KAP STUDY IN AWARENESS OF FORENSIC ODONTOLOGY:

ABSTRACT:

Aim:
The aim of this study is to assess the knowledge, attitude, and practice of forensic odontology
among undergraduate and postgraduate dental students and dental practitioners.

Objectives:

a)To assess the level of knowledge among undergraduate and postgraduate dental students
and dental practitioners regarding forensic odontology.

b) To examine the attitudes of undergraduate and postgraduate dental students and dental
practitioners towards forensic odontology.

Materials and methods:

A total of 326 samples were taken

A systematic questionnaire that will be given to dental practitioners and undergraduate and
graduate students will be used to perform the survey.

Expected outcome :
The survey's findings will shed light on the participants' present level of understanding of
forensic odontology. Finding out which topics participants have a solid comprehension of and
which topics may need additional training or instruction is the desired outcome. Additionally, it
involves recognizing positive attitudes like genuine passion and the significance of forensic
odontology in dentistry and forensic sciences.
This also includes the awareness among the dental students and dental practitioners in the field
of forensic odontology.

Conclusion:
The study found that even while dental teaching staff members are well-versed in forensic
odontology, they still need frequent awareness and interest enhancements. If there were more
prospects for better jobs in these disciplines, then the success of gaining such comprehensive
knowledge would be justified

INTRODUCTION:

Forensic odontology, a specialized field within dentistry, plays a crucial role in the
investigation of medico-legal cases and the identification of human remains.
 Keiser-Neilson defined forensic dentistry as "that branch of dentistry that in the interest of
justice deals with the proper handling and examination of dental evidence with the proper
evaluation and presentation of dental findings (1)

When Jai Chand, the ruler of Kanauj, was killed by Muhammad Ghori at the Battle of
Chandawar and his fake teeth were later discovered among the dead, forensic odontology was
first used in India in 1193 (2).Other significant cases in India include the 1991 murder of former
Prime Minister Rajiv Gandhi, who was later identified from his teeth (3). More recently, Dr.
Ashith B. Acharya, a forensic odontologist, used bite mark analysis to help solve the 16th
December 2012 Delhi gang rape case (4).
A thorough understanding of dental science is necessary for forensic dental fieldwork. The tooth
is a particularly important biological marker for age assessment. For forensic and
anthropological reasons, the dental maturity status can be used as a trustworthy metric to
determine the biological age.Teeth, with their physiologic differences,pathologies, and treatment
results, store knowledge that lasts a lifetime. Forensic odontology is slowly proving to be an
innovative spark in supporting forensic medicine, while in India, it is yet in a state of infancy (5).

Age and gender assessment of the living or dead; documentation of human remains through
dental records; bite marks and indentations resulting from physical trauma in cases of alleged
abuse of children or adults;The identification of people using the dentition as a tool and the
identification of victims through bite mark analysis can both be done with the help of dental
specialists(6).
Man-made disasters are quite common in India Such as bomb blasts, missile & bullet injuries
etc In these circumstances it becomes an important duty and responsibility of dental
practitioners to play an important role in identification of corpses of victims (7).

This study aims to assess the awareness and knowledge of forensic odontology among dental
undergraduate students, postgraduate students, and dental practitioners. By understanding their
level of exposure to this specialized field, we can identify potential gaps in education and
training, which can be addressed to enhance the integration of forensic odontology into dental
curricula and practice.

Materials and methods:

A total of 325 samples were taken

A systematic questionnaire that will be given to dental practitioners and undergraduate and
graduate students will be used to perform the survey.These questionnaires were distributed
online as Google forms using different platforms for communication like whatsapp, E-mail. Each
participants information and responses were collected and coded.Total 20 questions were taken
to assess knowledge perception and attitude over forensic odontology.
Question (1),(3),(5),(7-13),(15-18) were regrading knowledge and (6),(14),(19),(20) were
regarding attitude and (2),(4), were regarding perception.

Results and observation:

Knowledge :

1)Do you know about forensic odontology in dentistry?

In dentistry, 84% of respondents are aware of forensic odontology, while 16% are unaware of it.
The identification of human remains and the study of medico-legal cases depend heavily on the
specialty of forensic odontology in dentistry.

2)How familiar are you with the techniques used in forensic odontology?

Just 18.5% of people are familiar with forensic odontology techniques, whilst 57% are only
somewhat knowledgeable and 24.3% are not aware at all.The techniques involved in forensic
odontology include: bite mark analysis, tooth prints, rugroscopy, cheiloscopy, dental DNA
analysis, radiographs, and photographs.

3)What is the first step for the identification of unclaimed bodies?

Of those surveyed, 57% stated visual examination, 51% physical and anthropological
investigation, 48.6% indicated finger prints are the initial method of identification, and 14% said
they are completely unaware.The standard procedure in forensic medicine for individual
identification is visual identification.

4)Can teeth serve as a source of DNA?

Of those surveyed, 84.9% were aware that teeth can contain DNA, whereas 15.1% were
not.Teeth and bones are frequently the only sources of DNA available for identification of
degraded or fragmented human remains.Dentin is the greatest source of mtDNA, along with the
pulp and cementum, which are both significant sources of nuclear DNA found inside the tooth.
Because enamel lacks DNA, it is crucial for maintaining pulp and dentin integrity.

5)Which of the following statements is true about calculus in forensic odontology?

Just 27.1% of respondents said calculus aids in determining a person's diet, while 40.9% said it
aids in determining a person's age. 18.2% of respondents claimed it helps determine a person's
occupation, and 13.8% claimed it can provide information regarding drug use.Dental calculus
has been shown to contain well preserved microparticles, DNA and protein.It is also possible to
identify dietary sources and as well as study dietary shifts.

6)Which dental component plays a role in bite mark analysis?

37% are aware that bite mark analysis involves enamel. Calculus was selected by 31%, dentin
by 18%, and pulp by 14%.Enamel rod groups travel in distinct directions under the microscope,
differentiating themselves from neighboring groups and producing distinct patterns of enamel
rod ends on the surface of teeth. In forensic odontology, these are referred to as teeth prints,
and they aid in individual identification.

7)What is the significance of pulp in forensic odontology?

While 37% of respondents are aware that Pulp can be used to determine age, some are not.
For accurate genetic analysis in forensic science, pulp is the best source of DNA.DNA is an
identical unit of each individual.Dental pulp to determine age based on telomere length.

8)How are bite marks analyzed in forensic odontology?

63% of them said bite marks analyzed in forensic odontology by comparing them to dental
impressions of potential suspects,41% responded by examining the size and shape of the bite
mark and the remaining respondents provided incorrect information.Bite marks in forensic
odontology are primarily analyzed by comparing them to dental impressions of potential
suspects and by examining the size and shape of the bite mark itself .These methods help
forensic odontologists identify potential matches or exclusions by considering the dental
features and unique characteristics of the bite mark.

9)How can a forensic odontologist help in cases of mass disasters?

Of these, 62% responded. By supplying dental records for the victims, 48% stated that face
characteristics could be rebuilt using dental records, 44% stated that DNA samples could be
obtained from the victims, and 50% incorrectly stated that autopsies would be performed on the
victims.They do not typically perform autopsies; that is usually the role of forensic pathologists.
10)Do you keep up to date with the latest advancements in dental materials used in forensic
odontology?

45% were not aware of the most recent developments in dental materials used in forensic
odontology, whereas 55% kept up with them.

11)Are you familiar with the concept of "biological age estimation" using DNA markers in
forensic dentistry?

In forensic dentistry, the idea of "biological age estimation" utilizing DNA markers is known to
48% of respondents, compared to 24% who stated they might know about it and 28% who don't.

12)Are you familiar with the use of 3D imaging technology in forensic odontology?

In contrast to 27% who replied maybe and 30% who said they are not, 43% of respondents are
aware of the application of 3D imaging technology in forensic dentistry.

13)What ethical considerations are important for forensic odontologists?

Keeping dental records private and confidential was the response given by 16% of
respondents.11% believed the results were reported objectively and accurately. Following the
law and professional standards was stated by 5%, while all of the above was stated by 68%.

14)Have you received any formal training or education in forensic odontology?

50% didn’t had any formal training or education in Forensic Odontology.

Attitude:

15)To what extent do you agree with the following statement

"Enamel acts as an aid for the identification of age"?

95% are agreed enamel act as an aid for the identification of age as it represents incremental
growth lines.

16)Do you believe that the integration of artificial intelligence (AI) can enhance the efficiency of
forensic odontology processes?

84% are believed that the integration of artificial intelligence (AI) can enhance the efficiency of
forensic odontology processes

17)Do you feel confident in your ability to recognize and document dental evidence for forensic
purposes?
Forensic evidence can be identified and documented by 60% of experts, whereas 40% lack
confidence in their abilities.

18)Would you be interested in receiving additional training or education in forensic odontology?

66% are interested in receiving additional training or education in forensic odontology .

Perception:

19)If you answered "Yes" to the previous question, how would you define forensic odontology?

Sixty-seven percent of them agreed that Forensic odontology is the application of dental
knowledge in legal proceedings and identification of human remains.The use of dental evidence
in criminal investigations.Assessment of cases of child abuse and age estimation.

20) Have you ever been involved in any forensic odontology cases or collaborations?

72% of respondents had no involvement with forensic odontology cases or collaborations.

Discussion:

Forensic odontology is the branch of forensic anthropology that focuses on identification and
analysis of human teeth in legal context and helps to identify unknown remains and trace bite
marks to a specific individual.In the expanding realm of medicine, dental professionals would
need to have a deeper understanding of forensic odontology. The field of forensic odontology
has grown in significance in several industrialized nations worldwide. In emerging nations like
India, it has not yet attained its rightful place.In India, there aren't many forensic dentistry
studies or courses, nor are there many themes pertaining to forensic odontology.Evaluate how
extensively forensic odontology is included in the dental education curriculum in India. Assess
the depth and breadth of the topics covered and whether it adequately prepares students for
real-world forensic applications

In the present survey the questionnaire was designed,which consisted of 20 questions, to

assess knowledge, attitude and perception in forensic odontology of dental students and
practitioners. 84% percentage of people are aware of forensic in dentistry. The capacity of
dental tissues to endure external stresses while retaining part of their original structure explains
the importance of forensic odontology. Teeth are therefore a great and reliable source of DNA
material(8).This research shows that in order to learn the most recent technical skills related to
forensic odontology and to comprehend and be familiar with the various approaches of keeping
dental records, more comprehensive training is necessary(9).Only 28% are involved in forensic
odontology cases or collaborations.Forensic odontology has a number of difficulties, one of
which is human identification. In order to identify the unclaimed person, visual examination is
still the first and most important stage.Thus, identification of an individual is one of the primary
goals of forensic odontology(10).In contrast, the forensic community has not yet thoroughly
validated radiocarbon analysis of tooth enamel, as it is a relatively new technology (first
disclosed in 2005). In contrast to amino acid racemization analysis, radiocarbon dating of
enamel yields an individual's birthdate. The chronological age of the deceased can be
ascertained if the date of death is also known. Recently, the date of birth of both identifiable and
unidentified people has been determined with extremely high precision using radiocarbon dating
of tooth enamel(11,12).Only 43% people agree about the fact that enamel acts as aid for
identification of age.A similar study conducted the pulp used for dna analysis to determine age
by M.L.Avinash Tejasvi et al proves that age estimation can be done using pulp by assessing
the telomere length.36% people agrees that pulp helps in determining age.(13)Since 1950, bite
mark evidence and dentists have played roles in the legal system.The scientific basis of bite
mark analysis is founded on the assumption of human dentition individuality, which holds that no
two persons have identical dentitions in terms of size, shape, and tooth alignment.(14).In India,
the use of bite marks as forensic evidence is limited. A significant example is the infamous Delhi
Nirbhaya case from 2012 to 2013, in which Dr Ashith Acharya, secretary of the Indian
Association of Forensic Odontology (IAFO), played an important role in convicting all of the
accused. He used police images of the suspect's dental features and matched them to bite
mark injuries on the victim's body.(15).Once tooth imprints are obtained from a suspect, they
can be compared to bite mark data and matched for up to seventy-six parameters. These
include whorls, indentations, chips, abrasions, striations, cuspidal distances, tooth breadth and
thickness, alignment, and mouth arch.About 62.8% people are aware that dental impression
comparison to suspects are the first and primary step in bite mark analysis.A similar study
conducted by Ayana ogata et al., declares that dental age estimation can be done by dna
analysis using dna methylation.48% are aware about the boliolgical age estimation using dna
markers in forensic odontology(16).Among the participants 50%of them are aware and have
knowledge about forensic odontology and are also intrested in this department.Forensic
odontology within Indian academic and professional realms is imperative.So bolstering studies
and integrating comprehensive curriculum on forensic odontology would be effective and useful.

The attitude of the dentist towards recieving additional training and education in forensic
odontology is positive as per the result obtained in Q20.

The perception of the dentists towards applying AI in forensic odontology would enhance the
efficacy is positive based on Q14.

Conclusion:

The results of this study provided insight into the state of forensic odontology among surgeons,
staff members, and dentistry students. The results of the poll indicated that they must have
learned enough while teaching, continuing their dentistry education, or throughout their study
period. Although awareness and interest are connected, it was discovered that they are less
prevalent among dentistry students, staff members, and surgeons. These two characteristics
were assessed in the survey. If dental surgeons are the target audience, then holding regular
conferences, workshops, CDEs, and seminars will enhance their expertise and understanding.
Furthermore, more dentists will be interested in attending and taking part in such programs if
more jobs are generated in this industry.
References:

1)Catherine Adams. Forensic Odontology: An Essential Guide. First Edition. John Wiley & Sons,
Ltd; 2014. Disaster victim identification.
2)Senn David R, Stimson Paul G. Forensic dentistry. 2nd edition. U.S.A: CRC Press; 2010. pp.
11–24. [Google Scholar]
3)Preethi S, Einstein A, Sivapathasundharam B. Awareness of forensic odontology among
dental practitioners in Chennai: A knowledge, attitude, practice study. J Forensic Dent Sci.
2011;3(2):63–66. [PMC free article] [PubMed] [Google Scholar]
4)http://timesofindia.indiatimes.com/city/hubli/Forensic-odontology-department-plays-key-role-
in-solving-crime-cases/articleshow/22562742.cms
5)Bagi BS. Role of forensic odontology in medicine J Indian Dent Assoc. 1977;49:359–63
6)Shamim T. Forensic odontology J Coll Physicians Surg Pak. 2012;22:240–5 [PubMed ]
[Google Scholar]
7)Shekar BR Chandra, Reddy CVK. Role of dentist in person identification. Indian J Dent Res.
2009;20(3):356–60. [PubMed] [Google Scholar]
8)J Pharm Bioallied Sci:
Role of DNA profiling in forensic odontology
2015 Apr; 7(Suppl 1): S138–S141. doi: 10.4103/0975-7406.155863
PMCID: PMC4439652PMID: 26015692
9)J Forensic Odontostomatol:Forensic odontology education
2017 Dec; 35(2): 149–156. Published online 2017 Dec 1.
10)Pretty IA, Sweet D. A look at forensic dentistry-Part 1: The role of teeth in the determination
of human identity. Br Dent J. 2001;190:359–66. [PubMed] [Google Scholar]
11)Cook G. T., Dunbar E., Black S. M., Xu S. (2006) A preliminary assessment of age at death
determination using the nuclear weapons testing 14C activity of dentine and enamel.
Radiocarbon 48, 305–310 [Google Scholar]
12) Spalding K. L., Buchholz B. A., Bergman L. E., Druid H., Frisén J. (2005) Forensics: age
written in teeth by nuclear tests. Nature 437, 333–334 [PubMed] [Google Scholar]
13)M.L. Avinash Tejasvi, Anulekha Avinash CK,
E. Rajendra Reddy, Pavan Kulkarni,
Harsha Bhayya,' and Manohar S. Kugaji Individuals Age Determination from human Dental Pulp
through DNAAnalysis by PCR.Glob Med Genet. 2021 Jun; 8(2): 57-61.Published online 2021
Feb 15.
14)J Oral Biol Craniofac Res. 2013 May-Aug; 3(2): 88–91. Published online 2013 Jun 10.
15)Austin J Dent. 2022; 9(1): 1167.
16)https://doi.org/10.1016/j.forsciint.2022.111445