Teaching forensic odontology: an opinion on its content

and format*

A. B. AcharyaDepartment of Forensic Odontology, College of Dental Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Abstract Forensic odontology involves dentists’ participation inassisting legal and criminal issues. Formal teaching in forensic

odontology has existed for over a 100 years. Over the lastcentury, forensic odontology has evolved and, today, it is

an integral part of undergraduate dental training in manycountries. Dentists have been trained in the specialty, and

dedicated departments established in institutes and universitiesaround the world. A survey undertaken at five universities

revealed that these centres have developed detailed curriculain forensic odontology, and a general standard exists in teaching

forensic odontology, however, coverage of recent advances in

forensic science may be lacking. While recognising that theseprogrammes are not representative of teaching in forensic

odontology worldwide, suggestions are made for an alternativeapproach to teaching the subject. Moreover, it is stressed that

teaching be undertaken by qualified forensic odontologists.

Key words: forensic odontology curriculum; undergraduate

dental education.

ª Blackwell Munksgaard, 2006Accepted for publication, 18 January 2006

Introduction

S ustained education and demand over the past

half-century has rendered forensic odontology a

valuable component of forensic investigations in many

countries. Forensic odontologists are routinely consul-

ted for assistance in legal and criminal problems.

Teivens and Mornstad, for example, have reported a

steady increase in the number of forensic odontology

cases in recent years (1). Moreover, forensic odontol-

ogy has made great strides in the last decade, ranging

from two- to three-dimensional digital analysis of bite

marks (2–4) to extracting DNA from teeth for the

purpose of identification (5). This is a reflection of

dentists’ willingness to contribute to the community in

ways other than preventive and therapeutic service.

However, in the wake of recent advances, it may be

useful to re-examine the purpose, constituents and

approach of education in the forensic odontology.

History of teaching forensic odontology

The application of dental sciences in criminal and legal

investigations gathered momentum in the West

during the 1950s and 1960s. The associated need for

formal training in forensic odontology and its inclu-

sion in dental curricula, was recognised and acted on

in the 1960s and 1970s. The discipline had been

practiced by individuals much earlier than this and

the first course in forensic dentistry was probably

conducted by Prof. Sadanori Mita of Japan as early as

1903. The correspondence course outlined ‘methods of

examination, evaluation and classification of bite

marks and the differences between ante- and post-

mortem appearances’ (6). This course subsequently

formed the basis of his lectures at Tokyo Dental

College between 1922 and 1936.

Undergraduate forensic odontology education in

North America dates back to the early 1960s (7), while

in the UK, it has been taught since the early 1970s (8).

The first postgraduate programme in forensic odon-

tology in the USA was conducted by the Armed Forces

Institute of Pathology (9) in 1963, while in continental

Europe, a postgraduate course was first offered in

Copenhagen in May 1979.

The need to teach forensic odontology

The legendary Gosta Gustafson stated that ‘it is

essential…that a course in forensic odontology should

form part of the basic undergraduate curriculum’ (10).

Salley (11) felt that knowledge of forensic odontology

*Guest lecture presented at the Third Annual Conference of the

Indian Association of Forensic Odontology, Ragas Dental College,

Chennai, India on 19 December 2004.

137

Eur J Dent Educ 2006; 10: 137–141All rights reserved

CopyrightªBlackwell Munksgaard 2006

european journal of

Dental Education

among dentists is essential to better understand the

intricacies and subtleties specific to forensic science

and criminal investigation. Dentists may be consulted

on occasion for assistance in post-mortem dental

identification, disaster victim identification, age esti-

mation and criminal cases involving bite mark evi-

dence. Hence, the dental graduate should

• have a wide-ranging knowledge of theoretical and

practical aspects of forensic odontology;

• be reasonably competent to recognise forensic cases

with dental applications when consulted by the

police, forensic pathologists, lawyers and associated

professionals;

• be capable of proper collection of dental evidence

related to cases of identification, ethnic and sex

differentiation, age estimation and bite marks;

• be able to assist qualified forensic odontologists in

analysis, evaluation and presentation of dental facts

within the realm of law.

Therefore, teaching forensic odontology to under-

graduates should ensure that dentists are able to assist

forensic investigations if, and when, the need arises.

What are the constituents of forensicodontology?

What constitutes the curricular needs for teaching

forensic odontology? Described below are trends in

forensic odontology teaching at five universities from

different countries. Forensic odontologists at these

institutions were asked to provide information on

curriculum content. The forensic odontologists were

chosen for the survey on account of the author’s

previous professional contact with them, and it is

recognised that this, in no way, represented an

unbiased sample. Comparing these programmes, it is

obvious that a common framework exists in teaching

forensic odontology. Topics such as (1) post-mortem

dental identification and disaster victim identification,

(2) age estimation, (3) anthropology, and (4) bite mark

analysis, are covered in all the universities.

(1) Post-mortem dental identification, which includes

identification of decomposed, traumatised or

burned remains, is regarded as the most important

aspect of forensic odontology (12). In fact, the

genesis of modern forensic odontology could be

attributed to the use of dental evidence in identi-

fying victims of two European disasters of the 19th

century: the fire at the Ring Theatre of Vienna in

1881 which claimed 449 lives, and the Bazaar de la

Charite fire of Paris in 1897 that resulted in 127

casualties (13).

(2) The dentition has long been used for estimating

age. In the first half of 19th century the Factory Act

of England prevented a child without the second

permanent molar from working in factories (14).

The tables of Schour and Massler (15) and Gus-

tafson’s method (16), two early scientific estima-

tors of age that utilised teeth, date back >50 years.

(3) Anthropological examination of teeth can yield

information useful in building the profile of

unidentified individuals, e.g. Lund and Mornstad

(17) suggested that tooth measurements could

indicate sex, while morphological features such as

Carabelli’s trait give clues to a person’s ethnicity.

(4) Bite mark investigation is probably the most

challenging aspect of forensic odontology. Its

judicious use can prove critical in sexual assault,

homicide (Fig. 1) and other criminal investiga-

tions.

(5) Interpretation of ante-mortem dental records is a

crucial part of dental identification. The ability to

decipher terminologies, short-hands and notations

used by dentists from different parts of the world

is essential to successfully match the dental record

to the post-mortem data (18).

(6) To the general practitioner not used to the prac-

tical details of court procedures, the possibility of

testifying in court can be intimidating. Therefore,

session(s) on the dentists’ role as an expert witness

and mock court trials (9) can be an invaluable

prelude to real-life situations.

(7) While the value of skull-face superimposition

(Fig. 2) in identification is debatable, it is a useful

adjunct in identifying skeletal specimens in the

absence of ante-mortem dental records.

Topics such as dental record interpretation (5), the

dentists’ role as an expert witness (6), and extra-oral

Fig. 1. Bite mark on a homicide victim. (Reprinted from: Thali MJet al. Bite mark documentation and analysis: the forensic 3D/CADsupported photogrammetry approach. Forensic Sci Int. 2003; 135:115–21, with permission from Elsevier.)

Acharya

138

identification methods such as skull-face superimpo-

sition (7) are covered at the majority of the institutes.

In addition to these topics, specific aspects of

forensic odontology are emphasised in individual

institutions. In the University of Oslo, Norway, as

many as five lectures and two 3-h seminars are

devoted to dental jurisprudence and ethics (T. Sol-

heim, personal communication). In one of the semi-

nars, students are given cases where problems have

occurred or could occur, and they discuss what they

would do under such situations in their own practice.

Recognising the need for forensic odontologists to

prepare injury reports, a lecture on dental injuries and

a court case involving the same is organised.

Coverage of forensic odontology in the University of

Adelaide, Australia, is brief, with a total of three

lectures in 5 years (H. James, personal communica-

tion). There is, however, a substantial elective compo-

nent in the fifth year which lasts for 1 week and places

emphasis on court and legal procedures. The session

on expert evidence is complemented with a visit to

court.

Most aspects of forensic odontology are covered in

the University of Malaya, Malaysia (P. Nambiar,

personal communication). Of particular interest are

the lectures on animal dentition and lip prints (which

are commented on later). A lecture ‘structure of the

court system’ is taken by a lawyer attached to the

attorney-general’s office. In fact, some (19, 20) argue

that special lectures which include professionals from

other aspects of forensic sciences, such as forensic

pathologists, toxicologists, anthropologists, photogra-

phers, lawyers and police, should be included since an

approach involving multidisciplinary interactions can

be useful.

At Tokyo Dental College, Japan, a comprehensive

spectrum of subjects ranging from forensic medicine,

serology and molecular biology are included in ‘four-

teen 85-min lectures’ (K. Minaguchi, personal com-

munication). These delve into genetic markers from

blood cells, examination of body fluids (which

includes salivary cell polymorphisms), age estimation

(from bone and skull), sex determination (from bone

and DNA) and population genetics. There is in-depth

coverage of DNA techniques. DNA analysis of saliva

and dental tissues can be crucial in bite mark analysis

and dental identification, respectively, and it is felt

imperative that students are exposed to the basics of

such procedures.

Dental DNA analysis is covered briefly under the

title ‘unconventional identification’ at B.P. Koirala

Institute of Health Sciences, Nepal, where third year

dental undergraduates are taught forensic odontology

and forensic medicine. Forensic medicine makes up a

major component and, in addition to lectures (termed

‘structured interactive session’ or SIS), include practi-

cal exercises in soft tissue examination, examination of

weapons, toxicology, injury report writing and autop-

sies. The philosophy behind teaching detailed forensic

medicine to dental undergraduates is that dentists

should be able to assist routine medico-legal cases,

particularly since some of this country’s regions are

geographically isolated, with minimal health profes-

sionals available.

Practical exercises in forensic odontology include

post-mortem dental examination, simulated dental

identification and disaster victim identification, radi-

ographic age estimation, craniomandibular sex differ-

ences, as well as bite mark evidence collection and

analysis. The latter makes use of two-dimensional

digital analysis suggested by Johansen and Bowers (2),

making the exercise more exciting for students.

Animal dentition and lip prints are also covered in

Nepal. While some may be surprised at the inclusion

of animal dental patterns in forensic odontology, a

basic knowledge of comparative dental anatomy is

essential in investigating cases of animal bite marks.

This has great relevance in Nepal, particularly when

frequent cases of carnivorous attacks on the fringes of

nature may necessitate accurate identification of

the species or individual animal. The investigation of

latent lip prints (Fig. 3) is analogous to fingerprint

analysis, and can be considered a genuine subspecialty

Fig. 2. Superimposition of a putative deceased’s photograph on anunknown skull. (Reprinted from: Bilge Y et al. The identificationof a dismembered human body: a multidisciplinary approach.Forensic Sci Int, 2003: 137: 141–6, with permission from Elsevier.)

Teaching forensic odontology

139

of forensic odontology; however, a lack of routine

casework and research (21) seems to preclude its

detailed coverage.

While relevant aspects of forensic odontology are

integral to the institutes surveyed, insufficient cover-

age of DNA techniques in most of these institutes may

deprive students of exposure to frontier forensic

science. That stated it does not imply the non-

existence of institutes that teach these topics. The

author recognises that the institutes surveyed do not

necessarily represent their respective countries, and at

least two of the specialists surveyed have indicated

that the programmes are specific to their universities.

How can forensic odontology be taught?

It was considered that many concepts of forensic

odontology resemble oral biology and that the forensic

odontology curriculum could be modelled along this

assumption (22), e.g. tooth morphology has applica-

tion in sex and population determination, while the

chronology of dental development has forensic use in

age estimation. Alternatively, it was suggested that

forensic odontology should be taught only after

students have been exposed to pathology, jurispru-

dence, practice management and clinical dentistry

(19). While the different institutions surveyed in the

present study teach forensic odontology at different

stages of undergraduate training, this author suggests

that topics such as anthropology, DNA polymor-

phisms, animal dentition, histological age estimation

techniques and bite mark analysis can be taught to

students during the early undergraduate years, since

these often require detailed knowledge of basic

sciences, oral biology and occlusion dynamics. Topics

that require clinical acumen, such as interpretation of

dental records, post-mortem procedures, and radiog-

raphy methods (including post-mortem radiography

and radiographic age estimation) could be introduced

towards the latter stages of undergraduate training. In

countries which are yet to have forensic odontology as

a separate subject, and where specialty-based depart-

ments are still in existence, topics in forensic odontol-

ogy may be combined with other related dental

subjects, e.g. ethnic and sex differences in tooth

morphology as part of tooth morphology, radio-

graphic age estimation of children and adolescents

as part of paedodontics or orthodontics. However, it

has been emphasised that one department should

have overall responsibility for teaching the course

undertaken by dentists with specialist training and

adequate experience in the discipline (19, 23). It is,

therefore, not surprising that separate departments in

forensic odontology exist in most of the surveyed

universities, with specialist forensic odontologists

teaching the subject.

Conclusion

To maximise dental application in forensic cases, it is

necessary to train dentists in the practical aspects of

forensic odontology. This necessitates exposing dental

undergraduates to the basic principles and techniques

of the subject. While this, in itself, does not ensure

competency, it will facilitate dentists to (1) recognise

forensic cases with dental implications; and (2) assist

forensic odontologists in routine casework. In his

summing up one of the first cases in Britain which

made use of dental evidence, Lord Grant said of

forensic odontology: ‘This is a relatively new science,

but there must of course be a first time. Scientific

knowledge and medical knowledge advance as the

years go on…’ (24). Forensic odontology has evolved

and its importance in police investigation is widely

acknowledged by the general public and legal author-

ities (6). It is essential that the curriculum content is

constantly updated for the benefit of the discipline and

the community it serves. This ensures that undergrad-

uates are aware of new trends in the subject and also

enables more objective decision-making by prospect-

ive post-graduates. It is stressed that the preceding

forensic odontology curricula do not represent the

global norm. Hence, an in depth analysis of trends

in teaching forensic odontology is possible only

after undertaking a more comprehensive worldwide

survey.

Fig. 3. Latent lip prints reproduced on a glass surface. (Reprintedfrom: Alvarez M et al. Persistent lipsticks and their lip prints: newhidden evidence at the crime scene. Forensic Sci Int, 2000: 112: 41–7, with permission from Elsevier.)

Acharya

140

Acknowledgements

The author wishes to thank Tore Solheim, Kiyoshi

Minaguchi, Phrabakaran Nambiar and Helen James

for providing the forensic odontology content at their

respective institutes. Many thanks to Dr Jane Taylor of

the University of Newcastle, Australia, for her valu-

able suggestions on the content and language of the

manuscript. Most of the literature cited below is

archived in the Forensic Odontology Unit, Faculty of

Dentistry, University of Adelaide, Australia, to which

the author obtained access during his post-graduate

study.

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Address:

Ashith B. Acharya

Department of Oral Pathology

S.D.M College of Dental Sciences and Hospital

Dhavalanagar

Sattur

Dharwad – 580009

Karnataka

India

Tel: +91 836 246 8142

Fax: +91 836 246 7612

e-mail: ashithacharya@hotmail.com

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