Assessment of Knowledge, Awareness and Practice of Forensic Odontology among Interns and Post Graduate Students

Introduction

The term “forensic” has its origin within the Latin word “forensis” from “forum,” which implies a place wherever legal matters are discussed.¹ The science of dentistry which is associated with the law is known as forensic medicine or forensic odontology.² Forensic medicine may be a specialized field of odontology associated with legal issues. It’s one among the foremost speedily developing branches of forensic medicine and forensic science.³ Forensic odontology can be defined as the branch of dentistry that addresses the proper handling and examination of dental evidence and the evaluation and presentation of dental findings in the interests of justice.⁴

The few important applications of forensic odontology include identification of human remains through dental records and assisting at the scene of crime; through bite marks or physical injuries child or adult abuse cases can be identified ; living or deceased subjects age and gender may be determined and to testify as an expert witness in court to present forensic dental evidence.⁵ Dental identification, bite marks investigation, cheiloscopy (study of lip prints) and rugoscopy (study of palatal rugae patterns) are the four foremost areas of interest of forensic medicine.⁶ Dental identification plays a major task in identification of human remains once postmortem alterations like traumatic tissue injury occur to such associate extent that finger prints cannot be recorded.⁷ However, regarding forensic sciences among dentists the experience is still insufficient in India.⁸

Thus, the need for the survey is to assess among Interns and post graduate about the awareness of Forensic odontology.

Methods

A cross-sectional institutional-based study was conducted among 100 subjects out of which 60 were interns and 40 were post graduates. The survey tool employed was a questionnaire comprising of 15 multiple choice questions (Q1-Q15) based on Likert scale.

The questionnaire was designed based on knowledge, attitude & practice towards Forensic odontology. Questionnaire copies were distributed to the Interns and post graduate dental students and filled copies of the same were collected. Ethical clearance was obtained from institutional review board and participation was voluntary. The questionnaire consisted of 3 groups - knowledge -5, attitude -5, and practice-5.

Statistical Package for Social Sciences [SPSS] for Windows, Version 22.0. Released 2013. Armonk, NY: IBM Corp., was used to perform statistical analyses. Descriptive Statistics was used to include expression of the responses to the questionnaire by the study participants in terms of frequency and proportions. Chi Square Goodness of Fit Test was used to compare the distribution of responses to Knowledge, Attitude & Practice based questions. Chi Square Test was used to compare the responses to Knowledge, Attitude & Practice based questions between interns & PGs. The level of significance [P-Value] was set at P<0.05.

Results

Out of 100 dental students, 99% were aware about forensic odontology. Sixty three percent knew about periodontal post mortem can help in identification of time of death, age and sex determination of the deceased, 67% were aware of the significance of teeth in forensic dentistry and 56% were aware that a dentist can testify as an expert witness in court to present forensic dental evidence (Table 1). When compared between interns and post graduates, postgraduates were better aware of significance of bite mark patterns of teeth in forensic dentistry and that a dentist can testify as an expert witness in court to present forensic dental evidence, it was statistically significant (Table 2). 67.6% Interns and 87% Post graduates had adequate knowledge about forensic odontology.

Regarding the attitude about forensic odontology, 70% were interested in formal training in forensic odontology, 38% update themselves regarding the current aspects of forensic odontology (Table 3). 53% Interns and 59% Post graduates showed positive attitude.

Regarding the practice, 91% record past medical and dental history, 92% maintain treatment details of the patient, 70% use intra/extra-oral photography in primary practice and 51% retain previous radiographs (Table 4) (Image 1). Fifty nine percent interns and 83% post graduates showed positive response towards practice (Table 5).

Discussion Primary concern of forensic science is with the appliance of science in court or legal proceedings. Forensic dentistry is a very important branch of the study of dentistry that might assist in finding cases of abuses and deaths. Greater knowledge and awareness of forensic dentistry among the dental practitioners would be required within the growing field of medicine.⁹

Greater knowledge and awareness variations of teeth and mucosa with photographs and radiographs, this antemortem record will help to identify deceased persons and criminals by comparing with the postmortem records prepared by examining deceased persons during investigations, in homicide and mass disasters.¹⁰

In the present survey, the questionnaire was designed, which consisted of 15 questions, to assess the awareness, knowledge, and practice in forensic odontology among interns and postgraduates.

In the present study almost all the participants were aware of forensic odontology, 31% of participants thinks that knowledge level about forensic odontology is adequate, where as 41% in the study done by Hannah et al¹¹ and 61% of participants in study by Bhakhri S et al¹² thinks that knowledge level is adequate.

Tooth acts as a reliable tool in age estimation that’s adopted by most of the anthropologists, archaeologists, and forensic odontologists. The age-related changes in tooth can be divided into three categories: Degenerative, formative and histological changes. Formative changes includes crown and root completion and eruption of tooth and thus it act as good predictors till the age of 12 years. Degenerative changes include periodontosis, periodontitis, secondary dentin and cementum apposition (both seen microscopically), root resorption, and transparency of the root seen in ground sections. Histological measures mainly include incremental lines of enamel/dentin, dentinal translucency, neonatal lines, degree of formation of crown, and root etc.¹³ Age assessment by means of teeth can provide the most trustworthy guide in the process of identification. A variety of methods are used including the radiographic method, visual method, histological method, physical and chemical analysis. Eruption sequence, incremental lines of Retzius, neonatal line formation, Schour and Massler chart and Gustafson’s method are main parameters in age estimation.¹⁴

For the determination of sex dental calculus may be used by PCR method using primers, which recognize DYZ3 region of Y-chromosome and DXZ1 of X-chromosome. Using DNA for sex determination in dental calculus will be quite useful for forensic application because it can be done without destruction of morphological characteristics of the teeth.¹⁵ In this study 63% of respondent were aware of periodontal structures post mortem can help in identification of time of death, age & sex determination.

Other important aspect of forensic odontology is bitemark analysis. It can be easily found in food stuffs. Each dentition, including the number of teeth, occlusion, their position and the restoration are unique for each individual. Therefore, these bite marks provide a kind of dental identification.¹⁶ In current study, 67% of participants were aware about significance of bite mark pattern of teeth in forensic odontology while study conducted by Preethi et al ¹⁷ and Bhakhri S et al¹², 82% and 71.4% respectively knew the significance of bite mark pattern of the teeth, this could be because of higher number of participants involved and also study was conducted among the dental practitioners. In study done by Harchandani N et al¹⁸ where 72% responders did not know the significance of bite mark patterns which is contradictory to current study. Knowledge about bite marks was found to be statistically significant among post graduates than Interns in the present study which corresponds to study done by Rahman et al¹⁹ and Abdul et al.²⁰ Organization of seminars and conferences, can provide information on the progress of technologies and guidelines in forensic dentistry at the undergraduate level, which will enhance the level of knowledge among the Interns.

56% were aware that a dentist can testify as an expert witness in court to present forensic dental evidence which corresponds to study done by Bhakhri S et al¹² which was 57.4% and this was in contradiction to the studies conducted by Rathod et al²¹ and Harchandani N et al^[18] wherein 75% and 65% respondents, respectively, were not aware that dentist can testify as an expert witness. Postgraduates were significantly aware about testifying as an expert witness in court to present forensic dental evidence than Interns. According to Krishan et al²² forensic odontologists are involved in assisting the law enforcing agencies in proper presentation of the dental evidence collected from the scene of crime or mass fatality incidents. The evidence is compared with the antemortem records available to the dentists for identification of the deceased.

In current study, 70 % of respondents were interested in formal training in forensic odontology, other studies conducted by Hannah et al^[11] and Sahni et al²³, 83% and 94% respondents, respectively, were interested in formal training. In between the groups Post graduates have positive attitude towards updating about the current aspects of forensic odontology than Interns.

91% of responders recorded past dental and medical history and there was no significant difference between the groups which is similar to the study conducted by Rahman et al¹⁹.

Only, 51% and 39% of participants retained previous radiographs and dental casts respectively, wherein 73.9% and 62.7% respondents retained radiographs and dental casts in the study conducted Rahman et al¹⁹. Postgraduates were significant than Interns, formal training by conducting CDE programs and workshop could improve the attitude towards practice.

In study conducted by Rahman et al19, 79.7% respondents use intra/extraoral photography where as in this study 70% of participants use, postgraduates were significant which corroborates with study by Rahman et al.¹⁹

Dentists should know the importance of preparing an accurate dental record as well as the importance of preserving these records. These records serve the  purpose of the future reference for their practice when needed and for medicolegal cases. As stated by the law, a minimum of 7 years to a maximum of 10 years the records should be maintained for forensic purposes.²³

Various studies done by Preethi et al^[17], Harchandani et al^[18] conducted that there is inadequate of knowledge, Poor attitude and lack of practice. In study conducted by Nagarajappa et al24 revealed adequate knowledge and attitude but lack of practice in maintaining dental records.

The observation in present study overall results showed adequate knowledge, attitude and practice however, regarding individual questions post graduates showed better knowledge, attitude and practice when compared to intern group. Similar surveys and research should be undertaken at all levels to raise awareness so everyone benefits in the near future.

The study’s drawback is that it was limited among interns and post graduates, in the future scope of the study it can be expanded widely to include Undergraduate students, dental practitioners and academicians to assess the awareness, knowledge and practice on forensic odontology.

Forensically valued dental records should be maintained in detail, ensuring accuracy, accessibility and legibility. Furthermore, profession-wide strategies for teaching students and professionals about forensic dentistry should be implemented, including the provision of Continuing Dental Education modules by the Indian Association of Forensic Odontology.

Conclusion

Dental records are created and maintained to contribute to the safety and continuity of dental care, for treatment decisions, treatment planning, and legal purposes. Our results showed adequate level of knowledge in both the groups, however poor attitude and lack of practice was revealed in under graduates when compared to postgraduate students. Therefore, emphasis should be put on increasing knowledge by developing better curriculums for undergraduates and postgraduates.

Conflict of Interest

None.