|Year : 2018 | Volume
| Issue : 1 | Page : 17-20
A cross-sectional study to assess knowledge, attitude, and awareness of forensic odontology among medical students: An emergency concern
Jayalakshmi Kumaraswamy1, Raghunandan Bangalore Nagarajachar1, Roopavathi Keshavaiah1, Archana Susainathan2, Mahesh Batalahalli Sreenivas Reddy3, Jaya Naidu4
1 Department of Oral Pathology and Microbiology, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
2 Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
3 Department of Oral Medicine and Radiology, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
4 Department of Paedodontics, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka, India
|Date of Web Publication||19-Jun-2018|
Dr. Jayalakshmi Kumaraswamy
Department of Oral Pathology and Microbiology, Vydehi Institute of Dental Sciences and Research Centre, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Medical professionals are important in treating and management of victims of mass disasters, abuse, and organized crimes. Although the forensic odontologist has a pivotal role in the investigation, health-care provider in the emergency medicine should have the potential to detect, inform, and interact with the dentist for further applications in legal issues. We aimed to conduct the present study on the knowledge, awareness, and attitude among the medical students.
Materials and Methods: With informed consent, we conducted a cross-sectional study among 194 4th-year medical students. A structured questionnaire consisting of 17 items relating to forensic odontology to assess the knowledge, awareness, and attitude among medical students and data were collected and reviewed.
Results: On analyzing the collected data of 194 participants, the percentage of participants who knew: the meaning of forensic odontology, forensic odontology a part of forensic medicine, and role of forensic odontology in the criminal analysis were 172 (87%), 192 (99%), and 181 (93%), respectively. A total of 183 (94%) were aware of bite mark patterns, 171 (88%) would examine for bite marks in child abuse, 89 (46%) the lip prints, DNA as accurate and sensitive method of comparison and teeth as source of DNA was 128 (66%) and 122 (63%), respectively. A total of 127 (65%) agreed that forensic odontologist as experts, 101 (52%) had opted for dental evidence, and 139 (72%) had agreed that postmortem unit should include a dental laboratory facility. However, only 79 (41%) knew the tooth as the choice of evidence in mass disaster. 101 (52%) stated dentist as expert witness. The awareness of the role of teeth in age and gender estimation was 147 (76%) and 79 (41%), respectively. Forty-nine (25%) had handled forensic dentistry case in emergency medicine and importance of maintaining dental records were known to 85 (44%).
Conclusions: Medical students had inadequate knowledge of forensic odontology. As a health-care provider, medical professionals should understand the implications of forensic odontology.
Keywords: Age estimation, bite marks, dental evidence, dental records, DNA analysis, expert opinion, forensic medicine, forensic odontology, gender determination, medical students, postmortem unit
|How to cite this article:|
Kumaraswamy J, Nagarajachar RB, Keshavaiah R, Susainathan A, Sreenivas Reddy MB, Naidu J. A cross-sectional study to assess knowledge, attitude, and awareness of forensic odontology among medical students: An emergency concern. Int J Forensic Odontol 2018;3:17-20
|How to cite this URL:|
Kumaraswamy J, Nagarajachar RB, Keshavaiah R, Susainathan A, Sreenivas Reddy MB, Naidu J. A cross-sectional study to assess knowledge, attitude, and awareness of forensic odontology among medical students: An emergency concern. Int J Forensic Odontol [serial online] 2018 [cited 2019 Aug 22];3:17-20. Available from: http://www.ijofo.org/text.asp?2018/3/1/17/234749
| Introduction|| |
Forensic dentistry plays a major role in the identification of those individuals who cannot be identified visually or by other means. Forensic odontology is a fascinating specialized branch of dentistry related to solving legal problems. Dental evidence has significant application in identification of victims, suspects, and abused individuals. Dental identification has played a pivotal role and was first accepted by the court of law in the year 1849. The ante-mortem and post-mortem dental records assist in identification of the deceased through the human remains. Keiser-Neilson defined Forensic odontology as “the branch of forensic medicine which deals with the proper handling, examination and presentation of dental evidence in the best interest of justice.
Forensic medicine is a branch which deals with the application of medical knowledge in the judiciary system. It not only involves medico-legal autopsies and forensic pathology but also solving issues related to rape cases and domestic violence. Forensic medicine course is necessary in the field of health-care, and this fascinated branch eventually improves the knowledge and attitude of students. Furthermore, educating the undergraduate graduates about forensic medicine is extremely important.,
Estimation of time of death is a very crucial concern in the field of forensic medicine. The accuracy of estimation may be affected by postmortem changes due to several factors. Hence, there is growing increase in various studies to establish time of death. Regrettably, most of the methods do not convene the necessity in practical application.
In conjunction with other health-care providers, dental professionals do come across cases of injuries for that may be non accidental. A dentist who is qualified in forensic science provides expert opinion in cases related to dental identification, analysis of bite mark, estimation of age, and other malpractices. Along with these, maintenance of dental records is a crucial role in investigation by a dental practitioner. Blood group antigen may also be determined by using teeth by a dentist.
The medical professionals are the first line of primary health-care providers in the emergency medicine department. They encounter a large number of medico-legal cases in the emergency medicine department. Cases such as victims of abuse, mass disasters, and other organized crime are treated and managed the emergency department. Although forensic odontology is establishing its significant role in crime scene investigations most of the health-care providers have insufficient knowledge about it. Active participation in routine investigations would be an added advantage in providing the knowledge and team work is necessary for a successful response. Although the forensic odontologist has a pivotal role in the investigation, health-care providers such as the medical care staff who are present as primary staff in the emergency medicine should have the potential to detect, inform, and interact with dentist for further applications in legal issues.
With this background, we aimed to conduct a study on the knowledge and attitude among the medical students.
| Materials and Methods|| |
The survey comprised 4th-year medical students and medical interns, 194 in total. A structured questionnaire consisting of 17 questions [Table 1], of which seven were multiple choice questions and 10 were Yes/No options. With informed consent from all the participants, data were collected and analyzed. Sufficient time was given to fill the questionnaire while maintaining the confidentiality of the participants.
| Results|| |
With 100% response from the participants, the data were collected and analyzed. On analyzing the collected data, we found about 172 (87%) students knew the meaning of forensic odontology. A total of 128 (66%) participants were aware that DNA comparison is the most accurate and sensitive method to identify an individual. A total of 127 (65%) of them agreed that identification experts included forensic odontologists. About 101 (52%) had opted that along with other evidence collection, collecting dental evidence is also important. About 139 (72%) had agreed that postmortem unit should include a dental laboratory facility. Only 79 (41%) said that tooth is the choice of evidence collection in mass disasters.
About 192 (99%) agreed that forensic odontology is a part of forensic medicine. 181 (93%) knew forensic dentistry plays a role in victim/criminal analysis. About 101 (52%) were aware that court of law accepts the statement of a dentist as an expert witness. Only about 49 (25%) had handled forensic dentistry case in emergency medicine. The significance of maintaining dental records were known to only 85 (44%) participants. 183 (94%) were aware of bite mark patterns of teeth. 171 (88%) examine for bite marks in child abuse. Only 89 (46%) knew that lip prints could be presented as dental evidence. 147 (76%) were aware that forensic dentistry helps in age estimation. Using teeth, gender estimation could be done was known to only 79 (41%). 122 (63%) were aware that DNA analysis could be done using teeth.
| Discussion|| |
Forensic dentistry involves the application of dental knowledge in the investigation of crime and administration of justice in the court of law. As educating forensic medicine is important for medical students, knowledge and awareness about forensic odontology is equally important.
The study was conducted to assess the knowledge, awareness, and attitude among medical students, as they are the primary health-care providers. The participants had better knowledge about awareness regarding the meaning of forensic odontology (87%), forensic odontology as a part of forensic medicine (99%), role of forensic dentistry in victim analysis (93%), bite mark patterns of teeth (94%), and examination for bite marks in child abuse (88%).
As teeth and jaws are impermeable to most types of injuries and also well protected from fire and other mechanical trauma, it may be implicated in human identification during mass disasters. When the deceased person is skeletonized, decomposed, burned, or dismembered, identification of dental remains plays a major role. The major advantage of teeth is it can be preserved after death and also teeth are highly durable that they can resist a temperature of 1600°C without loss microscopic structure. However in our study, we found only 41% would prefer dental evidence collection in mass disasters.
The best method for gender identification is DNA analysis, as morphological patterns vary with external factors and with time. The extracted DNA from the teeth of an unidentified individual may be compared with the antemortem DNA samples. Though DNA comparison is the most accurate and sensitive method to identify an individual, only 66% were aware and 63% knew that DNA analysis could be done using teeth. Knowledge and awareness about teeth as an excellent source for DNA extraction was inadequate among the participants.
Bite mark analysis helps in identification of an individual. Teeth may be used as a weapon and may leave the mark of a biter. Bite mark registration plays a pivotal role in the forensic field. In our study, 94% were aware of bite mark patterns, 88% agreed they would examine for bite marks in child abuse.
Although the knowledge about the inclusion of forensic odontologists along with other identification experts and postmortem unit consisting of dental laboratory facility was 65% and 72%, respectively, only 52% opted for collecting dental evidence. Insufficient knowledge about the determination of gender using teeth (41%) and lip print presentation as dental evidence (46%) was observed in our study. We also found that only 52% were aware that court of law accepts the statement of the dentist as an expert witness.
Age estimation is crucial in establishing the distinctiveness of an individual as the development of human dentition follows a consistent developmental sequence starting from 4 months in utero until the emergence of third molars, i.e., second to third decade of life. In our study, awareness about the estimation of age using teeth was 76%, which is inadequate.
The dental record provides the continuity of care for the patient and is crucial in the incident of any unethical insurance claim. Dental records are also useful in identification of a deceased by comparing ante-mortem and post-mortem reports. In our study, only 44% of participants were about the significance of maintaining dental records.
The overall result of our study was inadequate knowledge, awareness, and attitude about forensic odontology among the medical students. The reason for this could be lack of handling of forensic dentistry cases in emergency medicine department (25%).
| Conclusions|| |
Multiple scientific and allied services are necessary to the forensic field. Medical care professional should be given a basic training in forensic odontology, to assist a dentist in the presentation of evidence for the detection and solution of crime or in civil proceedings. A medical care staff should possess the skill to understand the forensic implications. It is mandatory to report any instance of human abuse to the proper authorities in most jurisdictions.
Further research work on large scale basis is required for evaluation of awareness, knowledge, and attitude among medical professionals. Medical students should also be included in periodic conferences and seminars conducted in forensic odontology which would improve their knowledge. Workshops may be conducted so that the practical skill would be developed in handling forensic odontology related cases in emergency department.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Achary AB, Sundharan BV. Shafer's Textbook of Oral Pathology: Forensic Odontology. Vol. 6. India: Elsevier Private Ltd.; 2009. p. 871-92.
Sharma G, Yadav M, Singh H, Aggarwal AD, Sandhu R. Forensic odontology: Role in mass disasters. J Indian Acad Forensic Med 2006:28:971-3.
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;3:63-6.
] [Full text]
Keiser-Nielsen S. Person Identification by Means of the Teeth. Bristol: John Wright and Sons; 1980. p. 54-72.
Uotila U. Experiences and reflections in the field of forensic medicine. Forensic Sci 1975;6:115-8.
Madea B, Saukko P. Future in forensic medicine as an academic discipline – Focussing on research. Forensic Sci Int 2007;165:87-91.
Kennedy KM, Vellinga A, Bonner N, Stewart B, McGrath D. How teaching on the care of the victim of sexual violence alters undergraduate medical students' awareness of the key issues involved in patient care and their attitudes to such patients. J Forensic Leg Med 2013;20:582-7.
Sharma BR, Harish D. Teaching, training and practice of forensic medicine in India: An overview. J Ind Acad Forensic Med 2005;27:247-51.
Madadin MS. Assessment of knowledge about, attitudes toward, and awareness of a forensic medicine course among medical students at the university of Dammam. J Forensic Leg Med 2013;20:1108-11.
Henssge C, Madea B. Estimation of the time since death. Forensic Sci Int 2007;165:182-4.
Stratton TD, Witzke DB, Elam CL, Cheever TR. Learning and career specialty preferences of medical school applicants. Journal of Vocational Behavior 2005;67:35-50.
Shamim T, Varughese V, Shameena PM, Sudha S. Forensic odontology: A new perspective. Med Update 2006;6:1-4.
Adams BJ. Establishing personal identification based on specific patterns of missing, filled, and unrestored teeth. J Forensic Sci 2003;48:487-96.
Aswath N, Selvamuthukumar SC, Karthika B. Role of dental pulp in identification of the deceased individual by establishing ABO blood grouping and rhesus factor. Indian J Dent Res 2012;23:811-3.
] [Full text]
Rothwell BR. Principles of dental identification. Dent Clin North Am 2001;45:253-70.
Hemanth M, Vidya M, Nandaprasad, Karkera BV. Sex determination using dental tissue. Med Leg Update 2008-07 2008-12;8:2.
Gatliff BP. Facial sculpture on the skull for identification. Am J Forensic Med Pathol 1984;5:327-32.
Charangowda BK. Dental records: An overview. J Forensic Dent Sci 2010;2:5-10.
] [Full text]