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  • 1. Eur J Dent Educ 2006; 10: 137–141 Copyright ª Blackwell Munksgaard 2006 All rights reserved european journal of Dental Education Teaching forensic odontology: an opinion on its content and format* 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 137
  • 2. Acharya 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.) 138
  • 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 be useful. 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 139
  • 4. Acharya 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 Conclusion 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. 140
  • 5. Teaching forensic odontology Acknowledgements 12. Levine LL. Forensic odontology: identification by dental means. Aust Dent J 1977: 22: 481. The author wishes to thank Tore Solheim, Kiyoshi 13. Gustafson G. Forensic odontology. Aust Dent J 1962: 7: Minaguchi, Phrabakaran Nambiar and Helen James 293–303. 14. Saunders E. The teeth a test of age, considered with for providing the forensic odontology content at their reference to the factory children. London: H Renshaw; respective institutes. Many thanks to Dr Jane Taylor of 1837. Cited in: Demirjian A. Dentition. In: Falkner F, the University of Newcastle, Australia, for her valu- Tanner JM, eds. Human growth 2: postnatal growth. New York: Plenum Press, 1978: 413–444. able suggestions on the content and language of the 15. Schour I, Massler M. Studies in tooth development. The manuscript. Most of the literature cited below is growth pattern of human teeth. J Am Dent Assoc 1940: archived in the Forensic Odontology Unit, Faculty of 27: 1918–1931. Dentistry, University of Adelaide, Australia, to which 16. Gustafson G. Age determination on teeth. J Am Dent Assoc 1950: 41: 45–54. the author obtained access during his post-graduate 17. Lund H, Mornstad H. Gender determination by odonto- ¨ study. metrics in a Swedish population. J Forensic Odontoto- matol 1999: 17: 30–34. 18. Clark DH. Dental record interpretation. In: Clark DH, ed. Practical forensic odontology. Oxford: Butterworth-Hein- References emann, 1992: 101–110. 19. Herschaft EE, Rasmussen RH. Model curriculum for 1. Teivens A, Mornstad H. Ten years of forensic odontol- ¨ forensic dentistry in US dental schools. J Am Dent Assoc ogy: a report from the department of forensic odontol- 1979: 99: 21–26. ogy, Stockholm, Sweden. J Forensic Odontostomatol 20. Fulton PR. Deontology and forensic odontology. In: 1992: 10: 50–57. Proceedings of the Michigan Dental Association 121st 2. Johansen RJ, Bowers CM. Digital analysis of bite mark Annual Meeting 1978, 15–18 April; Detroit, MI, USA. evidence using AdobeÒ PhotoshopÒ. Santa Barbara, CA: 21. Ball J. The current status of lip prints and their use for Forensic Imaging Services, 2000. identification. J Forensic Odontostomatol 2002: 20: 3. Sweet D, Parhar M, Wood RE. Computer-based produc- 43–46. tion of bite mark comparison overlays. J Forensic Sci 22. Adams D, Cooke BE. The teaching of oral biology. Brit 1998: 43: 1050–1055. Dent J. 1970 Sep;129(5):209–10. Cited in: Whittaker DK. 4. Thali MJ, Braun M, Markwalder TH et al. Bite mark The teaching of forensic odontology to the undergradu- documentation and analysis: the forensic 3D/CAD sup- ate. Br Dent J 1971: 131: 199–200. ported photogrammetry approach. Forensic Sci Int 2003: 23. Pedersen PO. Forensic dentistry in Denmark. Dent Mag 135: 115–121. Oral Top 1965: 82: 105–107. 5. Sweet D, Hildebrand D, Phillips D. Identification of a 24. Furness J. Forensic odontology. Community Health skeleton using DNA from teeth and a PAP smear. (Bristol) 1972: 4: 14–22. J Forensic Sci 1999: 44: 630–633. 6. Suzuki K. The history of forensic odontology in Japan. Forensic Sci Int 1996: 80: 33–38. Address: 7. Gardner DG, Kenny DJ. Forensic odontology in Canada. Ashith B. Acharya J Can Dent Assoc 1971: 37: 299–304. Department of Oral Pathology 8. Whittaker DK. The teaching of forensic odontology to the S.D.M College of Dental Sciences and Hospital undergraduate. Br Dent J 1971: 131: 199–200. Dhavalanagar 9. Johanson G, Drinnan AJ, Keiser-Nielson S. Education in Sattur forensic odontology. Int Dent J 1981: 31: 6–13. Dharwad – 580009 10. Gustafson G. Research, organisation and teaching in Karnataka forensic odontology. Proc R Soc Med 1958: 51: 1055– India 1057. 11. Salley JJ. Forensic dentistry in the United States. Dent Tel: +91 836 246 8142 Abstr. 1968 Aug; 13(8): 458. Cited in: Pullon PA and Fax: +91 836 246 7612 Gantner GE. Teaching forensic odontology in a dental e-mail: school. Forensic Sci 1974: 4: 201–206. 141