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 Table of Contents  
FORENSIC ODONTOLOGY: ORIGINAL ARTICLE
Year : 2019  |  Volume : 31  |  Issue : 3  |  Page : 239-245

Knowledge, awareness and practice of forensic odontology among the dentists of Punjab


1 Department of Oral Medicine and Radiology, BJS Dental College, Hospital and Research Institute, Sarabha, Ludhiana, Punjab, India
2 Department of Conservative Dentistry and Endodontics, SKSS Dental College and Hospital, Sarabha, Ludhiana, Punjab, India
3 Department of Oral Medicine and Radiology, BJS Dental College, Hospital and Research Institute, Ludhiana, Punjab, India

Date of Submission21-May-2019
Date of Acceptance21-Jun-2019
Date of Web Publication30-Sep-2019

Correspondence Address:
Dr. Damanpreet Kaur Isher
Department of Oral Medicine and Radiology, BJS Dental College, Hospital and Research Institute, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_108_19

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   Abstract 


Introduction: Forensic odontology involves application of dental sciences in the identification of deceased individuals through comparison of ante-mortem and post-mortem records. Forensic odontology plays an important role in criminal, monetary disputes, marital, social, and burial and the identification of individuals missing for prolonged periods. Aim: To study knowledge, awareness, attitude, and practice of forensic odontology among the dentists of Punjab. Materials and Methods: A questionnaire based cross-sectional survey that included a total of 15 questions was conducted on 644 subjects of Punjab state which were further divided on the basis of their degree as undergraduate and postgraduate students, BDS and MDS dental practitioners. These were further categorized into urban and rural dentists. Results: In our study, the general awareness about forensic odontology is more among the undergraduates than postgraduates of Punjab. Overall, there is lack of adequate knowledge, awareness, and practice of forensic odontology among the dentists of Punjab. However, the practitioners did have a positive attitude toward the field and were keen to learn more about it. Conclusion: Conducted on 644 dentists of Punjab, this study reflects the current situation of Punjab in the field of forensic odontology. It also reveals significant lack of record maintenance, inadequate knowledge, poor attitude, and lack of practice prevailing among these study subjects of Punjab. This condition can be improved if necessary steps are taken to make forensic odontology a part of our course and need more exposure from practical point of view.

Keywords: Dentition, disputes, forensic odontology, identification


How to cite this article:
Isher DK, Singh Isher PP, Kaur N, Rakhra J. Knowledge, awareness and practice of forensic odontology among the dentists of Punjab. J Indian Acad Oral Med Radiol 2019;31:239-45

How to cite this URL:
Isher DK, Singh Isher PP, Kaur N, Rakhra J. Knowledge, awareness and practice of forensic odontology among the dentists of Punjab. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2019 Oct 14];31:239-45. Available from: http://www.jiaomr.in/text.asp?2019/31/3/239/268270




   Introduction Top


Forensic odontology as defined by the FDI is that branch of dentistry which in the interest of justice deals with the proper handling and examination of dental evidence and proper evaluation and presentation of dental findings.[1] Forensic is derived from the Latin word forum, which means Court of Law.[2] It involves application of dentistry in the identification of deceased individuals through comparison of ante-mortem and post- mortem records.[1]

From AD 66 till date, dental identification has proved vital in identifying deceased individuals, the first case being accepted by law in the year 1849.[3] The first case of identification using dentition, in India, was that of King Canouj, Jayachandra Rathore in 1911, who died in a war and his body was recognized by his false anterior teeth.[4] The various materials used in the identification of human remains involve things like pieces of clothing, jewellery, finger prints, blood grouping, and dentition.[2]

Forensic odontology plays an important part in criminal, marital, monetary, social, burial disputes, and identification of individuals missing for a prolonged period of time.[5] Identification is important in civil cases like insurance claims, matrimonial and property disputes, impersonation and issue of passports and licenses.[6] Despite leaps in modern technology and medical breakthrough during the last century, our society is faced with challenges in every known area. Violence, natural calamities, and disasters shatter and disrupt the lives of innumerable individuals each day. Identification of individuals at the crime site and disasters by the dentist through dental records assists those involved in the investigation. But lack of adequate knowledge and training in forensic odontology among the dentists is a major setback in achieving this goal.[7]

The important applications of forensic odontology include identification of human remains through dental records and assisting at the scene of criminal activity; in case of suspected child or adult abuse through bite marks or physical injuries; determination of age and gender and testify as an expert in the court of law.[3] Dental identification plays a significant task in the identification of human remains when post-mortem alterations, such as traumatic injury, occur to such an extent rendering the mutilation of the body to such an extent that fingerprints cannot be recorded. In cases of manmade catastrophes and natural disasters, dental records conform as useful tools in identifying the individual bodies mutilated beyond recognition.[8]

Human dentition is considered as hard tissue analog to the fingerprints. It is almost as unique to an individual as fingerprints.[2] The identification of remains by dental evidence is possible because, the hard tissues are preserved after death and can even withstand a temperature of 1600°Cwhen heated without appreciable loss of microstructure. The status of a person's tooth changes throughout the life and combination of decay, missing, filling (DMF Teeth Criteria) can be obtained from any fixed time.[9]

The question always arises as to whether the dental practitioner should know about forensic odontology, the reason being that dental identification provides an accurate source of identification of the victim or the suspect.[2] Unfortunately, in India, experience among the dentists regarding forensic sciences is still insufficient.[8] This may be due to lack of proper awareness; neither the government nor the people have completely understood the role that can be played by the forensic dentist in settling the disputes and identification of individuals.

Hence, the present study was conducted to assess the knowledge, awareness, attitude, practice, and career preferences in the field of forensic odontology among the dentists of Punjab.


   Materials and Methods Top


Objective

A cross-sectional study was conducted to determine the knowledge and awareness of forensic odontology among the dentists in the rural and urban areas of Punjab.

Selection criteria for study

Selection for study was done on the basis of following inclusion criteria-

  1. UG students, BDS, PG students, MDS were included in the study.
  2. Subjects were included from both urban and rural areas of Punjab.


  • A total of 738 dentists in the urban and rural areas of Punjab were approached out of which 644 of them responded back with complete questionnaires. The incomplete questionnaires were excluded.
  • The study was conducted over a period of 6 months. The approval for the study was taken from the ethical community of Baba Jaswant Singh Dental College and Research Centre, Ludhiana; Punjab.


Questionnaire

  1. A self-administered, well-structured questionnaire written in English language with both open and closed end questions was prepared.


  2. A pilot assessment was done on 15 dental practitioners to ensure the lucidity and appropriateness of the questions. This panel of 15 dentists was excluded from the study.


  3. Most of the contributors found the questionnaire to be uncomplicated and precise.
  4. The questionnaire consisted of 15 questions dealing with-


    • Patient dental record maintenance and its importance.
    • Attitude and knowledge of dentists toward forensic odontology.
    • Career preferences of dentists in the field of forensic odontology.


  5. All the participants were asked to respond to each item. Confidentiality and ambiguity of contributors was ensured and taken responsibility of.


1. Have you ever studied about forensic odontology? [Graph 1]



YES

NO

2. Do you have knowledge about-[Graph 2]



  • Bite mark pattern YES/NO
  • Identification in mass disasters YES/NO
  • Physical abuse of a child YES/NO
  • Examination of a tooth for dental age YES/NO
  • Gender examination of a deceased YES/NO


3. Do you preserve dental records of the patients? [Graph 3]





YES

NO

4. Do you have an organized methodology for preserving dental records and for how many years? [Graph 4]





YES

NO

If YES, _______ Years?

5. Would you agree to share your patient's record data with fellow dentists and government agencies without hesitation? [Graph 5]





YES

NO

6. Are you aware that a dentist can substantiate as an expert witness in court? [Graph 6]





YES

NO

7. Are you versed with the legal issues associated with forensic dentistry? [Graph 7]





YES

NO

8. Are you aware of any criminal case in India which has been identified by the virtue of forensic odontology? [Graph 8]





YES

NO

9. Do you think you can handle a forensic case with the contemporary knowledge you have? [Graph 9]





YES

NO

10. How would you enhance your knowledge about forensic dentistry? [Graph 10]





_____________________________________________

11. Do you think forensic odontology should be included as an independent subject in undergraduate courses? [Graph 11]





YES

NO

12. Would you be keen to pursue forensic odontology as a career option for life? [Graph 12]





YES

NO

13. Do you know of any recognized institutions in India offering courses in forensic odontology? [Graph 13]





YES

NO

14. Do you agree that the horizon of forensic odontology will grow in India in forthcoming years? [Graph 14]





YES

NO

15. Would you suggest the recruitment of forensic dentists for jobs by the Indian government? [Graph 15]





YES

NO


   Results Top


Data analysis

The results have been shown in the graphs 1-15 which were analyzed statistically by using Analysis of variance test, T-test, Chi-square test.

P value was calculated for all the results of the study. P value ≤0.05 was considered as the level of significance.


   Discussion Top


Forensic odontology is a challenging and fascinating branch of forensic medicine.[10] Forensic odontology may be defined as the specialized branch of dentistry that applies dental knowledge to civil and criminal problems.[11] The significance of forensic dentistry can be attributed to the ability of the dental tissues to withstand environmental assaults and still retain some of its original structure.[8] Tooth is the hardest tissue in human body that is extremely resistant to physical and chemical changes. Thus, they are the best repositories for DNA in the human body.[12]

The focus of our study was to analyze the awareness, knowledge, and practice of forensic dentistry amongst the dentists of Punjab.

According to our study, the ratio of contributors who have studied forensic odontology is highest amongst the UG students followed by MDS and PG students and BDS. This may be because DCI has made forensic odontology a mandatory year-end examination subject (as a part of oral pathology and oral medicine/radiology) in revised Bachelor of Dental Surgery (BDS) curriculum of 2007.[13]

Dental clinicians, as other healthcare professionals are at the forefront in spotting the signs of violence appearing on their patients. The dentist should be aware of child, elderly, or spousal abuse and bite marks when confronted with unusual oral injuries, especially in cases of persons with accompanying body injuries. Abusive trauma to the face and mouth includes fractured anterior teeth, missing or displaced teeth, fractures of the maxilla and mandible, laceration of labial frenum, bruised or scarred lips, face and neck.[1] Kenney and Clark have cited numerous researches that suggest approximately 50% of injury in child abuse cases occur in the oral and perioral region.[14] From legal point of view, matching of the bite marks produced on human tissues to a suspect's dentition may enable law enforcers to implicate the suspect in the crime case.[2] According to our study, PG students presented better level of knowledge and skill to identify the physical abuse of a child followed by UG students, MDS graduates and BDS graduates. This may be because PG students are pursuing specialized study which puts them at a greater par theoretically as well as practically to study and encounter abused child patients in the clinics.

Age is one of the essential factors in establishing the identity of a person. Estimation of the human age is a procedure adopted by anthropologists, archaeologists, and forensic scientists. This has helped forensic odontologists to solve cases in countries abroad, and could similarly play a very important role in solving cases in India.[3] According to the present study nearly 26% of BDS graduates did not know how to estimate the dental age by examining the teeth. The reasons for this could be lack of basic knowledge and confidence in answering this question and also, ignorance toward the significance of dental age in forensic odontology. These findings were in contrary to the Preethi et al. study where nearly half of the dental practitioners did not know how to estimate the dental age.[3]

Bite mark analysis is one aspect of forensic dentistry requiring an immediate response by the forensic dentist. The marks fade rapidly, both in the living and in the dead, changing appearance in a matter of hours; delay in examination may result in the loss of valuable evidence. The forensic dentist is also responsible for the examination of the dentition of those suspected of bite mark perpetration. (Vale and Noguchi, 1983; Harvey, 1976; Sweet et al., 1997).[15],[16],[17] In our study, majority of the contributors (around 90%) from all the strata were confident of bite mark analysis of teeth. Reason may be because bite mark pattern is a much emphasized topic in oral medicine and oral pathology in the UG syllabus. Also, it certainly happens to be a well discussed topic in majority of the forensic dentistry conferences and workshops.

Dentist has a role in identifying deceased in case of mass catastrophe as they can aid in issuing death certificate which helps in claiming the insurance, settlement of property, facilitate remarriage of a surviving spouse, and allows last ritual of the body. Identifying features include displaced/rotated teeth, restorations, carious tooth, missing teeth, occupational or habit created wear facets, fractured teeth, diastema, prosthodontic appliances, and extent of shoveling of the maxillary incisors, presence, and angulation of impacted teeth, dental anomalies, intrinsic staining and bone level present. Sex of a person can be identified by finding out Barr bodies and Y-chromosomes in dental pulp.[1] However, in our study more than 40% of contributors were unaware of the role of dentist in the event of mass disaster, which happens to be an important field of action for a forensic odontologist. Also, more than 30% of the contributors were unaware of the methods of gender identification of a deceased.

The dental record serves a purpose of future reference for the practitioners when needed and is not always maintained for a forensic purpose. It is also maintained as consumer court evidence and for dental insurances. There has been an increasing awareness among the public regarding legal issues involving healthcare, which warrants for any dental practitioner to have a thorough knowledge of dental record issues.[3] According to the present study around 60% of UG students, 71% of BDS, 84% of PG students, and 82% of MDS maintained dental records. But only very few practitioners maintained complete records due to lack of organized methodology, skill and space for record keeping. Also, very few practitioners knew the duration of dental record maintenance as stated by the law, which is a minimum of 7 years to a maximum of 10 years.[18] Majority maintained the records for an average span of 2--5 years. Considering all these findings it is a valid question to ask whether the records maintained by practitioners are useful for the purpose of forensic dentistry.

More than 30% of the contributors were hesitant to share patient dental records with fellow dentists and government authorities. Reasons can be attributed to lack of awareness about the significance of records, ignorance, lack of organization of records, long tedious procedures associated with government dealings, confidentiality clause of the patients, and fear of misuse of records.

Forensic dentists who are associated with identification of the deceased and crime investigations are usually required to provide testimony in the court of law in the capacity of an “expert witness.”[3] According to our study, nearly one-fourth of the contributors were not aware that they could substantiate as an expert witness in court to present forensic evidence. Also, around 30% of the contributors were not well versed with the legal issues associated with forensic dentistry.

There have been several cases in the history of India that have resolved by the virtue of forensic dentistry. The Sheena Bora case, Nirbhaya rape case, Rajiv Gandhi murder case are the few cases to begin with.[19] Despite of major contribution of forensic dentistry in the resolution of these famous historical cases, nearly half of the contributors were unaware about them.

Nearly, three-fourth of the contributors stated that they were incapable of handling any forensic dentistry case with the contemporary knowledge of the subject they had. The reason can be attributed to lack of exposure, formal training, and theoretical knowledge about the field. Also, in another study conducted by Rajendra Baad in western Maharashtra, 89% dental practitioners did not have any formal training in collecting, evaluating, and presenting dental evidence, due to the lack in institutions offering formal training and fully equipped laboratories of forensic odontology in India. The subject was not included as part of academic curriculum for dental students until recently and very few workshops and conferences have been conducted in forensic odontology for dental surgeons.[7]

According to our study, majority of contributors were keen to enhance their knowledge about forensic odontology. Contributors stated that they would either opt for specialized courses like conferences, CDE programs, workshops, seminars, short-term courses, or self-educating methods like books, internet, case studies, clinical examination, and journals. UG students were more inclined toward self-educating methods to enhance their knowledge about the subject. On the contrary, BDS graduates, PG students, MDS graduates were more inclined toward specialized courses. Similar results were stated in another study conducted by Rajendra Baad in western Maharashtra, where majority of BDS dental practitioners upgraded their knowledge related to forensic dentistry by Books and Internet, while MDS dental practitioners upgraded their knowledge through CDE, Conferences, Journals, and Workshops which are more updated sources. This was also considered as the reason for better level of knowledge among MDS than BDS dental practitioners.[7]

More than 90% of the contributors stated that it would be a good reform to introduce forensic dentistry as a separate subject in the UG course syllabus. 90% of the contributors also agreed that the horizon of forensic odontology will grow in the forthcoming years. Nearly, one-third of the contributors expressed keen interest to pursue forensic odontology as a career modality. These findings clearly state that despite the low level of knowledge and awareness, contributors have a positive attitude toward learning more. This can actively raise the awareness of forensic dentistry, thereby uplifting the field.

Only around 40% of the contributors were aware of recognized institutions in India that offered specialized courses in India. This shows extreme lack of awareness in terms of pursuing forensic odontology as a career option despite the will to do so. This may also be due to limited recognized institutions in India offering courses in the field.

The law enforcement authorities in India usually seek the help of dental surgeons in government service rather than dental practitioners who have degrees in forensic odontology from universities outside India and who are not in government service. The outcome is that there is a dearth of qualified forensic odontologists in India, which is evident by the rare instances wherein forensic odontology has been applied successfully in solving criminal cases or to identify the deceased. (Chandrasekharan, 2010).[20] A significantly high number of contributors suggested that Indian government should allocate more jobs for forensic dentists so that qualified forensic odontologists from India can be recognized. This can help bring about a revolution in unveiling the criminal cases and mass disaster identification in the country.


   Conclusion Top


Within the scope of present study, it was concluded that there is lack of knowledge, awareness, and practice of forensic dentistry amongst the dentists of Punjab. However, despite the lacunae in awareness and knowledge, there is willingness among the dental professionals to further enhance their knowledge and pursue forensic odontology as a career option.

With proper steps such as introduction of forensic odontology as a separate subject, introduction of more government jobs and formal training through workshops and CDE programs; the advent of forensic odontology will become bold in the coming years. Moreover, there have been few instances where forensic odontology has been highlighted to its full potential and hence, it can be concluded that this branch will create an impact in the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Sharma A, Shokeen S, Arora R, Dhaginakatti SA. Survey on knowledge, attitude and practice of forensic odontology among private practitioners in Ghaziabad city, India. J Dent Specialities 2015;3:43-7.  Back to cited text no. 1
    
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Bhakhri S, Kaur A, Singh K, Puri MS, Puri N, Anandani C. Perception of forensic odontology and its practice among the local dentists of an institution. J Forensic Res 2017;8:377.  Back to cited text no. 8
    
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Acharya AB. Education in forensic dentistry in India. J Educ Ethics Dent 2011;1:45  Back to cited text no. 13
    
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Acharya AB, Sivapathasundaram B. Forensic odontology. Shafer's Textbook of Oral Pathology. 5th ed. Elsevier; 2006. p. 1219.  Back to cited text no. 14
    
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Harvey W. Dental Identification and Forensic Odontology. London: Kimpton; 1976. p. 88.  Back to cited text no. 16
    
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Chandrasekharan P. The first human bomb. The Untold Story of Rajiv Gandhi Assassination. Tamil Nadu: ALT Publ; 2010.  Back to cited text no. 20
    




 

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