SYMPOSIUM: CHILD ABUSE
Identifying human bite marks
in children
Milena Aleksandrova Sirakova
Geoff Debelle
Abstract
Human bite marks in children are relatively common but are either not
recognized as such or, when suspected, not subjected to rigorous forensic
assessment. When a human bite mark on a child is identified, the expla-
nation generally given is that it was either self-inflicted or the result of
being bitten by another child. Adjudication on whether it is a child or
adult bite mark must not be attempted, as there is insufficient evidence
to determine this by inspection. However, the bite may show sufficient,
unique dental characteristics to identify a perpetrator. Thus, it is vital
that a forensic odontologist is involved from the outset. This paper de-
scribes the characteristics of human bite marks and emphasises the key
role of forensic odontology in possible perpetrator identification.
Keywords bite injuries; bite marks; bite wounds; human bite marks
Introduction
Bites are a relatively common injury in children. Approximately
1 in 600 children present to unscheduled care settings having
been bitten by humans. A bite mark might also be encountered
during a scheduled clinical examination for another reason. The
explanation most commonly given is that the bite mark is self-
inflicted or the result of being bitten by another child. When-
ever present they always indicate inflicted injury. Abusive bites
are unique as currently they are the only physical injury that has
the potential for identifying (or excluding) a specific perpetrator.
This can be done from comparison of the dental characteristics of
the bite mark or, if recently inflicted, from obtaining salivary
DNA.
Without the benefit of a history many human bites are not
initially recognised as bite marks and are interpreted as bruises.
It is essential that paediatricians are familiar with the charac-
teristic marks of bites and recognise them as such. In a thorough
systematic review of the literature scanning more than 50 years,
Kemp and co-workers could only find 5 case studies that
confirmed abusive bites to a child. All highlighted the general
characteristics of a human bite mark, namely a 2e5 cm oval or
circular mark made up of 2 opposing concave arcs, with or
without associated ecchymosis. Any such annular mark should
Milena Aleksandrova Sirakova MD MRCPCH is a Specialist Paediatric
Registrar with the Birmingham Community Healthcare NHS Trust, Bir-
mingham Children’s Hospital, Birmingham, UK. Conflict of interest:
none declared.
Geoff Debelle MB BS FRACP FRCPCH DRCOG is a Consultant Paediatrician with
the Birmingham Community Healthcare NHS Trust and Birmingham
Children’s Hospital, Birmingham, UK. Conflict of interest: none
declared.
PAEDIATRICS AND CHILD HEALTH 24:12
be treated as suspicious for a human bite mark and a forensic
odontologist should be involved in the investigation early.
This paper will discuss the characteristics of human bite
marks in children, the role of the forensic odontologist in iden-
tification of human bite marks and the importance of obtaining
accurate and high quality photographic images of the residual
mark to assist in perpetrator identification. Bite mark analysis
will not be described in any detail as it is an ever-changing
discipline and remains within the province of the forensic
odontologist.
Characteristics of a human bite mark
A human bite mark classically has the appearance of two
opposing arcs caused by crushing pressure from the incisors,
canines and premolars and lip and tongue compression (causing
bruising), cutting from the biting edges of the teeth (causing
lacerations) and dragging of the teeth (causing scrapes or abra-
sions). In the centre of the bite mark, there may be petechial
haemorrhage due to negative pressure created by the tongue and
suction. The opposing arcs represent the maxillary (upper) and
mandibular (lower) arches separated from one another at their
base. This appearance is illustrated in Figure 1. The diameter of
the bite mark injury varies considerably but is usually between
25 and 40 mm.
Individual arch and teeth characteristics provide a unique
human dentition to assist the forensic odontologist. The upper
jaw is usually wider than the lower jaw. The bite mark charac-
teristics help to determine which marks were made from maxil-
lary teeth and from the mandibular teeth: for example, the
maxillary central incisors and lateral incisors leave rectangular
marks of which the centrals are wider than the laterals whereas
the mandibular central incisors and lateral incisors produce
rectangular marks of almost equal width. If the upper teeth can
be distinguished from the lower teeth in this way, the position of
the perpetrator with respect to the victim can be assessed.
A child’s bite mark will show the uniform spacing of decid-
uous teeth compared with overlapping, rotated and displaced
teeth of an adult’s dentition. Each tooth will also have its own
individual characteristics caused by attrition, damage and
restoration. However, these unique patterns may not always be
present, making perpetrator identification more difficult.
The bite mark is usually clearest in the early stages, becoming
more blurred as it heals. Sometimes the mark becomes clearer
after a few hours or days as general inflammation disappears and
the colour of the lesion changes.
Not every tooth will leave a mark; the perpetrator may have a
missing or shortened tooth or clothing may prevent the tooth/
teeth from contacting the skin, leaving gaps between the marks.
When the teeth of only one arch contact the skin during biting,
only one arc of the bite mark will be seen. If the bite mark is on a
limb, its detail and shape will depend on the position of the limb
and whether it is moving when bitten (Figure 2).
Animal bites
The arch and teeth characteristics described above distinguish a
human bite mark from animal bites. Animal bites from dogs, cats
and rodents are far more common than human bites and usually
result in tearing rather than compression of the flesh.
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 SYMPOSIUM: CHILD ABUSE
Figure 1 Characteristics of a human bite mark (reproduced with kind
permission of Archives of Disease in Childhood).
Domestic dogs have four prominent canine teeth that are
considerably longer than the incisor teeth. A dog bite mark
consists of opposing pairs of triangular or rounded puncture
wounds from the canine teeth (Figure 3). In addition, dog upper
and lower dental arches are V-shaped.
Other marks that mimic human bite marks
Other patterned bruises such as that from a belt buckle (Figure 4)
or shoe print (Figure 5), burns or dermatological lesions may
cause confusion.
Assessment of the bite mark
Whenever the possibility of a human bite marks arises, advice
must be sought from a forensic odontologist to determine whether
the lesion is a human bite mark and, if so, whether it is from a
child or adult. In the UK, this can be done through the British
Association for Forensic Odontology website (see Further
reading). If the bite mark has sufficient detail and is not too
distorted the forensic odontologist will attempt to identify the
perpetrator. This is a highly complex process and is dependent as
Figure 2 Bite marks on a limb.
PAEDIATRICS AND CHILD HEALTH 24:12
Figure 3 (a) and (b): Dog bite marks.
much on the quality of photographic evidence as on the skill and
experience of the odontologist.
DNA extraction
DNA can be extracted from the saliva deposited onto the skin of
the victim at the time the bite is inflicted. This should only be
attempted when the victim presents within hours of the bite
being inflicted and has not washed the area as salivary DNA
degrades rapidly. This situation might arise in a case of acute
sexual assault. The DNA is collected using Sweet’s double swab
technique (Box 1). Reference DNA from the victim is sampled
using a buccal swab or blood.
All the swabs and samples are exhibits and must be appro-
priately marked with a reference, date, time and place that they
were taken, by whom and signed. In such cases, a Police Officer
and Forensic Medical Examiner in attendance will advise on
technique and they will submit the samples to the appropriate
laboratory.
Photography
The ability of the forensic odontologist to determine whether a
child or adult has inflicted a bite and to undertake comparative
analysis of potential perpetrators is highly dependent on accurate
documentation of the bite mark. Digital images have now
551 Ó 2014 Elsevier Ltd. All rights reserved.
 SYMPOSIUM: CHILD ABUSE
Figure 4 Patterned bruises from a belt buckle.
replaced film-based images. Departments of Medical Illustration
should liaise with the forensic odontologist to achieve the
exacting standards required to document and preserve the bite
mark evidence, particularly to prevent photographic distortion.
A broad orientation view that includes enough anatomical
landmarks in the field to see exactly where on the body the bite
occurred is taken first. Close-up images of the bite mark itself are
then taken, firstly without a scale in order to demonstrate that no
part of the mark is obscured by subsequent images with a scale in
place, and then with a scale placed adjacent to, but not covering
the mark (Box 2). The scale is placed in the same plane as the
Figure 5 Patterned bruises from a shoe print.
PAEDIATRICS AND CHILD HEALTH 24:12
injury with the camera lens perpendicular to the bite to minimise
distortion.
An L-shaped scale is recommended. This has two arms
perpendicular to each other and includes neutral grey-colour
blocks and perfect circles placed at the ends of each arm to
Sweet’s Double Swab Technique
- Dip the head of one sterile cotton swab in sterile, distilled water
to thoroughly moisten the tip (10 s). Roll the swab head over the
saliva stain using circular motions and medium pressure to wash
the stain from the surface. Place this swab in the evidence box to
thoroughly air-dry (at least 30 min).
- Within 10 s of completing the first swab procedure, roll the tip of
the other dry sterile swab over the area of skin that is now wet
from the first swab. Use circular motions with light pressure to
absorb the moisture from the stain on to the swab head. Place
this swab in the evidence box to thoroughly air dry (at least 30
min).
- Since the two swabs come from the same site, they are consid-
ered a single exhibit. Both swabs can be placed in the same swab
box, marked with evidence continuity details and submitted to
the laboratory.
- This process should be repeated on a site away from the bite
mark (control swabs) and placed in separate containers.
- The swabs are kept dry and cool to prevent degradation of DNA
and contamination by micro-organisms. They should be submit-
ted for analysis as soon as possible.
Box 1
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 SYMPOSIUM: CHILD ABUSE

Photographs of bites on curved surfaces of the body are

Photography e views
Wide view, showing anatomical landmarks (for correct
orientation)
Bite mark without scales
Bite mark with right-angled measurement scales e both arches
Bite mark with right-angled measurement scales e each arch
separately when bite is on a curved surface such as the forearm
Box 2
Figure 6 L shaped scale.
detect any photographic distortion, particularly on a limb that
may be flexed or rotated. The American Board of Forensic
Odontology (ABFO) No. 2 scale is the most commonly used
reference scale (Figure 6).
particularly prone to distortion due to difficulty in achieving
correct angulation of the camera for the entire bite. To overcome
this, each arch is photographed separately from the correct angle
(Figures 7 and 8).
Both colour and black and white digital images are used due to
the ability of the human eye to discern differing details between
the two formats. The use of a yellow or green filter with black and
white images will provide a fluorescing image, enhancing the
difference between injured and uninjured tissue below the
epidermis where the blood pigment components are located.
Non-visible light images, using infrared (IF) and ultraviolet
(UV) photography, should also be used. UV and IF light pene-
trates the skin surface and enable a bruise to be detected when it
is no longer visible to the naked eye (Box 3).
The detail of a bite mark improves as inflammation subsides
and the bite changes colour with time (Figure 9). Serial photo-
graphs should therefore be taken at regular intervals until the
bite mark begins to fade. If the mark has already faded, it may be
detected using non-visible light sources such as UV light. (For
further information on photography of human bite marks, see
Golden (2011) in Further Reading.
Encrypted images of the injury can be sent to the forensic
odontologist who may be able to exclude a human bite mark or
conclude that the pattern of the injury is suggestive or indicative
of a human bite mark, depending on the detail and quality of the
images provided. With the exception of sexual assault, the usual
explanation for human bite marks in a child is that they were
either self-inflicted or caused by other children. It may be
possible for the forensic odontologist to determine whether the
bite mark is that of a child or adult on inspection of the injury or
photographs, without requiring comparison with each possible
suspect’s dentition.
Adult or child?
Determination of the arch size by measurement of the inter-
canine distance (ICD) of the bite has been used to distinguish
between adult and child bites (ICD 3e4.5 cm, the bite is more
likely to be that of an adult; ICD 2.5e3.0 cm a child or small

Figure 7 Bite on surface of the body.

PAEDIATRICS AND CHILD HEALTH 24:12 553 Ó 2014 Elsevier Ltd. All rights reserved.
 SYMPOSIUM: CHILD ABUSE

Figure 8 Bite on curved surface of the body.

adult; ICD less than 2.5 cm, a child’s bite). However this has not
Photographic images e light source been scientifically validated and there are individual, racial and
gender differences, with considerable overlap between the ICD of
Colour a child and adult (Figure 10). The size of arch does not indicate a
Black and white child or adult bite mark unless extreme (more than 4.0 cm).
Black and white with filter If the photographic image shows detail of the dentition, tooth
Non-visible light source (UV, IR) size can be a distinguishing feature, with permanent incisors
Box 3 recognisable by approximately 9 years (Figure 11) and deciduous

Figure 9 Changes in the detail of bite marks.

PAEDIATRICS AND CHILD HEALTH 24:12 554 Ó 2014 Elsevier Ltd. All rights reserved.
 SYMPOSIUM: CHILD ABUSE

Figure 10 Determination of arch size.

teeth represented by marks of similar size and spaced uniformly Comparative analysis
(Figure 12).
Digital imaging and computer imaging software have replaced
If a human bite mark is thought unlikely to have been caused
the historical, film-based capture of image when comparison was
by a child, further assessment by the forensic odontologist should
made by hand between a life-sized printed photograph of the
be undertaken under local interagency child protection pro-
victim’s mark and transparent overlays of traced incisor edges
cedures, as this will enable the examination of other persons of
from the dental cast of the suspected biter. This is a rapidly
interest, including taking dental impressions.

Figure 11 Identifying tooth size. Figure 12 Identifying tooth size.

PAEDIATRICS AND CHILD HEALTH 24:12 555 Ó 2014 Elsevier Ltd. All rights reserved.
 SYMPOSIUM: CHILD ABUSE
Conclusions available following a bite mark comparison
Excluded: there are discrepancies between the bite mark and the
suspect’s dentition that exclude the individual from having made
the mark
Inconclusive: there is insufficient forensic detail or evidence to
draw any conclusion on the link between the suspect’s dentition
and the bite mark injury
Possible biter: teeth like the suspect’s could be expected to
create a mark like the one examined but so could other dentitions
Probable biter: the suspect most likely made the bite; most
people in the population would not leave such a mark
Beyond reasonable doubt: the suspect is identified for all prac-
tical purposes by the mark. Any expert with similar training and
experience evaluating the same evidence should come to the
same conclusion.
Box 4
Figure 13 Abusive bite marks.
changing field of forensic odontology and is outside the scope of
this review.
Despite these advances, it may still be still be difficult to prove
that a particular bite mark was produced by a specific dentition
(Box 4). Emphasis is placed upon features that are unusual and
therefore unlikely to have been caused by someone else. A
‘match’ involving an arc of teeth of average size and shape and
with no irregularities or other distinguishing features is of less
value than a match of unusual features. It is possible to exclude a
suspected biter if the bite mark contains features that are missing
from the biter’s teeth or conversely if the biter’s teeth have fea-
tures which are missing from the bite mark.
Abusive bite marks
Adults or older siblings usually inflict abusive bite marks. They
may be self-inflicted. They are frequently multiple and accom-
panied by other cutaneous injuries (Figure 13). They occur all
PAEDIATRICS AND CHILD HEALTH 24:12
over the body, including upper and lower limbs, cheeks, chest,
buttocks, digits and penis. In sexual assault, bites are commonly
found on the breast and genital region.
It is important to document, verbatim where possible, any
purported explanation using a standard child protection medical
examination proforma and to use appropriate body maps to
draw, measure and label the bite marks and other lesions. It is
also important to document any decisions made and actions
taken on the basis of forensic odontological opinion obtained.
Conclusion and implications for practice
1) Paediatricians must be familiar with the characteristics of
human bite marks.
2) A human bite on a child should be suspected if there is any 2
e5 cm oval/circular lesion with a circumscribed annular
border, with or without central ecchymosis.
3) Attribution of the suspected bite mark to a child should not
be undertaken despite the explanation given.
4) Advice must be sought from a forensic odonologist and serial
photographs taken according to forensic protocol.
5) If a human bite mark is thought unlikely to have been caused
by a child, a child protection referral should be made and
further assessment by the forensic odontologist undertaken
to identify a specific perpetrator. A
FURTHER READING
Baker MD, Moore SE. Human bites in children. A six-year experience. Am J
Dis Child 1987; 141: 1285e90.
Child Protection Companion, RCPCH (2013).
Freeman AJ, Senn DR, Arendt DM. Seven hundred seventy eight bite
marks: analysis by anatomic location, victim and biter demographics,
type of crime, and legal disposition’. J Forensic Sci 2005; 50:
1436e43.
Golden GS. Standards and practice for bite mark photography. J Forensic
Odonto-stomatol 2011; 29: 29e37.
Kaushal N. Human bite marks in skin: a review. Internet J Biol Anthropol
2010; 4.
Kemp A, Maguire SA, Sibert J, Frost R, Adams C, Mann M. Can we identify
abusive bites on children? Arch Dis Child 2006; 91: 951.
Schweich P, Fleisher G. Human bites in children. Pediatr Emerg Care 1985;
1: 51e3.
Sweet D, Lorente M, Lorente J, et al. An improved method to recover
saliva from human skin: the double swab technique. J Forensic Sci
1997; 42: 320e2.
The British Association for Forensic Odontology. http://www.bafo.org.uk/.
Acknowledgements
The authors wish to thank Dr Andrew Walker BDS, Dip FOD, RFP for
the use of photographs and ADC for permission to reproduce
Figure 1.
556 Ó 2014 Elsevier Ltd. All rights reserved.