INTRODUCTION

Forensic dentistry is one of the most developing

branches of forensic medicine and forensic science.

A comprehensive understanding of this science is

absolutely necessary for the pedodontist as they are often the first one to deal with children.

DEFINITIONS
FORENSIC MEDICINE : branch of medicine wherein

the knowledge of medicine is applied to the knowledge of law in order to derive justice.(Rao,2000).
FORENSIC SCIENCE : is a study of physical

information connected with crimes or collection of evidences by scientifically examining the objects or substances involved in the crime.

 FORENSIC ODONTOLOGY :

branch of dentistry which, in the interest of law, deals with the proper handling and examination of dental evidence and the proper evaluation and presentation of such evidence (keisler Neilson,1981)

HISTORICAL PERSPECTIVE Forensic dentistry began in 2500 BC, when the first evidence was found in the pyramid at Giza, Egypt , in a skull with a gold wire holding two molar teeth. The first text of a mass disaster on forensic dentistry was published in 1897 at Paris after the burn incidence at Bazaar de Charite. In 1967 , a 14 year old girl linda peacock had the bite mark along with other evidence which led to conviction of a young man.

MAJOR FIELDS OF FORENSIC ODONTOLOGY

CIVIL

MAJOR FIELDS
CRIMINAL
RESEARCH

1. Civil non criminal

Identification of an individual remains, where death is not due to suspicious circumstances. Mass disasters identification of victims of hotel fires, aircraft and other accidents. Craniofacial superimposition for identification

2 . Criminal Identification of persons from their dentition or teeth - living person - dead person Dealing with bite marks identification - foodstuff - on the assailant - the victim

3 . Research Academic training courses final year dental (BDS) and second year medical (MBBS) students.
PG training ( MD/ PhD- Forensic Medicine ).

METHODS OF DENTAL IDENTIFICATION :

Comparative
Profile Ageing

DNA

Comparative Post mortem dental remains can be compared to antemortem dental records ( including written notes , study casts , photos , radiographs , etc.) to confirm identity.

Post mortem Dental profiling When antemortem dental records are unavailable, the forensic pedodontist can assist in limiting the population pool to which the deceased is likely to belong , thus increasing the likelihood of locating ante-mortem dental records.

Ageing Determination of age plays a significant role within forensic science, not only in identification of bodies but also in connection with crimes and accidents.

DNA and Dental identifications Comparison of DNA from the teeth of an unidentified individual can be made to a known ante - mortem sample ( stored blood, clothes, hairbrush, etc.) or to a parent or sibling.

THE ROLE OF PEDODONTIST MASS DISASTER CHILD ABUSE AND NEGLECT ACCIDENTAL &NON ACCIDENTAL TRAUMA DENTAL FRAUD AGE DETERMINATION BITEMARK EVIDENCE

LIP PRINT IDENTIFICATION

POISONING

DENTAL RECORDS

MASS DISASTER In the analysis of the incidences where children often become victims, the task of identification is very complicated. These cases can be systemically examined and identified skillfully by the dentist.

CHILD ABUSE/ NEGLECT

The Dentist who handles children is required by law in

virtually all jurisdictions to report cases of child abuse and neglect.

ACCIDENTAL AND NON ACCIDENTAL ORAL TRAUMA Dentist can play important role in examination of children who have sustained trauma involving oro facial structure via accident, negligence , malpractice or child abuse. A detailed and accurate examination supported with radiographs, tests, and photograph will be required by the enquiring agency as often these cases are challenged in the court.

Dental fraud
With the introduction of consumer protection act, the

dentist is required to examine patients carefully and records are to be maintained properly to defend himself if needed. Also records are to determine whether a treatment paid for by a third party has been actually performed or not.

Age determination
Age determination with the help of human dentition

or bite marks have proved to be of great importance.

Lip print identification

No two individuals have same pattern of the skin on the

lip. Thus lip print can be evaluated in identification of victims and suspects.

Poisoning
Most commonly associated with metallic taste and a

non specific ulcerative gingivitis and pigmentation.

An alert pedodontist should be able to diagnose

poisoning by clinical signs and symptoms , coupled with the history.

Dental records
Teeth

are unique in individuality, resistant to destruction and their record can be maintained well along with noting of developmental variations and appliances delivered if any to children. Thus routine findings of the patient if preserved can be used successfully for their identification.

INTRODUCTION
Dental evidence has become increasingly important

in the investigation of non-accidental injuries to children.

Most often bites are reported to be inflicted in female

children of age group 11-15 years,while most of the male victims are in the age group 4-10 years.

 Most common areas to be bitten in children are head,

neck, limbs and trunk.

Female victims are bitten most commonly on breast,

arms and legs.

Arms and shoulders are most affected in males

DEFINITION
BITE MARK

A mark caused by teeth alone or in combination with other oral parts or consists of teeth marks produced by the antagonist teeth, which can be as two opposing arCh marks.

CLASSIFICATION
Bite marks are basically classified according to

causative agent(etiological factors), material bitten(Cameron and sims,1973 and McDonald,1974) and degree of biting(Whittaker et al,1989)

DEPENDING ON BITING AGENT

HUMAN Children Adults ANIMALS Mammals Reptiles fish MECHANICAL Full denture Saw blade tooth marks Bicycle chain and others like electric cord marks, belt marks etc

DEPENDING ON MATERIAL BITTEN

SKIN Human Animal PERISHABLE ITEMS Food items like cheese, apple etc NONPERISHABLE Unanimated objects such as pipes, pens,pencils

Depending on degree of biting

Definite bite marks Tooth pressure marks are formed when a direct application of pressure by the biting edges caused tissue damage. Other marks may be caused by tongue pressing tissues between necks of teeth. Amorous bite marks Marks made in amorous circumstances, tend to be made slowly with absence of movement between the teeth and tissue. Lower teeth marks are formed when teeth are pressed into tissue with gradual increasing pressure. Marks of upper teeth form a series of arches where tissues are sucked into mouth and pressed against the back of teeth with the tongue. Aggressive bite marks These marks may show evidence of scraping, tearing and avulsion of the tissue. This usually involves the ears, nose or nipples. Such bites are difficult to interpret.

BITE MECHANISM (A) TOOTH PRESSURE: Marks caused by direct application of incisal edges of the anterior teeth or occlusal surfaces of posterior teeth. Marks depends on the force applied and degree of movement between the tissue and teeth. Pale area incisal edges Bruising margin of incisal edges Tooth mark pattern as an attack or defensive bite mark is seen most commonly in battered child syndrome.

(B) TONGUE PRESSURE Tooth pressure is caused when the material is taken into the mouth and pressed by the tongue against the teeth or palatal rugae.
This can leave a distinctive mark due to mechanism of

suckling,a combination of sucking and tongue thrusting.

Bite marks of sadistic origin exhibit central ecchymotic or

suck mark radiating linear abrasion pattern surrounding the central area and resembling a sunbrust.These are mostly found in sexually oriented assaults.

TOOTH SCRAPE
May be caused by teeth scraping across the surface of

skin. These marks are usually inflicted by anterior teeth. May appear as scratches or abrasions. If scratches,they might indicate a peculiarity of incisal edges and assist in identification.

FACTORS AFFECTING BITE MARK INJURIES

Inherent skin factor: loose skin at site of injury will bruise more easily in the where excess of subcutaneous fat is present compared to skin supported fibrous tissue with good muscular tone. Age: infants and old people tend to bruise more easily and severely infants,because they have more delicate,loosely attached skin and presence of subcutaneous fat;old people because of decreasing elasticity of skin and lost subcutaneous fat.

Sex: females tend to bruise more easily than males and bite mark bruise persist longer in females because of more subcutaneous fat.

time: duration depends on force applied and extent of tissue damage.

Vascularity: intensity of discoloration depends on vascularity of area.

BITE MARK ANALYSIS

Guidelines for analysis are given by American Board of

Forensic Odontology (ABFO)

The collection of evidence regarding the bite mark falls in

following categories:

Description of bite marks

Demographic data Location of bite marks Shape Color Type of injury

Collection of evidence from victim photography Salivary swabbing Impressions Tissue sample

Collection of evidence from suspect Before collecting evidence from suspect,the dentist should ascertain that necessary search warrant court order or legal consent has been obtained,and should make a copy of this document as part of his/her records.

RECENT ADVANCES FOR COLLECTING EVIDENCES

Xeroradiography: there is an advantage of seeing through tissue damage

Transillumination: successful in enhancing low light energy images produced by interdental injection of chemically luminescent liquids.

Videotape analysis: with this advanced computer technique it is easy to anlayse a transparency

Superimposition technique : an image of the bite marks inflicted on the deceased child is compared with bite marks obtained from suspect for identification.

Scanning microscope: helps in demonstrating three-dimensional characteristics in a bite mark.

DNA fingerprinting: has been developed since 1980s as a molecular tool for genetic specification of an individual.

LIP PRINTS(CHEILOSCOPY)
Lip prints have been used as an identification aid in much

same manner as fingerprints. It is analogous to bite mark analysis. Of the many different types of lip prints,vertical,branched,intersected and reticular pattern are most commonly found. Minor differences have also been observed between the right and left sides and between upper and lower lips. .

 Lip prints on drinking glasses, facial tissues and magazines

have been used as evidences in actual court cases also.

The science of examining the lip prints is called

CHEILOSCOPY.

Lip prints - male

Lip prints - female

LEGAL ASPECTS
Basic knowledge of legal aspects and practices pertaining to

child protection is paramount.

A dentist should be well versed with the current legal system

for child protection.

A separate doctrine,parents patriae is also important in

understanding laws developed to protect children.

 Dental professionals should know the definitions proposed

of child abuse/neglect and existing related laws under the Draft Model Child Protection Act 1977,to protect himself and apply it correctly in child abuse/neglect cases.
Dentist should always follow the dont do or do always

principles.

Principles which one has to remember in forensic pedodontics:

Should always be fully aware of legal standards of care and

legal responsibilities. Should keep legibly written, accurate case records. Records should be made in the presence of the patient. Additions or corrections should never be made to alter the original records. Should keep an up-to-date knowledge. Diagnostic tools like radiographs should always be used preoperatively and postoperatively. Should always be in consultation with legal/medicolegal expert to review insurance policies or any financial,legal matter.

PREVENTION OF CHILD ABUSEROLE OF PEDODONTIST

In general, the dentists role who handles child patients in identifying and preventing child abuse/neglect is as follows:
To observe and examine any suspicious evidence that can be

ascertained in the office.

to record according to the law, any evidence that may be

helpful in the case, including physical evidence and comments obtained from questioning or interviewing. .

 To remain objective toward all parties. To treat any dental injuries to establish and maintain a professional therapeutic

relationship with family.

To hold the child whose life is in danger and transfer

the child to a hospital or a physician for proper care.

LEVELS OF PREVENTION OF CHILD ABUSE/NEGLECT

A pedodontist can contribute towards the prevention

of this criminal act by understanding various issues related to child abuse and applying them at different level:

Primary level

Secondary level

Tertiary level

PRIMARY LEVEL
Greater attention needs to be given directed at screening

children at a higher risk of maltreatment. Greater use should be made of routine child health supervisory visit to explore psychological issues. Parents at risk for abusing their children are frequently very needy themselves , and being nurturant to their children is difficult. Therefore , they should be screened and counseled.

SECONDARY LEVEL
Secondary prevention concerns efforts directed to those who

are known or thought to be at a specially high risk for child abuse and neglect.
It is important that pedodontist recognizes his limitations and

assumes responsibilities for applying a interdisciplinary team approach.

Goal of intervention should be to enhance parenting

capabilities and family functioning , thereby enabling them to more adequate care for their children and avoid possible maltreatment.

TERTIARY LEVEL
Refers to interventions after the condition is already

identified. still considered prevention because the goal is to prevent a recurrence of the condition or the potential negative sequelae. This treatment of abused child depends on the accurate identification of abuse and neglect. The pedodontist should ensure that child is referred to a designated child protection agency and childs situation is further evaluated.

DETERMINATION OF GENDER Female specific

Distinguishing feature Male specific variation variation

Size of mandible Mandibular angle Frontal angle Palate Occipital condyle Teeth

Large and broad Large,rough outer surface Small Large and broad,u shaped Large Large,lower 1st molar,more often 5-cusped

Small and less broad Small, smooth outer surface Large Small, parabola like Small Small,more often 4cusped

DENTAL AGE ASSESSMENT

INTRODUCTION
The determination of age plays a significant role within

forensic science,not only in identification of bodies but also in connection with crimes and accidents Age determination can be considered in two periods:

developmental period which the post Begins in utero and ends when developmental Dentition has reached maturity Period which extends from time of dental maturation to termination of life.

THE DEVELOPMENTAL PERIOD

(A) METHODS APPLICABLE DURING FIRST STAGE

Gravimetric method

Histological approach

visual and radiographic method

GRAVIMETRIC METHOD
In fetus or infant where teeth are not present in mouth,any

evidence of dental development is concealed within the jaws.

A gravimetric observation can be made on the mineral

content of fetal and infantile teeth and relationship between the square roots of the weights of the ashed teeth and known age of subject can be determined.
This method appears to be reliable method.

HISTOLOGICAL APPROACH
In order to understand rationale of this technique,knowledge

of pattern of dentin formation is necessary.

Development of hard tissues of a tooth is a rhythmic process

with the formation of successive layers of tissues.

Evidence for this is to be found in the incremental lines that

can be observed microscopically in undercalcified sections of the enamel and dentin.

VISUAL AND RADIOGRAPHIC METHOD

They are usually applied together for age determination.

Visual examination provides information regarding the

number of teeth that are present in the dental arches and dentition to which they belong.
Radiographs would reveal the resorption of the roots of

primary teeth.

Methods applicable during second stage

This stage refers to calcification of the permanent teeth

which begins during the first six months after birth in the case of incisors and canines, and ends with the completion of the roots of the second molar at about fifteen years.
Most common method used is visual supported with

radiographs.

 Gleiser and Hunt (1955) - the degree of calcification

of a tooth is more meaningful indication of dental maturation than the time of its clinical emergence.
Demerjian et al (1973) forumulated a new method

of age by reference to the radiological appearances of the seven teeth on the left side of the mandible.
Eight stages A TO H Have been defined from the first

appearance of calcified points to the closure of apex.

Tooth development stages A to H

 Mornstad et al ( 1994) estimated the age with the aid

of tooth development based on objective measurements such as crown height, apex width and root length.
Tounsend and Hammel (1999) proposed a method

based on number of erupted teeth.

 Willems et al. (2001) adapted a method for dental age

estimation in a Belgian Caucasian population. It is a modification of Demirjian method (new tables for boys and girls with age scores directly expressed in years). Cameriere et al. (2006) published a mathematical formula for calculating dental age on teeth. The method is based upon measuring the completeness of apical development via a computer method and all studies to date show a very strong correlation to chronological age.

II. POST DEVELOPMENTAL PERIOD

The physiological age changes occuring in teeth

during post natal period the principal clues to the age of an individual . Gustafson (1950) introduced multifactorial histologic approach to the determination of age based on arbitary scale of points. - Secondary dentin formation; transparency in root formation from the apex appears to be directly related to chronologic age.

 Zander and Huzeler (1958) thickness of cementum

covering the roots can also be related to age.

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