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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 33  |  Issue : 4  |  Page : 385-390

Awareness towards forensic dentistry - A questionnaire-based cross-sectional study


1 Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
2 Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, Maharashtra, India
3 Community Health Centre, Moradabad, Uttar Pradesh, India
4 Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India

Date of Submission26-Jul-2021
Date of Decision12-Oct-2021
Date of Acceptance01-Nov-2021
Date of Web Publication27-Dec-2021

Correspondence Address:
Dr. Sneha R Sharma
Assistant Professor, Department of Oral Medicine and Radiology, Pacific Dental College and Hospital, Udaipur (313024), Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_211_21

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   Abstract 


Background: Forensic odontology is a vital branch of dentistry which applies the knowledge of dentistry mainly for age and gender estimation, person identification and the identification from human remains. The role of a general dentist towards forensics is crucial for medicolegal cases. Aim: The aim of the study was to scrutinize the awareness and approach of dental fraternity namely Interns, Postgraduate students and practicing clinicians towards forensic odontology. Methods and Material: A cross-sectional study was conducted in 1,860 participants, divided according to age and educational qualifications. Data was collected digitally using Google forms. Descriptive analysis were performed to describe frequencies and percentages. Chi-square test was used to analyze statistical significance. Results: 97% of the total participants maintained dental records, with only 13.4% maintaining complete records. Maximum participants were unaware of the duration for which patient records should be maintained. The significance of patient radiographs was known to 71.6% participants. 72% were vigilant of the implication of maintaining dental records in identification of the deceased. 57% knew about radiographic methods used for age estimation. 47.74% gave a response that DNA comparison has the maximum accuracy to ascertain the identity of an individual. 46.7% had the knowledge about formal training centers of forensic odontology in India. Conclusion: The present study revealed partial lack of knowledge, awareness and information of forensic odontology among the participants. Amongst all participants, the highest responses were noted amongst students and younger age group.

Keywords: Awareness, dental practitioners, forensic dentistry, forensic odontology, knowledge


How to cite this article:
Sharma SR, Karjodkar FR, Sansare KP, Saalim M, Sharma AH, Chavan SA. Awareness towards forensic dentistry - A questionnaire-based cross-sectional study. J Indian Acad Oral Med Radiol 2021;33:385-90

How to cite this URL:
Sharma SR, Karjodkar FR, Sansare KP, Saalim M, Sharma AH, Chavan SA. Awareness towards forensic dentistry - A questionnaire-based cross-sectional study. J Indian Acad Oral Med Radiol [serial online] 2021 [cited 2022 Aug 11];33:385-90. Available from: https://www.jiaomr.in/text.asp?2021/33/4/385/333868




   Introduction Top


Forensic dentistry is a complex, intriguing subdivision of forensic science, which is involved in identifying the human remains in addition to determination of age and gender. As previously put forth by Keiser–Nielson, forensic odontology, comprises of the appropriate handling, investigation, and presentation of dental records as proof in the court of justice.[1]

Forensic odontology has become an integral and essential part of forensic medicine in the last century.[2] Forensic dental fieldwork necessitates a broad understanding of dental science. The tooth is a very significant biological marker for age estimation owing to its mineralized contents and its ability to withstand taphonomic processes as well as postmortem changes. The dental maturity status can be taken as a reliable parameter for evaluating the biological age for forensic and anthropological purposes. 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.[3]

The human dentition is unique to every individual, the way fingerprints are unique to an individual. Dental clinicians, like healthcare professionals are at the leading edge in determination of age as well as in identification of victims. General dental clinicians must have a basic understanding of the character of a forensic pathologist, autopsy methods, the role of a dentist in proving an individual's identity, and the value of maintaining patients' dental records.[2] Documentation of human remains by dental records; bite marks and indentations due to physical trauma in alleged abuse of children or adults; age and gender estimation of living or dead; and attesting as a competent expert in court to put forth dental proof are important applications of forensic odontology. The dental professionals can play an extremely crucial role in the identification of individuals using the dentition as a tool as well as in identification of victims through bite mark analysis. Unfortunately, in India, there are very few qualified forensic odontologists; perhaps because of the dearth of proper awareness, and incomplete understanding of the importance of a forensic dentist.[4]

Most dentists are conscious of the presence of the field of Forensic Odontology, but they also need to acknowledge the implications and importance of maintenance of dental records and encourage execution of Forensic Odontology. In spite of the need for well-trained and qualified forensic odontologists being acknowledged worldwide, the evolution of forensic odontology in India has been comparatively dawdling. There have been studies done in the past to evaluate the understanding and approach of students, faculty and professionals in the dental fraternity but they have been mostly done on a smaller sample size. As a result, the current research was conducted with a greater sample size in order to gain a deeper understanding and appraisal of forensic odontology and its practice, among dental interns, postgraduate students, teaching faculty affiliated with dental colleges and dental clinicians across various parts of the country.


   Materials and Methods Top


A questionnaire-based cross-sectional observational study was done amongst the Interns, Postgraduate students, teaching faculty of dental colleges and private dental practitioners. The research was conducted after approval from the Institutional Ethical Committee (EC-89/DOMR-29ND/2018 dated 13/06/2018) and was in accordance with the Declaration of Helsinki.

Sample size was determined using a single proportion formula -



Where p = Estimate of the expected proportion

d = Desired level of absolute precision

Assuming the current error prevalence/event rate to be at least 50%.

Keeping 5% confidence limit, for P = 0.05

n = 1.96 (0.5 × 0.5)

0.05 × 0.05

n = 384 for each group

A total sample Size of 1,900 was estimated out of which 1,860 participated in the study.

Study tool

The questionnaire consisting of 10 questions was pre-tested by giving it to 10 professionals to assess its feasibility, ease of understanding and reliability. They were requested to complete the survey and convey any doubtful questions to the chief investigator. The finalized questionnaire was uploaded online through Google forms and was distributed digitally using a link via email and other social media platforms by a single investigator. The consent of the participants was given by their willingness to take part in the survey. The participants' privacy and confidentiality were guaranteed. As the participants included were educated and literate professionals the questionnaire was only in English language, consisting of 10 open and close-ended questions and the participants were requested to respond to each question by selecting the most suitable option.

The Participant information documented were Age, Gender, Educational Qualification - Intern/Postgraduate dental student/Faculty of a dental college/Private Practitioner (the participant was asked to tick the appropriate qualification) and Number of Years into Dental practice (For participants having a private dental practice).

Statistical analysis

Data gathered from completed questionnaires were entered in a Microsoft Excel spreadsheet and statistical analysis was done by using Statistical Package of Social Science (SPSS 21). A descriptive statistical analysis was used to describe the data included in the survey. The percentage was used to describe the categorical data. The responses were tabulated and represented graphically. The Comparison of frequencies of categories of variables with groups and determination of statistically significant differences was done using Chi-square test. P ≤ 0.05 was considered statistically significant.


   Results Top


Demographic data

The complete questionnaire and participant responses to the different questions has been presented in [Table 1]. Out of the total 1,860 respondents who took part in answering the questionnaire, 43.22% (n = 804) were males and 56.77% (n = 1056) were females. [Figure 1] The participants were divided into five groups according to age – [Figure 2] Group 1 – less than 25 years of age (639), Group 2 –26 to 35 years of age (894), Group 3 –36 to 45 years of age (165), Group 4 –46 to 55 years of age (87) and Group 5 –more than 56 years of age (75).
Figure 1: Distribution of study participants as per gender

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Figure 2: Distribution of study participants as per age

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Table 1: Questionnaire and responses

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Considering the variation in the educational qualification and number of years into dental practice, the total sample was also divided into 7 groups [Figure 3]–:
Figure 3: Grouping of study participants as per their educational qualification

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Group A - Intern in a dental college (492)

Group B - Postgraduate student in a dental college (450)

Group C – Teaching Faculty of a dental college (207)

Group D - Private Practitioner - less than 5 years (381)

Group E - Private Practitioner - 6 to 10 years (156)

Group F - Private Practitioner -11 to 20 years (57)

Group G - Private Practitioner - More than 20 years (117)

The data analysis revealed that a very high percentage of participants (97.58%) 1,815 out of 1,860 participants of the study maintained dental records and only 45 participants did not maintain any dental records. There was a statistically significant/highly significant difference seen for the frequencies between the groups (P < 0.01, 0.05) with higher frequencies of age group (26--35 years) responding to option 1. When asked about the type of data recorded and maintained by the participants, every option (from a to h) was given a score of 1 and multiple responses could be given for this question. Respondents who preserved all records had the highest score of 8. [Figure 4].
Figure 4: Score for maintenance of dental records

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A statistically significant difference was noted for the frequencies between the groups (P < 0.01, 0.05) with higher frequencies age group 2 (26--35 years) corresponding to score 8 and Group A (Interns), closely followed by group B (postgraduate students). Out of the 1,860 participants, all records were maintained only by a handful of participants (13.4%). Study casts were maintained by 36.82%, radiographs were preserved by 71.66% and photographs were preserved by 48.76% of the participants.

Further, it was observed that 52.5% of the participants knew about the number of years recommended by the IDA for maintenance of dental records, 34.67% of the participants were unaware of it, while 12.37% of the participants chose not to answer this question. A statistically significant/highly significant difference was noted for the frequencies between the groups (P < 0.01, 0.05) with higher frequencies of age group 1 & 2 responding to option 1 [Figure 5].
Figure 5: Response to awareness of the number of years recommended by the IDA for maintenance of dental records

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Only 468 out of 1,860 (25.16%) participants responded to the question which asked about the number of years for which dental records should be preserved as per the Indian Dental Association (IDA). Amongst the 468 participants, 108 (23.07%) opted for option 6--10 years. Also, a highly significant difference seen for the frequencies between the groups (P < 0.01, 0.05) with higher frequencies of age group 2 responding to option A.

72% of the total participants had knowledge about the significance of maintaining dental records in identifying the deceased and crime suspects with highest number of positive responses being in Group 2 and Group A. 77.23% of the total participants responded that they knew about the dental age of a patient being estimated by examination of teeth. A statistically significant difference was noted for frequencies between groups (P < 0.01, 0.05) with higher frequencies of age Group 2 and Group A (Interns) responding to option 1.

Out of the total respondents, 77.9% said that a dentist can give testimony as a witness to submit scientific dental evidence, with the highest being in age Group 2 and group A.

A total of 57% of the participants knew about radiographic methods used for age estimation. Higher frequencies being of Group 2 and almost equal frequencies in Group A and B [Figure 6]. When asked about the most reliable and sensitive methods of identifying an individual, 52.15% of respondents opted that DNA comparison is the most reliable and sensitive method of identifying a person. Lastly, 46.7% had the knowledge about formal training centers available in India for the field of forensic odontology in India, out of which higher scores were recorded for Group 2 and Group A.
Figure 6: Responses to awareness of radiographic methods of age estimation

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   Discussion Top


The utilization of dental sciences in determining the age and gender of human beings and the identification of remains through dental records is known as forensic dentistry. Maintenance of patient details, pre and post treatment radiographs, photographs, impressions study casts, etc., is a moral and a legal obligation of the dentist as these play a vital part in forensic dentistry.[5]

In the present study, there was an excellent positive response with regards to maintaining patient details; as 97% of the participants' maintained dental records.

In 2011, in the study done on 322 participants, Preethi et al.[6] stated that 79% of dental practitioners maintained dental records, out of which only 12% maintained complete dental records. Unfortunately, this situation had barely changed even after a decade. In a recent survey done in Croatia in 2021, it was seen that 87% of the dental practitioners preserved the dental records. It was also noted that 21% did not know about forensic odontology and its uses.[7] In the present study, which was done on a much larger sample size, 97% of the participants maintained dental records but only 13.4% of them maintained complete records.

Also in the same study it was found that 41% of the clinical practitioners were not aware of dental age estimation methods, and 38% did not know about the exact technique of evaluating a person's identity. This number had lowered in the current study where 22.77% of the total respondents were unaware of the fact that teeth examination is helpful in knowing the dental age of the patient. A dental professional working in a clinic or in a hospital must be proficient with the importance of taking accurate and precise dental records and also preserving these records, as they serve as a source of future reference as and when needed as well as can be used as a tool in medicolegal circumstances. As per legal specifications, patient records should be retained for a minimum of 7 years up to a maximum of 10 years for forensic purposes.[8]

Radiographs are also a vital and essential aspect of forensics as they play a substantial role in revealing the identity of a person majorly through age estimation methods.[9],[10] Study casts are extremely reliable as they are a duplication of the patient's natural dentition. There were 71.6% participants maintaining the radiographs of patients while only 36.82% maintained study casts of a patient. This was in accordance with Sarode et al.[11] who stated in 2017 that 78% of the General dental practitioners retained radiographs. In the current study, 57% of the total participants knew about radiographic methods used for age estimation. Regarding the number of years advised by the IDA for maintenance of dental records, only 108 participants out of the total 1,860 participants responded accurately with the option of 6--10 years. The ideal time recommended by the IDA for preservation of dental records is 7 years. Maximum participants chose not to answer this question. This lack of confidence could be attributed either to lack of interest or lack of seminars and conferences held on the subject.

In the present study, significance of maintaining dental records in identification of the dead was acknowledged by 72% of the participants. In a study done in Saudi Arabia in 2015, it was found that dental students are more aware and likely to preserve patient records in a teaching hospital and college as compared to private dental practitioners. This can be due to the fact that the students are assessed on their skills of history taking and obtaining accurate records which have to be produced to obtain their grades during examinations.[12] A similar result was also seen in the present study where the highest positive responses were from the participants of age group 2 (26--35 years) and to educational qualification Group A and B (Interns and Postgraduate students)

In 2019, another study in Punjab, India concluded significant inadequacy in maintenance of dental records, inadequate knowledge, poor attitude and awareness and it was noted that about 26% of the graduates did not know about dental age estimation methods.[13] A systematic review in 2016 stated that the knowledge and awareness of the dental community was insufficient, with significantly low approach and practice scores.[14] Dental practitioners had negligible familiarity of applied aspects of forensic odontology in a clinical set up.[14] In the previous surveys done by Rathod et al.[15] and Khare et al.[16] in India and abroad it has been concluded that awareness of forensic dentistry is inadequate mainly due to insufficient formal training. In 2011, Shetty P et al.[17] concluded that out of 120 oral pathologists, 28% voiced confidently in handling forensic circumstances.

The present study had 1,860 participants; inclusive of Interns, Postgraduate students, teaching faculty as well as dental practitioners so as to compare the level of their awareness, interest and knowledge regarding the current concepts and situation of forensic dentistry in the nation. Most of the positive responses had higher frequencies corresponding to the younger age group involving interns and postgraduate students. A reason for this could be that the interns and postgraduate students are in continuous exposure to academics as they are working in a dental school and are bound to maintain dental records and photographs as a part of their curriculum and also for comparing the pre and post treatment photographs so that they can assess their work. The present study took into consideration involvement of interns as they contribute an integral part to the future of forensics. It was noted that the lack of confidence or lack of knowledge is most likely a result of lack of awareness and lack of training opportunities. Dentists who are employed and affiliated to teaching colleges and hospital as academicians are constantly improvising their knowledge through continuing dental education (CDEs), conferences and article etc., thus their knowledge is generally up to date.

A general dental surgeon is most likely to encounter and contribute to forensic dentistry through patient records which can be used as a means of comparison (ante mortem v/s postmortem). So it is the moral and ethical responsibility of the treating clinician to accurately produce, preserve, maintain and release clear patient records as and when required. In India, forensic odontology is still in its inception, but it has the potential to reach new heights if sufficient knowledge and education are given. Even though there have been many studies published previously describing and quoting about the awareness, interest, and knowledge of the general dental professionals, even then the level of interest about forensics is uncertain. Related conferences, webinars and programs held at regular intervals, would help the dental fraternity to boost up their awareness regarding forensics in dentistry.

Study limitations and future prospects

This study included participation of dental professionals from different regions of the country though not all, and hence a larger multi-centric study including multiple states and provinces should be done to understand the nationwide status of the attitudes, awareness and scope of forensic dentistry. Inclusion of a standardized questionnaire and consideration of relevant factors will help to bring out the real scenario and point out the lacunae which need to be filled.


   Conclusion Top


In the current study, a larger sample size was taken compared to previous studies and hence the data and results accumulated in this study can serve as an addition to the existing database and can be used for future reference. All the previously conducted questionnaire studies have been done in metro cities or towns and urban areas. Therefore, the authors suggest such similar studies involving dentists in rural settings all over the country should be done so that more valuable information can be added to the existing data.

Key Messages

  • Teeth are most resilient to wear as they resist the influence of taphonomic processes and hence can be used as an important aid in age estimation.
  • The role of a general dental practitioner towards forensics is substantial and crucial for age estimation and medicolegal cases.
  • Dental professionals should preserve accurate dental records for a considerable period of time, as they are an aid in identification of individuals.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Keiser-Nielsen S. Forensic odontology. Int Dent J 1968;18:668-83.  Back to cited text no. 1
    
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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.  Back to cited text no. 6
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Savić Pavičin I, Jonjić A, Maretić I, Dumančić J, Zymber Çeshko A. Maintenance of dental records and forensic odontology awareness: A survey of Croatian dentists with implications for dental education. Dent J (Basel) 2021;9:37.  Back to cited text no. 7
    
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Neville BW, Damn DD, Allen CM, Bouquot JE, editors. Oral and Maxillofacial Pathology. 2nd ed. India: Elsevier Publications; 2004.  Back to cited text no. 8
    
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American Academy of pediatric dentistry. Guideline on adolescent oral health care. Pediatr Dent 2011;33:129-36.  Back to cited text no. 9
    
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American Academy of Pediatric Dentistry. Clinical Affairs Committee – Infant Oral Health Subcommittee. Guideline on infant oral health care. Pediatr Dent 2012;34:e148-52.  Back to cited text no. 10
    
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Sarode GS, Sarode SC, Choudhary S, Patil S, Anand R, Vyas H. Dental records of forensic odontological importance: Maintenance pattern among dental practitioners of Pune city. J Forensic Dent Sci 2017;9:48.  Back to cited text no. 11
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Waleed P, Baba F, Alsulami S, Tarakji B. Importance of dental records in forensic dental identification. Acta Inform Med 2015;23:49-52.  Back to cited text no. 12
    
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Isher DK, Singh Isher PP, Kaur N, Rakhra J. Knowledge, awareness and practice of forensic odontology among the dentists of Punjab. J Indian Acad Oral Med Radiol 2019;31:239-45.  Back to cited text no. 13
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Gambhir RS, Singh G, Talwar PS, Gambhir J, Munjal V. Knowledge and awareness of forensic odontology among dentists in India: A systematic review. J Forensic Dent Sci 2016;8:2-6.  Back to cited text no. 14
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Rathod V, Desai V, Pundir S, Dixit S, Chandraker R. Role of forensic dentistry for dental practitioners: A comprehensive study. J Forensic Dent Sci 2017;9:108-9.  Back to cited text no. 15
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Khare P, Chandra S, Raj V, Verma P, Subha G, Khare A. Status of forensic odontology in metro and in tier 2 city in urban India. J Forensic Dent Sci 2013;5:134-7.  Back to cited text no. 16
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Shetty P, Raviprakash A. Forensic odontology in India, an oral pathologist's perspective. J Forensic Dent Sci 2011;3:23-6.  Back to cited text no. 17
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    Figures

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