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The two worlds of Dr. Shirley Miranda

Dr. Shirley Miranda

Dr. Shirley Miranda, assistant professor in public health sciences

Photo by Steven Doll

The completion of a fellowship in forensic odontology is the latest step in this public health sciences faculty member’s unique career path

The acceptance letter came a week after Dr. Shirley Miranda joined the faculty at Texas A&M Health Science Center Baylor College of Dentistry. Her professional activities then took on a new dimension when she entered the Fellowship in Forensic Odontology at the University of Texas Health Science Center – San Antonio.

Every two months for the past two years, she has begun a week in one of TAMHSC-BCD’s bustling clinics or off-campus clinical rotation sites, then jumped in the car at the end of a Wednesday workday for a five-hour road trip to San Antonio. There, along with two other fellows, she has spent Thursday through Sunday poring over closed case reports, learning bite mark analysis and refining her expertise in victim identification and age estimation.

Miranda — who also holds a certificate in pediatric dentistry and a master’s degree in dental public health — has been intrigued by forensic dentistry for more than a decade. Her latest academic credentials add a beneficial thread to the fabric of her career experiences.

Mastering transition

This assistant professor in public health sciences spends most workdays supervising sealant program visits within the Dallas and Richardson school districts, staffing the Vickery Meadow clinic or juvenile detention center, providing preventive consults, and supervising and teaching dental students.

A co-worker’s
professional opinion

Dr. Brent Hutson, associate professor in restorative sciences and director of clinical fixed prosthodontics, works for the Collin County Medical Examiner’s office and recognizes the challenges associated with forensic odontology.

“Very few medical examiners’ offices staff a full-time forensic dentist,” Hutson says. “So as a part-time, on-call consultant, these calls usually come at the most inopportune time and usually involve high-profile cases where the results are needed quickly.”

Plus, adds Hutson, it can take several years to desensitize the mind to the stimuli encountered in forensic dentistry.

“Often, it is very sad and disturbing to see what mankind can do to one another. … It’s important to keep focused on the science,” he says.

He’s talked with Dr. Shirley Miranda throughout her fellowship and, when needed, has provided help and encouragement.

 “At times the program and training can be overwhelming, but Dr. Miranda has maintained a wonderful attitude,” Hutson says. “She is the perfect person to work in the forensic dentistry field.”

During the long weekends spent in the fellowship, however, Miranda’s days were markedly different. First thing Thursday morning, Miranda and her cohorts received a schedule outlining the weekend. If faculty gave presentations in the mornings, afternoons were spent analyzing case records or improving bite-mark analysis skills.

“They would tell us, ‘Here are the records, you guys work on the case. You have three hours. From that, tell us what you’ve learned and defend yourself,’” Miranda recalls.

By Sunday, the impact of those cases would set in, and Miranda’s return drive to Dallas on miles of open road proved therapeutic. “That would help a lot, because I would be analyzing and reanalyzing all the cases I encountered.” 

Once home, she would watch TV with her family as a way to unwind. On the agenda: definitely not “CSI: Crime Scene Investigation” or “Law & Order Special Victims Unit.”

“I don’t usually watch those shows, because sometimes it can get depressing. It works on your mind,” Miranda says, adding how real-life cases tend to be much more complicated.

“Plus, it can contaminate your way of analyzing a case, since they are definitely not scientific as portrayed.”

Now that those bimonthly fellowship weekends are over, Miranda plans to start working cases and gaining experience at the Tarrant County Medical Examiner’s District. On evenings and weekends, she’ll likely shadow cases, perform biopsies and build her case experience.

The ultimate goal is certification from the American Board of Forensic Odontology, which requires several years of case work, plus the experience of testifying in a courtroom setting before challenging the board. 

Pulling it all together

Miranda’s interest in forensics dates back to when she was still living in India, where she received her dental degree.

“When I graduated in the mid-’90s, I was interested in forensics because it’s such a different field,” says Miranda. “It’s like putting a puzzle together.”

But at the time, very few, if any, schools in India had a primarily focused forensic dentistry program.

So she went to Boston, and it was there, as a pediatric dentistry resident, that Miranda’s interest increased. She was learning about child abuse and ways dentists can recognize and document its signs.

“Our faculty always said, ‘You have to look at the child as a whole,’” Miranda says. “That stuck with me.”

For instance, bite marks on a child may be completely innocent, perhaps received from an unruly preschool classmate. But sometimes documentation of a rotated tooth, bite marks, even bruising may prove invaluable to police or medical examiners.

“That happens a lot. They’ll say, ‘Did you not see anything?’ Being in the pediatric field pulled me more into forensics,” Miranda says.

“If you have a rotated tooth or a crossbite, put it down. Even if there is a bruise on a knee, ask and document.”

—Dr. Shirley Miranda

She meshed the two subjects recently for her fellowship research project, which she presented Feb. 24 to an audience of nearly 200 forensic specialists at the American Academy of Forensic Sciences’ 2012 Annual Meeting in Atlanta.

Miranda started her research by methodically contacting Texas dentists listed in the American Academy of Pediatric Dentistry directory. The goal of her research: to get a better feel for how pediatric dentists document signs of child abuse – like bite marks, bruises or dental irregularities – and how well versed they are at recognizing bite marks.

“I noticed a lot of dentists who were under-reporting for various reasons,” says Miranda, whose research also delves into ways dentists can protect themselves while reporting possible child abuse.

Back at the Vickery Meadow clinic and the juvenile detention center, she tries to stress documentation to her dental students.

“If you have a rotated tooth or a crossbite, put it down,” Miranda tells them. “Even if there is a bruise on a knee, ask and document.

“They (students) all know how to do a filling and a crown. Sometimes it’s the other aspect everyone tends to overlook.”

Getting accustomed to the courtroom

“We were given a case six months in advance, and we had to research the suspects and the crime committed against the victim,” says Dr. Shirley Miranda, assistant professor in public health sciences.

During a retreat to a faculty mentor’s cabin in Colorado, she and the two other fellows had to testify in mock trial sessions. The day before each session, each of them found out if they would represent the defense or prosecution, with their instructors acting as judge.

“That was really intimidating. They put us in a real case scenario where we would be on the stand,” she says. “It was no laughing matter. It was very serious.”

Even the fellows’ résumés were called into question, as attorneys from the opposing side will try to discredit expert witnesses.

“Putting us on the stand forces us to think, ‘How will we answer the questions?’” says Miranda.

“And before making an accusatory statement,” she adds, “would I be this sure if the suspect was my mother or a loved family member?”