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Forensic Dentistry PODJ

Forensic Dentistry PODJ

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Published by: Muneer on Nov 05, 2008
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79
Pakistan Oral & Dental Journal Vol 27, No. 1Essential Guidelines for Forensic Dentistry
INTRODUCTION
The new millennium has brought many good thingsin our lives for example a boom in telecommunicationand information technology (TeleDentistry) etc. But ithas also brought new challenges of terrorism, naturaldisasters and high rate of crime. Forensic dentistry hasbecome an integral part of forensic medicine over thepast 100 years. This has been due to the dedication of people like Amoedo, Gustafson, Sognaes, Keiser-Nielsenand Suzuki, Whittaker, Clement, to name but a few.They established the essential role which forensicdentistry plays mainly in the identification of humanremains.Dental hard tissues are extremely resistant to fireand are usually the only remains after an extendedperiod of burial
1
. Since the late 1890s, forensic den-tistry has gradually established itself as impor-tant, often indispensable, in medico legal cases, inparticular for identification of the dead. The specialtyof forensic dentistry generally covers three basic areas,namely;1Identifications of human remains2Litigation relating to malpractice3Criminal proceedings, primarily in the areas obite-mark evaluation and abuse cases especiallychild abuseMuch of its expertise is based on clinical experi-ence, fundamental research and advances in knowl-edge in relation to dentistry in general
2
.Dental identification of humans occurs for a num-ber of different reasons, and in number of differentsituations
3
. The body of victim of violent crime
4
, fire
5
,road traffic accident, and work place accident
6
. Bodycan be disfigured to such an extent that identificationby a family member is neither reliable nor desirable.Bodies of people who have been deceased for some timeprior to discovery and those found in water also presentunpleasant and difficult identification. Through thespeciality of forensic dentistry, dentist can play a smallbut significant role in this process. By identifying the victims of crime and disaster through guidelines andstandards a dentist can assist those involved in crimeinvestigation
7
. A number of essential characteristics of the humandentition separate humans from other animals andprovide certain uniqueness. The first of these results
ESSENTIAL GUIDELINES FOR FORENSIC DENTISTRY
*MUNEER GOHAR BABAR,
 
BDS, DHP&M, MDSc, MPH**SHAHEED IQBAL
,
BDS, MDS***ADIL JAN, MBBS, DMJ, DHP&M
 ABSTARCT
Teeth can be used as a weapon of attack or defence. Dentistry has much to offer to law enforcementagencies in the uncovering and solution of crime. The permanent teeth develop throughout the first twodecades of life, and physiologic variations, pathologies, and effects of dental therapy may be recordedin the hard tissues of the remaining dentition throughout life and beyond. It is the role of the dentistto help extract this information and use it in the identification of the unknown body. Human teeth anddental restorations have proven to remain stable during a long time as well as in extreme situationssuch as fire. Therefore, dentist can play an important part in the identification of severe mutilatedbodies of unknown persons. The teeth may also be used as weapon and, under certain circumstances,may leave information as to the identity of the biter. Analysis of bite marks is the second majorresponsibility of the forensic dentist. The general practitioner has a major role to play in providing theaccurate dental records on which much of forensic activity is based.
 Key words:
death, crime, dentition, weapon, bite marks, identification, and dental restorations.
*Asst Prof Department of Operative Dentistry & Dental Materials Science, Sardar Begum Dental College,Gandhara University, 25120, Peshawar, Pakistan, e-mail: Muneer.Babar@gmail.com**Principal, Sardar Begum Dental College, Gandhara University, 25120, Peshawar, Pakistan***Asst Prof Department of Forensic Medicine & Toxicology, Kabir Medical College, Gandhara University ,25120, Peshawar, Pakistan
 
80
Pakistan Oral & Dental Journal Vol 27, No. 1Essential Guidelines for Forensic Dentistry
from the intermixing of genetic racial characteristicsthat have upset the natural balance between size andshape of the teeth and those of the supporting jawbones. The second is the modern chemical and struc-tural modification of teeth resulting from disease pro-cesses or the attempt to sure such disease
8
. Testifying to the similarity or dissimilarity of a suspect’s dentitionto the bite mark in question is probably the mostunique contribution that forensic dentistry makes tothe judicial inquiry. This is a grave responsibilitybecause a defendant’s life or freedom may depend onthe testimony given by the forensic dentist in court
8
.Teeth can be used to inflict serious injury on anattacker may be the only available defensive methodfor victim
8
. Alternatively, it is well known that assail-ants in sexual attacks, including sexual homicide, rape,and child sexual abuse, often bite their victims as anexpression of dominance, rage and animalisticbehaviour
9
. It should be worth mentioning that chil-dren who are unable to crawl cannot cause a self inflected injury, and therefore sever bruising or frac-tures in a child less than six months to nine months oldare almost universally inflicted non-accidentally by asecond party
10
.Dental treatment itself is the biggest single con-tributor to the uniqueness of an individual’s dentitionand, along with development characteristics, is the keyto enabling identification of the dead from an examina-tion of the oral cavity. Another important feature of theteeth is that they are the most indestructible part of thebody and exhibit the least turnover of natural struc-ture. They therefore not only survive death but alsoremain relatively unchanged thereafter for many thou-sands of years
11
. Forensic dentistry relies on thisindestructibility, and its scientific advancement is de-signed to extract increasing amounts of identifiableinformation from oral structures, which, more thanany other part of the body, mirror the fortunes of theindividual concerned. Identification of a deceased indi- vidual or of a mark left by his or her teeth is the purposeof the forensic dentist. Reduced to its simplest terms,forensic dentistry has only two aims the relativelysimple one of identification of the dead and the morecomplex one of identifying an assailant who has usedhis or her teeth as weapons
11
.
IDENTIFICATION
Death has major economic and financial ramifica-tions for the kin arising from issue of inheritance andinsurance. In criminal law, lack of identification seri-ously hampers murder enquires. Finally, false or uni-dentified cadavers offer an opportunity to illegallyobtain identity documents and thereby switch iden-tity
12
.The core of the identification procedure is compar-ing the post mortem remains with the ante mortemrecords. In civilized societies, it is socially and legallyessential to identify the dead before a death certificatecan be issued. Close relatives or associates who recog-nize facial appearance identify most human corpses. Ina small percentage of cases, post-mortem putrefactionor severe damage to facial features may render suchidentification impracticable or undesirable, and finger-prints and palm prints may be used. Natural or inten-tional loss of this information leaves a small number of cases where identification by traditional methods isimpossible
13
 At times forensic dentistry does not offer an objec-tive method of identification comparable to either thefingerprint or, more recently, the use of DNA technol-ogy, but it is relatively inexpensive, is capable of rapidresults, and at best produces a virtually certain identi-fication. Even when data are sparse, it may result inrecognized identification that can later be confirmed bymore scientific techniques
14
.
SPECIES, SEX, AND RACE DETERMINATION
Species determination usually presents no difficul-ties, unless only patchy evidence is found at the sceneof a crime. There may be a fragment of mandiblebearing teeth or, at worst, a small fragment of singletooth no more than a few millimetres in size
15
. Thetraditional method of procedure these circumstanceshas been to examine the fragmented tooth or bone,using comparative dental anatomy to determine thatspecies of origin. If this is not possible from the shapeof the fragment, the enamel may be examined withlight or electron microscopy because the arrangementof the enamel rods or prisms differs, for example,between primate and nonprime tissue
16
.More recently, it has been shown that dentinalfluids contain specific species information. These fluidsmay be compared using counter-current electrophore-sis with artificially antisera. This technique can deter-mine species up to atleast 12 months after death. In asimilar manner, remnants of cells from fragments of bone or teeth may be examined for the presence of Barrbodies or the sex chromosome status of the cells. Thesetechniques have also been shown to be applicable for atleast 12 months after death
16
.
 
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Pakistan Oral & Dental Journal Vol 27, No. 1Essential Guidelines for Forensic Dentistry
Racial determine form the skull and teeth is noto-riously difficult, but separation into the main Caucasoid,Negroid, and Mongoloid racial groups may be possibleusing cranial and facial morphology. Many redial traitshave also been described in individual teeth. Forexample, the evaginated odontome on the occlusalpreface of premolars in Chinese persons and the shovedshaped incisor of the Mongoloids might eliminate aCaucasoid origin
17
.
FACIAL RECONSTRUCTION
The process of human identification can be under-taken in two ways. In the reconstructive approachthere are no ante mortem data available and the aim isto establish generic elements for general identifica-tion. In the second comparative approach, records frombefore the individual’s death, including dental charts,are used as the basis for individual identification
18
.The average thickness of soft tissues overlying  various parts of the face is a rather stable characteris-tic. A representation of facial soft tissues can thereforebe reconstructed into an unidentified skull, using traditional sculpture methods or the application of computer technology. The resulting facial model mayresult in the recall of a name by a member of the public.Putative identification can be used in the search forprevious dental records that may confirm the identityof the deceased
19
.
 AGE DETERMINATION AT DEATH
The need for accurate technique for age estimationhas never been greater. In last few years the need hasincreased for mainly two reasons, both are related tosocio-political developments, wars etc. The first is theincreasing numbers of unidentified cadavers and hu-man remains (especially in big cities of Pakistan) thesecond relates to cases requiring age estimation forliving individuals with no valid proof of date of birth.The problem appears to be growing because of increasein flow of individuals into and across the Pakistanborder with neighbouring countries, e.g., Afghanistan. A very important stage in identification is anaccurate determination of the age of the body. Fortu-nately, the human dentition follows reliable and pre-dictable developmental sequence beginning about 4months after conception and continuing to the begin-ning of the almost third decade of life, when develop-ment of all the permanent teeth is completed. Radio-graphs of the jaws will indicate the extent of mineral-ization within each individual tooth type, enabling ageat death to be determined to within a few months ininfants and to within a few years in teenaged speci-mens
20
. An important medico legal problem is whether thedeceased infant was stillborn or survived birth with anindependent existence. In the absence of soft tissues, asingle primary tooth may be extracted, sectioned, andexamined microscopically. The physiologic trauma of the birth event will leave permanent biologic markerin the hard tissues of the developing child at birth, andthis may be visualized with scanning electron micros-copy. This co-called neonatal line may be of extrememedico legal importance in these cases
21
.The roots of the teeth in the permanent dentitioncontinue to grow for some years after eruption and, inthe case of the third molar or wisdom tooth, growth of the root is not completed until the end of the seconddecade of life. Age at the time of death may thereforebe determined from radiographs up to this stage
22
.Individual teeth erupt into the oral cavity in achronological sequence that is less reliable than thedevelopmental status, however, in younger people; areasonable determination of age at death is possiblefrom this feature alone. Wide racial and sex variationsmay need to be taken into account. The last of thepermanent teeth erupt at around 18 years of age. From20 years of age to old age, age determination at deathbecomes more difficult and is dependent on rathermore subtle changes, which, fortunately, are perma-nently retained within the hard tissues of the teeth
23
.The most important and useful change in the teeth isa poorly understood biologic phenomenon whereby thetubules within the root apex become progressivelymineralised as age progresses. This mineralizationalters the refractive index of the dentin, rendering ittransparent when examined microscopically. The ex-tent of this root translucency may be determined bycomputer mapping of serial hard tissue sections of thetooth. Regression tables prepared from large numbersof teeth of known age have been used to show that it ispossible to determine the age of an unidentified bodywithin about 7 years of the correct at death
24
.Researchers working largely on animal materialhas recently laid the foundations for a more objectivemethod of age determination. This depends on thefinding that amino acids are built into the collagen asoptically pure enantimoers of the S-aspartic acid type.Once the tooth has mineralized, these amino acidscannot be replaced. With the passage of time theaspartic acid enantiomer slowly undergoes recemization

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