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"TOOTH TELLS THE TRUTH" Forensic Dentistry: Introduction, Scope, and Applications

Updated: Aug 1, 2023

Dr. Jayasankar P. Pillai BDS, MSc (Forensic Odontology)

Fellow: Indian Board of Forensic Odontology (IBFO)

Govt. Dental College and Hospital

Medicity Campus, Ahmedabad-16

The branch of dentistry deals with the diagnosis, treatment, and prevention of conditions, disorders, and diseases of the teeth, gums, mouth, and jaw. The application of dentistry is considered necessary for better oral health and subsequently on the general health of the individual. However, there exists an unconventional and a non-clinical application of dentistry that is in the interest of Justice. This specialized branch of dentistry is called "Forensic Dentistry" or "Forensic Odontology".

Forensic Odontology deals with the application of dental sciences to the enforcement of Law and the furtherance of Justice. Unfortunately in India the science and the value of forensic Odontology are not well known or understood. However, over the last few years, the subject of forensic odontology is evolving as a budding branch of dentistry. That is evident through the number of courses and institutes in India imparting the knowledge of this special branch. In India, there are only a few qualified forensic odonatologists, most of them trained from foreign universities. The forensic odontologists or the dental professionals are being approached by the legal and the forensic medicine authorities to give expert opinions as and when the need arises in forensic cases. A well-known case was the involvement of a forensic odontologist in Dharwad, Karnataka during the "Nirbhaya case," where the bitemark on the victim's body played an important role as evidence.

Teeth are the strongest and the most indestructible components of the human body. They are structurally unique in their arrangement and possess the highest resistance to decomposition, fire, and environmental hazards. Thus in some cases, the teeth become the only means of identification of an otherwise unrecognizable body. That mandates the observation, recording, and preservation of dental findings for disaster victim identification, especially in the charred human remains. Thus one of the main domains of forensic odontology is the identification of unknown human remains, especially in case of mass disasters.

According to INTERPOL's disaster victim identification (DVI) guidelines, dental features are being considered as one of the three primary identifiers, along with fingerprints and DNA.

Reports from international sources also state that human identification through dental remains is a well-established and reliable method. However, the successful identification process relies on the availability of antemortem dental records and the proper recording of post-mortem dental status. A properly recorded post-mortem dental findings also help the forensic team to narrow the search for the antemortem dental records thus making a presumptive identification of the body. The complete dental profiling obtained during the post-mortem dental examination may provide information not only related to the age and sex of the individual but also may provide details related to the racial origin of the individual, his/her occupation, socioeconomic status, dietary pattern, parafunctional habits, etc. Such information from teeth or dentition may be useful in generating the profile of the individual thus helping in the identification of the unknown deceased.

Another important domain of forensic odontology is age estimation from dental structures. The dental development starts before birth during the intrauterine line and continues till the age of early twenties. Knowing the age is a basic human right. The documented age not only gives identity to the living individual but also helps in narrowing down the search of the missing person and in identifying the unknown or unidentified human remains.

For example, a badly decomposed body or a skeletonized remain is considered to be belonging to an individual in the age range of 40-50 years by the investigating officer. The police officials will be looking for an individual in that age range through the missing complaints lodged elsewhere. However, during the post-mortem examination and through thorough dental analysis, it may be found that the individual is in the early adolescent age group. Thus, the estimated age may be useful in narrowing down the search for a missing person in that age group. In the absence of age documents, or when age is disputed, age estimation is inevitable. In recent years, the need for age estimation has increased. Also, as 18 years is considered as the important threshold for deciding the majority and the third molars are still in their developmental stages at that age, the radiographic analysis of the third molars are becoming mandatory for estimating the age of the individual. In India, the ages of 14, 16, 18, and 21 years are considered to be legally important.

Thus the scientific method of age estimation is mandatory for cases under POCSO act 2012, Child and Adolescent Labour (Prohibition and Regulation) Act, 1986 and Juvenile Justice Act 2015, Hindu Marriage Act of 1955 ( clause iii of Section 5).

Also as age fraudulence cases in sports are expected, the sports authorities rely on the scientific documentation on the age of the players or trainees. The developmental pattern in tooth structures also follows a specific pattern particularly before and after birth.

The microscopic changes in the enamel (Neonatal line) may play an evidentiary role in the investigation of the cases of foeticide (criminal abortion of fetus) or infanticide (killing a child within 1 year of birth). The presence of such a line in the tooth germ of the child may indicate "live birth" and its absence indicates "stillbirth" and thus may help in differentiating foeticide and infanticide cases. However, such investigations by the forensic odonatologist will require the removal of the developing tooth germ and subsequent processing for microscopic examination.

During the childhood and adolescent stages, the teeth development is active in both the upper and lower jaws. The radiographs are used to visualize the development stages of the teeth. Based on the stages the age of the individual is estimated. This is possible only till the complete formation of the third molars. In the post-adolescent or during the adult phase of life, the regressive changes in the teeth contribute as factors for estimating the age.

Another important forensic application of dentistry is the investigation of bite marks in physical and sexual assault cases. In theft and criminal cases, the perpetrators of crime may sometimes leave their bite-marks on inanimate objects or foodstuffs after or during the commission of the crime. These may sometimes provide a piece of evidence to link the assailants to the crime scene. As mentioned earlier, the arrangement of teeth and the dentition status are unique just like how fingerprints are. Hence a bite mark may reflect the presumed 'unique' characteristics of the biter's teeth. That may be crucial to identify a suspect in a crime or in excluding an innocent person, both of which are equally important.

In India, the application of forensic odontology is still in its infancy, unlike in Western countries where it is considered a recognized branch of dentistry. However, this branch is slowly gaining its academic and practical importance in India. As the police authorities often approach the government institutes (Medical/ Dental colleges) for forensic investigations, the practical exposure to forensic odontology cases is limited to such institutes. With the availability of more and more qualified forensic odonatologists, the Forensic Science Laboratories in India too may recruit such specialties to handle forensic cases with dental evidence.

About the Author

Dr. Jayasankar Pillai is a qualified forensic odonatologist from Ahmedabad, Gujarat. He did his dental graduation from Mahatma Gandhi Postgraduate Institute of Dental Sciences, Pondicherry during 1992-97. Since 1997 he is serving the Health and Family welfare department, Govt. of Gujarat as a teaching faculty in Govt. Dental College and Hospital, Ahmedabad. He underwent Fellowship training in Forensic Odontology from the Indian Board of forensic Odontology (IBFO) in 2015. He passed his Post-graduation in Forensic odontology with Gold Medal from Gujarat Forensic Sciences University (GFSU), Gandhinagar. He is one of the members of the Dental age estimation Committee in his parent institute and is involved in dental age estimations in more than 400 medico-legal cases which includes some skeletal remains cases and in one bite-mark case. He is the recipient of two prestigious awards from the Indian Society for Dental Research (ISDR) and the recipient of the Late Manoramaben Patel award for excellence in Dental research by the Indian Dental Association (IDA), Gujarat branch in 2007. He is one of the Program Development and Research Committee (PDRC) members of the Gujarat Institute of Disaster Management (GIDM), Gandhinagar and he contributed to the drafting of the guidelines and SoPs for the dignified management of the Dead in the aftermath of a disaster- Role of Forensic odontology. He has presented scientific papers in several dental conferences and published original research and review articles in national and international scientific journals.

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