IOFOS and Quality Assurance

During 2003 the executive of IOFOS drafted working procedures for quality assurance at an international level.

We then called for an international workshop at Hafjell , Norway ( March 11-14 2004 ). About 30 participants from most parts of the world attended this meeting and contributed additional suggestions. It was soon apparent that practices varied considerably. It also became evident that what is good practice in one country, may be impossible to implement in another. The only way to solve these problems was to separate recommended steps in two types.

1. Steps which should be applied in all cases (required)

2. Steps which may be optional and applied only in certain countries (recommended)

We are most grateful to all individual forensic odontologists for their time and effort at Hafjell to contribute to this extremely important international work.

After the meeting, the suggested steps of quality assurance were edited into a more logic sequence, taking into accounts most of the suggestions from the meeting. These drafts were then distributed to all presidents of the IOFOS member associations for comments. Those were incorporated, and further improvements were made by the executive of IOFOS.

Quality Assurance at three levels

The most basic level to ensure quality is to describe the various steps taken during an examination and evaluation. That is what we have attempted to do. At this stage it seems impossible to reach any further on an international level.

The next level is to describe which methods or examinations should be used at each step. Here the disagreements might be almost impossible to overcome. With a few exceptions, we have avoided this level. Perhaps these recommendations should be cleared for all second level descriptions. These may be easier to implement on a national level and ought to be explored for national quality assurance efforts.

The third level, which is usually where the industry works, is to describe what a quality result is. An example may be the exact measurement and within which limits it can be allowed to vary in a product. We doubt that we will ever be able to implement this level in forensic odontology.

These Quality Assurance recommendations

The recommendations are divided according to topics. However, we are aware that there are overlaps, for example in "identification" and "identification after disasters". We hope that these overlaps do not contradict each other.

It has been found necessary to divide the steps into two groups as indicated above. In this text steps which apply in all cases are marked black. If one of these is omitted an explanation is required.

Steps marked in blue are optional. If omitted, no explanation is required.

We also hope that the IOFOS recommendations will be accepted by the member societies. Their members will then be requested to follow the IOFOS quality assurance recommendations in their work. We also suggest that forensic odontologists state in their reports that the IOFOS recommendations for quality assurance have been adopted.

Quality improvement

Quality assurance should never be static but be reconsidered and if possible always improved. We in IOFOS think this is only the first step in the work for better quality of forensic odontology all around the world. We have thus suggested that the work and the recommendations are reconsidered from time to time. The first occasion will be in Hong Kong in connection with the IAFS meeting in August 2005. There we will in a special session again focus on the quality assurance of "Identification" only. We hope a number of interested colleagues will meet there and again give their contribution to world quality assurance in forensic odontology.

Finally we suggest that IOFOS executives initiate sessions for further improvements of other parts of these recommendations for quality assurance.

IOFOS Executive, December 2004

Tore Solheim (president), Sigrid Kvaal (vice-president and secretary), Leif Grusd (cashier), Wencke Stene-Johansen (editor)