|Year : 2017 | Volume
| Issue : 1 | Page : 17-21
Applications of forensic odontology in pediatric dentistry: A brief communication
Pradnya J Dongre1, Raju Umaji Patil1, Sameer S Patil2
1 Department of Pedodontics and Preventive Dentistry, STES, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
2 Department of Orthodontics and Dentofacial Orthopedics, STES, Sinhgad Dental College and Hospital, Pune, Maharashtra, India
|Date of Web Publication||2-May-2017|
Raju Umaji Patil
Department of Pedodontics and Preventive dentistry, STES Sinhgad Dental College and Hospital, S. No. 44/1 Vadgaon (Bk), Off Sinhgad Road, Pune - 411 041, Maharashtra
Source of Support: None, Conflict of Interest: None
Forensic odontology is the application of dentistry to law and delineates the overlap between dental and legal professions. Pedodontist plays an important role in forensic odontology by applying his expertise in various fields such as accidental or nonaccidental oral trauma, child abuse and neglect, age determination, dental records, and mass disasters by examination of the teeth and jaws structure for clues. These dental findings/records may be helpful in forensic identification wherein an unidentified individual can be identified using dentition. Information of teeth record remains throughout life and beyond, due to their physiologic variations, pathology, and effects of therapy. Lip prints and palatal rugae patterns can also lead us to important information and help in person's identification. Teeth can also help in determining gender of the skeletonized remains using dental DNA. Forensic odontology also plays role in crime investigation caused by dentition, such as bite marks. Odontologist can help physician in evaluation of bite marks due to abuse. The aim of this article is to discuss the role of pedodontist in various aspects of forensic odontology and procedures needed for examination, identification, and investigations of bite marks.
Keywords: Age estimation, bite marks, forensic dentistry, forensic identification, pedodontist role
|How to cite this article:|
Dongre PJ, Patil RU, Patil SS. Applications of forensic odontology in pediatric dentistry: A brief communication. J Dent Allied Sci 2017;6:17-21
|How to cite this URL:|
Dongre PJ, Patil RU, Patil SS. Applications of forensic odontology in pediatric dentistry: A brief communication. J Dent Allied Sci [serial online] 2017 [cited 2017 Aug 17];6:17-21. Available from: http://www.jdas.in/text.asp?2017/6/1/17/205443
| Introduction|| |
Forensic is derived from a Latin word “forensis” which means “before the forum,” a place where legal matters are discussed. According to FDI, Forensic Dentistry is defined as a branch of dentistry which, in the interest of justice, deals with the proper handling and examination of dental evidence, and with proper evaluation and representation of dental findings. Dr. Oscar Amoedo is called as father of forensic odontology. He wrote first dissertation entitled “L'ArtDentaire en Legale” in 1898. This book was the first comprehensive text on forensic odontology. Today forensic odontology has evolved as separate specialty which relies on knowledge of teeth and jaws, dental anatomy, histology, radiography, pathology, dental materials, and developmental anomalies. Forensic identification is multidisciplinary team work that involves law enforcement officials, forensic anthropologists, forensic dentists, forensic pathologists, criminalists, serologists, and other specialists. The teams help establish diseased identity, cause of death, factors contributing to death, and time of death.
| Role Of Pedodontist|| |
Forensic odontology utilizes dentistry to identify human remains and bite marks, using both physical and biological dental evidence. Pedodontist can play important role in identification of bite marks. Dental trauma is a common finding in children which may be caused due to sports, accidents, or abuse. Thus, proper knowledge and its application is utmost important. Pediatric dentist can help in the investigations of legal officers by implementing his expertise in recognition of signs and symptoms of child abuse and identification of such victims. Furthermore, pedodontist can furnish worthy information to physicians about oral and dental manifestations of child abuse and neglect. Proper recording of dental findings is also important step in management of dental records. As child undergoes continuous physiological changes, every finding should be recorded in detail. The dental record is a legal document owned by a dentist. All the entries should be signed by recording personnel. Changes in the record should not be erased. They should be corrected with a single line drawn through the incorrect material. This will permit the original entry to remain readable. Dental records of pediatric patient should be retained until the patient reaches the age of maturity. In case of adults, the records should be kept for 7–10 years. Dental record includes various clinical tests, laboratory tests, study casts, prosthesis, photographs, and radiographs. Pedodontist is usually concerned with antemortem record maintenance which may later be useful in dental identification.
| Dental Identification|| |
Tooth is one of the most indestructible structures and usually resistant to postmortem decomposition. Human dentition is never same in two individuals. Morphology and arrangement vary from person to person. Thus, teeth are consider more unique and have been used as cornerstone in positive identification of living or diseased person. Dental impressions can serve as invaluable tool because they are more unique than DNA. Same genetic makeup is shared by identical twins, but their impressions differ. Most materials used in dentistry are also resistant to postmortem decomposition. Dental evidence is helpful in identity of badly burned, traumatized, decomposed, or skeletonized remains and in mass disasters.
The postmortem dental remains are compared to antemortem dental records to confirm the identity. Due to less restorative therapy and radiographic indications, no or minimal comparable data may be available in children below 5 years of age. Normal maturational changes may alter the dental records. Even if no filling exists or treatment need is low, bitewing radiographs are almost always a part of dental record if the child has reached the age of 5–6 years. Comparative identification includes oral autopsies such as removal of tongue and contents of floor of mouth in tunneling fashion to obtain postmortem radiographs or records. There are separate post- and ante-mortem units as a part of identification team.
This is considered when virtually no clue exists about the identity of the decedent. This is also termed as “dental profiling”, which attempts to elicit ethnicity, race, sex, and age of dead individual.
Because of human diversity, several nonmetric features such as shovelling, Carabelli's trait, three cusped maxillary second molar, mandibular molar groove pattern, and four cusped mandibular molars can be helpful in eliciting the ethnic origin by their presence or absence. Several features must be considered together before concluding ethnic origin.
Methods of sex determination using teeth are depicted in [Table 1]. In young adults, mesiodistal and buccolingual dimensions are important in sex determination. Canine exhibits greatest sexual dimorphism because it is highly resistant to disease and postmortem insults. Dental index (mandibular canine index [MCI]) had shown 86% of success rate in sex determination. It is measured by calculating mesiodistal mandibular canine crown width and mandibular canine width. The standard MCI value is 0.274. Higher MCI value indicates male and lower value indicates female.
Barr bodies remain stored in dehydrated pulp till 1 year. These are inactive X chromosome found in female somatic cell. Barr bodies show sexual diagnostic characteristics when heated up to 100°C for 1 h. [Figure 1] shows the presence of Barr bodies.
DNA analysis for the presence or absence of Y chromatin is definitive method of determining sex. Advance methods include use of AMEL gene and polymerase chain reaction (PCR). AMEL gene codes for “amelogenin” a major matrix protein secreted by ameloblasts. This gene is located on X- and Y-chromosomes. Females will show two identical AMEL genes while as males show two nonidentical genes. DNA amplification by PCR gives 100% success in sex determination.
Estimation by skeletal means/craniofacial structures such as long bones, closure of fontanelle/sutures, and ossification of hand-wrist bones, and mandibular features can be used in age estimation as enumerated in [Table 2].
Age assessment in prenatal, neonatal, and early postnatal period can be very accurate due to various events taking place such as primary tooth germ formation, deciduous teeth enamel formation completion, and permanent first molar formation. Neonatal line is termed as indicator of birth. The presence of neonatal line indicates a live birth. However, false result can be obtained as it takes around 3 weeks after birth to form. It has legal implications in feticide and infanticide.
In children and adolescents, tooth eruption and tooth calcification, these events are important in age estimation. Convenient clinical method and can be assessed visually and radiographically, helpful in observation for several years, and not altered by local factors. Modified Demirjian's method uses the development of mandibular teeth on the left side divided into eight stages each.
The regression formula given below for age determination in Indian children was formulated by Acharya.
Male age = 27.4351− (0.0097 × S 2) + (0.000089 × S 3)
Female age = 23.7288− (0.0088 × S 2) + (0.000085 × S 3)
Gustafson's method is used in adults includes various events such as attrition (A), secondary dentin deposition (S), loss of periodontal attachment (P), cementum apposition at the root apex (C), root resorption at the apex (R), and dentine translucency (T).
Acellular cementum incremental lines are used in age estimation. Mineralized unstained cross-sections of teeth are used. This method gives accuracy to within 2–3 years of actual age. Hypomineralized bands in the incremental line indicate pregnancy, skeletal trauma, and renal disorders which can be related to person's life history, facilitating identification. [Figure 2] shows incremental lines.
Amino acid racemization is used as biochemical indicator of age. Aspartic acid has a rapid rate of racemization (high in root dentin). It gets spontaneously converted from one type (L-aspartic acid) to another (D-aspartic acid) with increasing age. Thus, there is a constant change in the ratio of L- and D-aspartic acid at different ages. This D/L ratio may be used for age estimation. This method estimates age within ± 3 years of actual age.
| Dental Dna for Identification|| |
DNA has a greater likelihood of survival than fingerprints, scars, and facial appearance. DNA serves as a basis of all blood group types, red cell antigens, and protein isoenzymes. Teeth are an excellent source of DNA. Rich sources are odontoblasts, peripheral nerves, fibroblasts, undifferentiated mesenchymal cells, endothelial cells, and nucleated components of blood in pulpal soft tissue. Dental DNA helps in identification and can be collected by tooth sectioning, tooth crushing, or cryogenic grinding technique.
| Palatal Rugae Pattern|| |
“Palatal Rugoscopy” can be an ideal parameter for identification because rugae do not undergo any change except in length. These can also resist decomposition to an extent. They remain in same position throughout entire life of a person and reappear after trauma or surgery. These can be taken as unique to an individual. [Figure 3] shows different rugae patterns depicted on cast.
| Lip Prints|| |
Study of lip prints is termed as “cheiloscopy.” Lip prints are said to be permanent and unchangeable. Identification of pattern is possible from 6th week of intrauterine life. These can serve as important evidence left at crime scene. Disadvantages are major trauma to lips result in scarring. Surgical treatment also affects the size and shape of lips. Prints may differ in appearance depending on pressure applied or direction.
| Crime Investigation|| |
Forensic odontologist has a vital role in crime investigation. Preservation of dental records and proper storage of evidences for further investigations should be done. Crime investigation includes bite marks and child abuse.
| Bite Marks|| |
Apart from identification, forensic odontology is also applied in investigation of crimes caused by dentition such as bite marks. McDonald defines bite mark as “a mark caused by the teeth either alone or in combination with other mouth parts.” Bite marks can be found on injured tissue or an inanimate material such as foodstuffs. These may accurately depict the unique pattern of biter's teeth. Bite marks are often associated with violent fights, child abuse, sex crimes, or sporting events. They can be self-inflicted and can be collected at the scene of crime from foodstuffs or fruits, etc. Pedodontist should meticulously observe and document bite marks and are encouraged to be knowledgeable about such findings and their significance.
Bite marks appearance
Initially, indentations are seen due to the pressure applied by teeth. Soon these indentations disappear due to elasticity of skin and edema occurs over the bite area. The edema usually obscures the bite marks completely. When edema subsides subcutaneous bleeding is apparent as contusions or bruises. When the bite intensity is more lacerations can be seen. Avulsion is the most extreme form where part of tissue is bitten off.
Identification of the injury as a human bite mark
A deciduous dentition bite mark consists of smaller, rounded, bow-like arches with smaller teeth, and spacing between them. Grossly bite marks appear circular/elliptical with central ecchymosis. Classical features/appearance of incisors (rectangular marks), canines (triangular/rectangular), molars, and premolar (spherical/point) differ from each other. Individual features such as fractures, rotations, and spacing can be helpful to identification. A classical bite mark consists of oval or circular mark consisting of two opposing arcades, separated by a small open space at their bases, diameter of 25–40 mm, central bruising and clear tooth marks, and dental characteristics that may give high evidentiary value. [Figure 4] shows typical human bite mark.
Bite mark investigation
Following confirmation of the injury as a bite mark further investigation should include collection of evidence from the victim and records from the suspect. Dental record for bite mark includes photography, impression, models, and saliva swab collection. Photographs should be taken first as it does not affect any other recording such as impressions and taking swabs. Two types of photographs are to be taken, orientation and a close-up view. Photographs should be taken daily for 3 days for documentations. Polyvinyl Siloxane impression should be made for bite mark immediately after swabbing it.
Bite mark analysis
Recognition of uncommon characteristics of bite mark helps in accurate identification. Intercanine distance method is usually recorded for recognition of a child's dentition to an adult dentition as the distances <30 mm belong to a child and a distance above that to an adult. Other methods such as odontometric triangle method and comparison technique can also be used (i.e., comparison of bite mark measurements with suspect's impression models). Direct comparison can be carried by placing suspect's model on the bite mark. In indirect method, suspect's model is traced onto clear acetate and compared with photographs. Computer software programs can also be used for comparison.
| Conclusion|| |
Several studies have demonstrated that wide variations exist in shape, size, structure, form, cusp locations/projections, such as talon, of teeth, and variations exist even in facial profile and chin relations which are unique to individuals. Dental records of such clues are most commonly used in identification. American Academy of Pediatric Dentistry recommends the establishment of dental home, where clinical data are gathered, stored, and updated routinely. Such provision for data helps in identification of missing/deceased children. A pediatric dentist plays an important role in bite marks analysis, injuries, and child abuse. Pedodontist is concerned with the proper management, examination, evaluation, and preservation of child dental evidence in criminal or civil legal proceedings in the interest of justice.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]