1B. Rai, J. Kaur, Evidence-Based Forensic Dentistry,DOI 10.1007/978-3-642-28994-1_1, © Springer-Verlag Berlin Heidelberg 2...
2 1 Forensic Odontology: History, Scope, and Limitations1.2 History (Frness 1970; Keiser-Neilsen 1968, 1980; Valerieand So...
31.6 Age Assessmentdeath and not affected by adverse conditions. Thebasic principles of dental identification are thoseof c...
4 1 Forensic Odontology: History, Scope, and Limitations18, but both are unpredictable. Advanced tech-niques like aspartic...
51.11 Cheiloscopy and Palatoscopysuperimposition of skeletal and teeth fractures incases of identification. This technique ...
6 1 Forensic Odontology: History, Scope, and Limitationspatterns are preserved. Once the palatal rugae areformed, they do ...
7ReferencesFrness J (1970) Cited in forensic odontology, report of BDAWinter Scientific meeting. Br Dent J 130(4):161–162Ga...
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Evidence based forensic dentistry


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Evidence based forensic dentistry

  1. 1. 1B. Rai, J. Kaur, Evidence-Based Forensic Dentistry,DOI 10.1007/978-3-642-28994-1_1, © Springer-Verlag Berlin Heidelberg 20131Contents1.1 Introduction................................................. 11.2 History.......................................................... 21.3 Dental Identification ................................... 21.4 Dental Record as a Legal Document ......... 31.5 Mass Disaster Identification....................... 31.6 Age Assessment............................................ 31.7 Bite Mark Evidence..................................... 41.8 Child Abuse.................................................. 41.9 Facial Reconstructionand Superimposition................................... 41.10 Sex Determination....................................... 51.11 Cheiloscopy and Palatoscopy..................... 51.12 DNA Profiling.............................................. 61.13 Limitations of Forensic Odontology.......... 6References............................................................... 61.1 IntroductionForensic odontology involves the correct col-lection, management, interpretation, evaluation,and presentation of dental evidence for criminalor civil legal proceedings: a combination ofvarious aspects of the dental, scientific, andlegal professions (Hinchliffe 2011). Forensicdentistry may be defined as the specializedbranch of dentistry that applies dental knowl-edge to civil and criminal problems. The JBRGroup in forensic odontology, India (leader andfounder, Dr. Balwant Rai) has simply expandedthis definition to include the unique needs of theforensic odontologist in medicolegal and otherservices. While it is true that the primary mis-sion is to support requests for aid in forensicdental identification, we must understand thatdental identification is only one of a number ofmajor areas in forensic dentistry. These includedental identification, age estimation, sex deter-mination, cheiloscopy and palatoscopy, molec-ular biomarkers, bite mark analysis, humanabuse and neglect, dental malpractice and negli-gence, and dental anthropology and archaeol-ogy. The forensic odontologist helps legalauthorities by examining dental evidence in dif-ferent conditions. The subject can be roughlydivided into three major fields of activity: civilor noncriminal, criminal, and research (Cameronand Sims 1974).Forensic Odontology: History,Scope, and Limitations
  2. 2. 2 1 Forensic Odontology: History, Scope, and Limitations1.2 History (Frness 1970; Keiser-Neilsen 1968, 1980; Valerieand Souviron 1984)The establishment of forensic odontology as aunique discipline has been attributed to Dr. OscarAmoedo (considered the father of forensic odon-tology), who identified the victims of a fireaccident in Paris, France, in 1898. The followingtimeline highlights key moments in the history offorensic odontology:1453: First reported case of dentalidentification: The Earl of Shrewsbury, whofell in the Battle of Castillon, was identified.1775: Dr. Paul Revere, the first forensic odon-tologist, identified the remains of a victim basedon the retrieval of a prosthesis he hadconstructed.1849: The first conviction based on dental evi-dence occurred; the evidence was crowns fromcharred remains of the victim.1850: In Boston, Dr. John Webster was con-victed of murder based on dental evidence. Hewas later hanged.1884: R. Reid, a dentist, read an importantpaper to the British Dental Association meet-ing in Edinburgh about the applications ofdental science in the detection of crime.1887: Godon in Paris recommended the use ofteeth in the identification of missing persons,depending on accurate records being kept bydentists.1897: One hundred twenty-six Parisian social-ites were burned to death in a few minutes inthe Bazar de la Charité. At the request of theconsul, who knew many of victims, Dr. O.Amoedo (a Cuban dentist who worked inParis), aided by two French dentists, Drs.Devenport and Brault, examined and identifiedmany of the bodies. This incident was pub-lished as the first text in forensics dentistry ona mass disaster.1898: Dr. Amoedo wrote his thesis on thevalue of dentistry in medicolegal affairs; he isuniversally recognized as the father of foren-sic odontology.1932: Edmond Locard recommended the useof lip prints in identification.1937: A murder trial ended in a convictionbased on bite mark evidence for the first time.1946: Welty and Glasgow devised a comput-erized program to sort 500 dental records.1963: Hands, eyes, ears, scalps, and filledteeth had been removed after death to concealtheir identity by J. Taylor.1967: Linda Peacock had a bite mark alongwith other evidence that led to a young man’smurder conviction.1967: According to Keiser-Nielsen (1967),forensic dentistry is defined as the “proper han-dling and examination of the dental evidence, inthe interests of justice, so that the dental findingmay be properly presented and evaluated.”1972/1973: The International ReferenceOrganization in Forensic Medicine andSciences (I.N.F.O.R.M.) published a compen-dium of 1,016 references concerning dentalidentification and forensic odontology com-piled diligently by Dr. William and coveringover 120 years.1973: The basic practice of forensic odontol-ogy has changed little except that advances indental materials and laboratory techniques andimprovements in scientific and photographictechnology have established proof and presen-tationmuchclosertoforensicscienceasdefinedby Harvey. Harvey demonstrate that the factthat the external physical appearance of bite-marks changed with time, and the causativefactors precipitating these changes were largelyunknown. It will be examined later that the dra-matic realization of the possible value of bitemarks has assumed a great importance inidentification in the last 10 years.1.3 Dental IdentificationDental identification assumes a main role in theidentification of remains when there are postmor-temchanges,tissueinjury,andalackoffingerprintsor other identifying methods. The identification ofdental remains is of key significance in caseswhere the deceased person is decomposed, skele-tonized, or burned. The main advantage of dentalevidence is that it is frequently preserved after
  3. 3. 31.6 Age Assessmentdeath and not affected by adverse conditions. Thebasic principles of dental identification are thoseof comparison, of exclusion, and of making aprofile (Rai et al. 2006; Spitz 1993). In spite of themethod used to identify a individual, the results ofthe comparison of antemortem and postmortemdata lead to one of these four conditions (AmericanBoard of Forensic Odontology 1986):1. Positive identification: Comparable items aresufficiently distinct in the antemortem andpostmortem databases; no major differencesare analyzed.2. Possible identification: Commonalities existamong the comparable items in the antemortemand postmortem databases, but enough infor-mation is missing from either source to preventthe establishment of a positive identification.3. Insufficientidentificationevidence:Insufficientsupportive evidence is available for compari-son and definitive identification, but the sus-pected identity of the decedent cannot be ruledout. The identification is then deemedinconclusive.4. Exclusion: Unexplainable discrepancies existamong comparable items in the antemortemand postmortem databases. Sometimesexplainable discrepancies are present, such aschanges in restorations related to the passageof time, avulsion of a tooth or teeth second-ary to the trauma at the time of death, or addi-tional treatments by a second party that werenot registered in the antemortem record. Inall these cases, the discrepancies can beexplained and identification can still bemade.1.4 Dental Record as a LegalDocumentThe dental record is a legal document owned bythe dentist and all dental professionals and con-sists of subjective and objective informationabout the patient. It contains a physical examina-tion of the dentition and supporting oral and sur-rounding structures, results of clinical laboratorytests, study casts, photographs, and radiographs.It should be kept for 5–30 years. Correctionsin the record should not be erased, just cor-rected with a single line drawn through theincorrect material. Computer-generated (i.e.,digital) dental records are becoming morecommon for dental records. Thus, proper den-tal documentation is needed for forensicodontology.1.5 Mass Disaster IdentificationDifferent mass accidents form the majority of casesin which dental identifications are required, mainlyaircraft accidents, fires in and collapse of heavilyoccupied buildings, among others. The forensicodontologist is generally a member of the investi-gating team, the composition of which variesdepending on the nature of the disaster. Usually,teeth and restorations are resistant to heat if they areexposed directly to flame. Preservation is thereforepossible in most cases (Rai and Anand 2007a).Dental identification has been consideredone of the main members of the INTERPOL(INTERPOL 2008) disaster victim identificationprotocol. The orodental structures and dentalrestorations may be the only parts of the bodynot affected. The definite establishment of iden-tity of a body essentially comes from a detailedcomparison and matching of tangible antemor-tem records and postmortem findings. It is rarelythe case that the two match in all aspects, sosome judgment is required.1.6 Age Assessment (Rai et al.2009, 2010; Willems 2001)There are a number of medicolegal reasons andcriminal cases necessitating the estimation of anindividual’s age. Orodental structures can pro-vide useful indicators as to the individual’schronological age. The age of children can bedetermined by the examination of tooth devel-opment and a subsequent comparison withdevelopment charts, usually to an accuracy ofapproximately 2.3 years. The use of attrition andthe development of third molars have been sug-gested as means of aging those individuals over
  4. 4. 4 1 Forensic Odontology: History, Scope, and Limitations18, but both are unpredictable. Advanced tech-niques like aspartic acid racemization and trans-lucent dentine have been proposed and haveproven to be highly accurate in adult ageassessment.1.7 Bite Mark EvidenceBite mark evidence may be present in cases ofsexual or physical assault by an adult on a child;in rapes or attempted rapes, where bites are likelyto be noted on the breasts; in violence betweenhomosexuals; and in family or domestic violence(Pretty and Sweet 2000; Sweet and Pretty 2001).The marks, single or multiple in nature, may be ofvarying degrees of severity, ranging from a mildmarking of the tissues to a deep perforation of theepidermis and dermis, and may be found onbreasts, face/head, abdomen, shoulders, upperextremities, buttocks, female genitalia, male geni-talia, legs, ear, nose, and neck (Pretty and Sweet2000; Sweet and Pretty 2001; Vale and Noguchi1983). Its examination is the one aspect of foren-sic odontology requiring an immediate responseby the forensic odontologist. Sometimes nonhu-man bite injuries are found on victims. Animalbites are usually distinguished from human biteinjuries (Fig. 1.1) by differences in arch align-ments and specific tooth morphology. Dog bites,perhaps the most common nonhuman bite, arecharacterized by a narrow anterior dental arch andconsist of deep tooth wounds over a small area.Cat bites are small and round, with pointed cuspidtooth impressions caused by the conical shape ofthese teeth (Spitz 1993). As the introduction ofmolecular biology to dental identifications, theuse of DNA in bite mark cases was found in aneffort to eliminate the subjectivity associated withconventional analysis (Pretty and Sweet 2000).1.8 Child AbuseAbuse of a child by a caretaker is defined asphysical force that is outside the acceptable normof child care. The head and facial areas are regu-larly injured in such cases (Ambrose 1989).Human bite marks are often seen in abuse cases,frequently attended by other injuries. Thosefound in infants tend to be on different locationsfrom those in older children or adolescents, andthis is unclear because most injuries to childrenresult from punitive measures. The marks may beovoid or semicircular.1.9 Facial Reconstructionand SuperimpositionIf the postmortem profile does not obtain theprovisional identity of the deceased, it may beimportant to reconstruct the person’s appearanceduring life. This is the responsibility of forensicartists and forensic odontologists, who utilizethe dental parameters to aid with facial recon-struction (Gatliff 1984) (Fig. 1.2). Antemortemphotographs have been used to allow facialFig. 1.1 Bite marks
  5. 5. 51.11 Cheiloscopy and Palatoscopysuperimposition of skeletal and teeth fractures incases of identification. This technique requiresthe availability of appropriate antemortem pho-tographs that show views of the individual’steeth (Austin-Smith and Maples 1994).1.10 Sex DeterminationThe dimorphism of the canines, the mandibularcanine index, and the BR (Balwant Rai) formulahave been used as valid tools in the forensic andlegal identification of an individual (Rai et al.2004). Different molecular techniques have beenused for sex determination from teeth. Sex deter-mination from pulpal tissue depends on the pres-ence or absence of an X-chromosome. Sexdetermination from human tooth pulp in individ-uals is possible up to a period of 4 weeks afterdeath. But teeth can also serve as an excellentsource of genetic material, and nonrestored teethare even more appropriate for DNA analysis thanrestored teeth (da Silva et al. 2007).1.11 Cheiloscopy and Palatoscopy(Caldas et al. 2007; Rai andAnand 2007b)Lip prints (Fig. 1.3) and palatal rugae patterns(Fig. 1.4) are considered to be unique to an indi-vidual and hence hold potential for identifying anindividual. Cheiloscopy is appropriate in identi-fying the living, since lip prints are usually left atcrime scenes and can provide a direct link to thesuspect. Palatal rugae, also called plica palatinaetransverse and rugae palatine, refer to the ridgeson the anterior part of the palatal mucosa, eachside of the median palatal raphe and behind theincisive papilla. Catastrophic accidents involvingplane crashes, fires, and explosions can destroythe fingerprints, but, interestingly, palatal rugaeFig. 1.2 Facial reconstructionFig. 1.3 Lip prints
  6. 6. 6 1 Forensic Odontology: History, Scope, and Limitationspatterns are preserved. Once the palatal rugae areformed, they do not undergo any changes exceptin length, due to normal growth, remaining in thesame position throughout an entire person’s life.They help in the identification of an individual.1.12 DNA Profiling(da Silva et al. 2007)Different biological materials may be employedfor the isolation of DNA to be used in laboratorytests for human identification, including teeth,bone tissue, hair bulbs, biopsy samples, saliva,blood, and other body tissues. Many varied tech-niques were applied to identify thousands of vic-tims of the 2004 South Asian tsunami disaster,such as forensic pathology, forensic dentistry,DNA profiling, and fingerprinting.1.13 Limitations of ForensicOdontologyAlthough there are few shortcomings associatedwith the various methods used in forensic odon-tology, the inconsistencies associated with themare to be weighed cautiously to make forensicodontology a more accurate, reliable, and repro-ducible investigatory science.1. Palatal rugae cannot be used in cases of edentu-lous mouths, when antemortem records are notavailable, when palatal pathology exists, andwith fire, decomposition, and skeletonizationsince the palatal rugae are often destroyed.2. Lip prints cannot be used 20 h after the time ofdeath, with lip pathologies like mucocele andclefts, or with any postsurgical alteration ofthe lips, scars, etc.3. Bite marks cannot be used 3 days after the timeof death or with a decomposed or burned body.4. Errors may develop while taking radiographsand photographs, resulting in low-quality doc-uments. Errors may develop in sample collec-tion, processing, and interpretation. Anybacterial contamination and another person’sDNA can alter the interpretation.ConclusionsThe contribution of a forensic odontologist inmedicolegal proceedings can be of greatimportance.ReferencesAmbrose JB (1989) Orofacial signs of child abuse andneglect: a dental perspective. Pediatrician16(3–4):188–192American Board of Forensic Odontology (1986)Guidelines for bite mark analysis. J Am Dent Assoc112(3):383–386Austin-Smith D, Maples WR (1994) The reliability ofskull/photograph superimposition in individualidentification. J Forensic Sci 39(2):446–455Caldas IM, Magalhães T, Afonso A (2007) Establishingidentity using cheiloscopy and palatoscopy. ForensicSci Int 165:1–9Cameron JM, Sims BG (1974) Forensic dentistry.Churchill Livingstone, Edinburghda Silva RHA, Sales-Peres A, de Oliveira RN, de OliveiraFT, Sales-Peres SH (2007) Use of DNA technology inforensic dentistry. J Appl Oral Sci 15:156–161Fig. 1.4 Palatal rugae patterns
  7. 7. 7ReferencesFrness J (1970) Cited in forensic odontology, report of BDAWinter Scientific meeting. Br Dent J 130(4):161–162Gatliff BP (1984) Facial sculpture on the skull foridentification. Am J Forensic Med Pathol 5(4):327–332Hinchliffe J (2011) Forensic odontology, part 1. Dentalidentification. Br Dent J 210(5):219–224Interpol (2008) Disaster victim identification. http://www.interpol.int/Public/DisasterVictim/default.asp.Accessed on 3/6/2010Keiser-Nielsen S (1967) Editorial, News Letter. ScandSoc For Odont 1:4Keiser-Neilsen S (1968) Forensic odontology. Int Dent J18(3):668–681Keiser-Neilsen S (1980) Person identification by means ofteeth. John Wright & Sons, BristolPretty IA, Sweet D (2000) Anatomical location of bite-marks and associated findings in 101 cases from theUnited States. J Forensic Sci 45(4):812–814Rai B and Anand SC (2007a) Role of forensic odontologyin tsunami disasters. Int J Forensic Sci 2(1). DOI:10.5580/1c28. http://www. ispub.com/journal/the-internet-journal-of-forensic-science/volume-2-number-1/role-of-forensic-odontology-in-tsunami-disasters.html.Accessed on 6/6/2010Rai B, Anand SC (2007b) Palatal rugae: in forensicexamination. Indian Int J Forensic Med Toxicol 5(1):14–16Rai B, Narula SC, Madan M, Dhatterwal SK (2004)Evidence of teeth in sex determination. Med LegUpdate 4(4):119–126Rai B, Anand SC, Dhattarwal SK, James H (2006) Thevalue of dental record in identification. Ind Med Gaz104(1):89–100Rai B, Kaur J, Anand SC (2009) Mandibular third molardevelopment staging to chronologic age and sex inNorth Indian children and young adults. J ForensicOdontostomatol 27(2):45–54Rai B, Kaur J, Cingolani M, Ferrante L, Cameriere R(2010) Age estimation in children by measurement ofopen apices in teeth: an Indian formula. Int J LegalMed 124(3):237–241Spitz WU (1993) Spitz and Fischer’s medicolegal investi-gation of death: guidelines for the application ofpathology of crime investigation. Charles C. Thomas,SpringfieldSweet D, Pretty IA (2001) A look at forensic den-tistry—part 2: teeth as weapons of violence—identification of bitemark perpetrators. Br Dent J190(8):415–418Vale GL, Noguchi TT (1983) Anatomical distribution ofhuman bite marks in a series of 67 cases. J ForensicSci 28(1):61–69Valerie JR, Souviron RR (1984) Dusting and lifting thebite prints. A new technique, 1984. J Forensic Sci19:326–330Willems G (2001) A review of the most commonly useddental age estimation techniques. J Forensic Odontos-tomatol 19(1):9–17