1. Eur J Dent Educ 2006; 10: 137–141 Copyright ª Blackwell Munksgaard 2006
All rights reserved european journal of
Teaching forensic odontology: an opinion on its content
A. B. Acharya
Department of Forensic Odontology, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
Abstract Forensic odontology involves dentists’ participation in forensic science may be lacking. While recognising that these
assisting legal and criminal issues. Formal teaching in forensic programmes are not representative of teaching in forensic
odontology has existed for over a 100 years. Over the last odontology worldwide, suggestions are made for an alternative
century, forensic odontology has evolved and, today, it is approach to teaching the subject. Moreover, it is stressed that
an integral part of undergraduate dental training in many teaching be undertaken by qualiﬁed forensic odontologists.
countries. Dentists have been trained in the specialty, and
dedicated departments established in institutes and universities Key words: forensic odontology curriculum; undergraduate
around the world. A survey undertaken at ﬁve universities dental education.
revealed that these centres have developed detailed curricula
in forensic odontology, and a general standard exists in teaching ª Blackwell Munksgaard, 2006
forensic odontology, however, coverage of recent advances in Accepted for publication, 18 January 2006
during the 1950s and 1960s. The associated need for
Introduction formal training in forensic odontology and its inclu-
S ustained education and demand over the past
half-century has rendered forensic odontology a
valuable component of forensic investigations in many
sion in dental curricula, was recognised and acted on
in the 1960s and 1970s. The discipline had been
practiced by individuals much earlier than this and
countries. Forensic odontologists are routinely consul- the ﬁrst course in forensic dentistry was probably
ted for assistance in legal and criminal problems. conducted by Prof. Sadanori Mita of Japan as early as
Teivens and Mornstad, for example, have reported a
¨ 1903. The correspondence course outlined ‘methods of
steady increase in the number of forensic odontology examination, evaluation and classiﬁcation of bite
cases in recent years (1). Moreover, forensic odontol- marks and the differences between ante- and post-
ogy has made great strides in the last decade, ranging mortem appearances’ (6). This course subsequently
from two- to three-dimensional digital analysis of bite formed the basis of his lectures at Tokyo Dental
marks (2–4) to extracting DNA from teeth for the College between 1922 and 1936.
purpose of identiﬁcation (5). This is a reﬂection of Undergraduate forensic odontology education in
dentists’ willingness to contribute to the community in North America dates back to the early 1960s (7), while
ways other than preventive and therapeutic service. in the UK, it has been taught since the early 1970s (8).
However, in the wake of recent advances, it may be The ﬁrst postgraduate programme in forensic odon-
useful to re-examine the purpose, constituents and tology in the USA was conducted by the Armed Forces
approach of education in the forensic odontology. Institute of Pathology (9) in 1963, while in continental
Europe, a postgraduate course was ﬁrst offered in
Copenhagen in May 1979.
History of teaching forensic odontology
The application of dental sciences in criminal and legal
investigations gathered momentum in the West
The need to teach forensic odontology
The legendary Gosta Gustafson stated that ‘it is
*Guest lecture presented at the Third Annual Conference of the
essential…that a course in forensic odontology should
Indian Association of Forensic Odontology, Ragas Dental College, form part of the basic undergraduate curriculum’ (10).
Chennai, India on 19 December 2004. Salley (11) felt that knowledge of forensic odontology
among dentists is essential to better understand the (2) The dentition has long been used for estimating
intricacies and subtleties speciﬁc to forensic science age. In the ﬁrst half of 19th century the Factory Act
and criminal investigation. Dentists may be consulted of England prevented a child without the second
on occasion for assistance in post-mortem dental permanent molar from working in factories (14).
identiﬁcation, disaster victim identiﬁcation, age esti- The tables of Schour and Massler (15) and Gus-
mation and criminal cases involving bite mark evi- tafson’s method (16), two early scientiﬁc estima-
dence. Hence, the dental graduate should tors of age that utilised teeth, date back >50 years.
• have a wide-ranging knowledge of theoretical and (3) Anthropological examination of teeth can yield
practical aspects of forensic odontology; information useful in building the proﬁle of
• be reasonably competent to recognise forensic cases unidentiﬁed individuals, e.g. Lund and Mornstad¨
with dental applications when consulted by the (17) suggested that tooth measurements could
police, forensic pathologists, lawyers and associated indicate sex, while morphological features such as
professionals; Carabelli’s trait give clues to a person’s ethnicity.
• be capable of proper collection of dental evidence (4) Bite mark investigation is probably the most
related to cases of identiﬁcation, ethnic and sex challenging aspect of forensic odontology. Its
differentiation, age estimation and bite marks; judicious use can prove critical in sexual assault,
• be able to assist qualiﬁed forensic odontologists in homicide (Fig. 1) and other criminal investiga-
analysis, evaluation and presentation of dental facts tions.
within the realm of law. (5) Interpretation of ante-mortem dental records is a
Therefore, teaching forensic odontology to under- crucial part of dental identiﬁcation. The ability to
graduates should ensure that dentists are able to assist decipher terminologies, short-hands and notations
forensic investigations if, and when, the need arises. used by dentists from different parts of the world
is essential to successfully match the dental record
to the post-mortem data (18).
(6) To the general practitioner not used to the prac-
What are the constituents of forensic tical details of court procedures, the possibility of
odontology? testifying in court can be intimidating. Therefore,
What constitutes the curricular needs for teaching session(s) on the dentists’ role as an expert witness
forensic odontology? Described below are trends in and mock court trials (9) can be an invaluable
forensic odontology teaching at ﬁve universities from prelude to real-life situations.
different countries. Forensic odontologists at these (7) While the value of skull-face superimposition
institutions were asked to provide information on (Fig. 2) in identiﬁcation is debatable, it is a useful
curriculum content. The forensic odontologists were adjunct in identifying skeletal specimens in the
chosen for the survey on account of the author’s absence of ante-mortem dental records.
previous professional contact with them, and it is Topics such as dental record interpretation (5), the
recognised that this, in no way, represented an dentists’ role as an expert witness (6), and extra-oral
unbiased sample. Comparing these programmes, it is
obvious that a common framework exists in teaching
forensic odontology. Topics such as (1) post-mortem
dental identiﬁcation and disaster victim identiﬁcation,
(2) age estimation, (3) anthropology, and (4) bite mark
analysis, are covered in all the universities.
(1) Post-mortem dental identiﬁcation, which includes
identiﬁcation of decomposed, traumatised or
burned remains, is regarded as the most important
aspect of forensic odontology (12). In fact, the
genesis of modern forensic odontology could be
attributed to the use of dental evidence in identi-
fying victims of two European disasters of the 19th
century: the ﬁre at the Ring Theatre of Vienna in
Fig. 1. Bite mark on a homicide victim. (Reprinted from: Thali MJ
1881 which claimed 449 lives, and the Bazaar de la et al. Bite mark documentation and analysis: the forensic 3D/CAD
Charite ﬁre of Paris in 1897 that resulted in 127 supported photogrammetry approach. Forensic Sci Int. 2003; 135:
casualties (13). 115–21, with permission from Elsevier.)
3. Teaching forensic odontology
other aspects of forensic sciences, such as forensic
pathologists, toxicologists, anthropologists, photogra-
phers, lawyers and police, should be included since an
approach involving multidisciplinary interactions can
At Tokyo Dental College, Japan, a comprehensive
spectrum of subjects ranging from forensic medicine,
serology and molecular biology are included in ‘four-
teen 85-min lectures’ (K. Minaguchi, personal com-
munication). These delve into genetic markers from
blood cells, examination of body ﬂuids (which
includes salivary cell polymorphisms), age estimation
(from bone and skull), sex determination (from bone
and DNA) and population genetics. There is in-depth
coverage of DNA techniques. DNA analysis of saliva
and dental tissues can be crucial in bite mark analysis
and dental identiﬁcation, respectively, and it is felt
Fig. 2. Superimposition of a putative deceased’s photograph on an imperative that students are exposed to the basics of
unknown skull. (Reprinted from: Bilge Y et al. The identiﬁcation such procedures.
of a dismembered human body: a multidisciplinary approach.
Dental DNA analysis is covered brieﬂy under the
Forensic Sci Int, 2003: 137: 141–6, with permission from Elsevier.)
title ‘unconventional identiﬁcation’ at B.P. Koirala
Institute of Health Sciences, Nepal, where third year
dental undergraduates are taught forensic odontology
identiﬁcation methods such as skull-face superimpo- and forensic medicine. Forensic medicine makes up a
sition (7) are covered at the majority of the institutes. major component and, in addition to lectures (termed
In addition to these topics, speciﬁc aspects of ‘structured interactive session’ or SIS), include practi-
forensic odontology are emphasised in individual cal exercises in soft tissue examination, examination of
institutions. In the University of Oslo, Norway, as weapons, toxicology, injury report writing and autop-
many as ﬁve lectures and two 3-h seminars are sies. The philosophy behind teaching detailed forensic
devoted to dental jurisprudence and ethics (T. Sol- medicine to dental undergraduates is that dentists
heim, personal communication). In one of the semi- should be able to assist routine medico-legal cases,
nars, students are given cases where problems have particularly since some of this country’s regions are
occurred or could occur, and they discuss what they geographically isolated, with minimal health profes-
would do under such situations in their own practice. sionals available.
Recognising the need for forensic odontologists to Practical exercises in forensic odontology include
prepare injury reports, a lecture on dental injuries and post-mortem dental examination, simulated dental
a court case involving the same is organised. identiﬁcation and disaster victim identiﬁcation, radi-
Coverage of forensic odontology in the University of ographic age estimation, craniomandibular sex differ-
Adelaide, Australia, is brief, with a total of three ences, as well as bite mark evidence collection and
lectures in 5 years (H. James, personal communica- analysis. The latter makes use of two-dimensional
tion). There is, however, a substantial elective compo- digital analysis suggested by Johansen and Bowers (2),
nent in the ﬁfth year which lasts for 1 week and places making the exercise more exciting for students.
emphasis on court and legal procedures. The session Animal dentition and lip prints are also covered in
on expert evidence is complemented with a visit to Nepal. While some may be surprised at the inclusion
court. of animal dental patterns in forensic odontology, a
Most aspects of forensic odontology are covered in basic knowledge of comparative dental anatomy is
the University of Malaya, Malaysia (P. Nambiar, essential in investigating cases of animal bite marks.
personal communication). Of particular interest are This has great relevance in Nepal, particularly when
the lectures on animal dentition and lip prints (which frequent cases of carnivorous attacks on the fringes of
are commented on later). A lecture ‘structure of the nature may necessitate accurate identiﬁcation of
court system’ is taken by a lawyer attached to the the species or individual animal. The investigation of
attorney-general’s ofﬁce. In fact, some (19, 20) argue latent lip prints (Fig. 3) is analogous to ﬁngerprint
that special lectures which include professionals from analysis, and can be considered a genuine subspecialty
sciences, oral biology and occlusion dynamics. Topics
that require clinical acumen, such as interpretation of
dental records, post-mortem procedures, and radiog-
raphy methods (including post-mortem radiography
and radiographic age estimation) could be introduced
towards the latter stages of undergraduate training. In
countries which are yet to have forensic odontology as
a separate subject, and where specialty-based depart-
ments are still in existence, topics in forensic odontol-
ogy may be combined with other related dental
subjects, e.g. ethnic and sex differences in tooth
morphology as part of tooth morphology, radio-
graphic age estimation of children and adolescents
Fig. 3. Latent lip prints reproduced on a glass surface. (Reprinted
as part of paedodontics or orthodontics. However, it
from: Alvarez M et al. Persistent lipsticks and their lip prints: new has been emphasised that one department should
hidden evidence at the crime scene. Forensic Sci Int, 2000: 112: 41– have overall responsibility for teaching the course
7, with permission from Elsevier.) undertaken by dentists with specialist training and
adequate experience in the discipline (19, 23). It is,
of forensic odontology; however, a lack of routine therefore, not surprising that separate departments in
casework and research (21) seems to preclude its forensic odontology exist in most of the surveyed
detailed coverage. universities, with specialist forensic odontologists
While relevant aspects of forensic odontology are teaching the subject.
integral to the institutes surveyed, insufﬁcient cover-
age of DNA techniques in most of these institutes may
deprive students of exposure to frontier forensic
science. That stated it does not imply the non-
existence of institutes that teach these topics. The To maximise dental application in forensic cases, it is
author recognises that the institutes surveyed do not necessary to train dentists in the practical aspects of
necessarily represent their respective countries, and at forensic odontology. This necessitates exposing dental
least two of the specialists surveyed have indicated undergraduates to the basic principles and techniques
that the programmes are speciﬁc to their universities. of the subject. While this, in itself, does not ensure
competency, it will facilitate dentists to (1) recognise
forensic cases with dental implications; and (2) assist
forensic odontologists in routine casework. In his
How can forensic odontology be taught? summing up one of the ﬁrst cases in Britain which
It was considered that many concepts of forensic made use of dental evidence, Lord Grant said of
odontology resemble oral biology and that the forensic forensic odontology: ‘This is a relatively new science,
odontology curriculum could be modelled along this but there must of course be a ﬁrst time. Scientiﬁc
assumption (22), e.g. tooth morphology has applica- knowledge and medical knowledge advance as the
tion in sex and population determination, while the years go on…’ (24). Forensic odontology has evolved
chronology of dental development has forensic use in and its importance in police investigation is widely
age estimation. Alternatively, it was suggested that acknowledged by the general public and legal author-
forensic odontology should be taught only after ities (6). It is essential that the curriculum content is
students have been exposed to pathology, jurispru- constantly updated for the beneﬁt of the discipline and
dence, practice management and clinical dentistry the community it serves. This ensures that undergrad-
(19). While the different institutions surveyed in the uates are aware of new trends in the subject and also
present study teach forensic odontology at different enables more objective decision-making by prospect-
stages of undergraduate training, this author suggests ive post-graduates. It is stressed that the preceding
that topics such as anthropology, DNA polymor- forensic odontology curricula do not represent the
phisms, animal dentition, histological age estimation global norm. Hence, an in depth analysis of trends
techniques and bite mark analysis can be taught to in teaching forensic odontology is possible only
students during the early undergraduate years, since after undertaking a more comprehensive worldwide
these often require detailed knowledge of basic survey.
5. Teaching forensic odontology
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