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Review Article
Bitemarks – A review
Dhanya S. Rao, I. M. Ali1, Rajeshwari G. Annigeri1

Department of Oral
Medicine and Radiology,
A. J. Institute of Dental
Sciences, 1Department
of Oral Medicine and
Radiology, College
of Dental Sciences,
Davangere, Karnataka,
India
Address for correspondence:
Dr. Dhanya S. Rao,
E‑mail: dhanyarao21@
gmail.com
ABSTRACT
Teeth have been used as tools and weapons since the advent of time. Bite marks inflicted by them during violent
interactions, form the basis for one of the most intriguing, broad and sometimes controversial encounters in
forensic dentistry. Bite mark evidence validates the involvement of the alleged biter in the crime, assuming that
the person who made the bite was the one who committed the crime. Forensic odontologist has to determine
that the pattern injury is a bite mark record and it represents a human bite and has to make a decision as to
its evidentiary value. This recognition and examination of the bite marks and their subsequent comparison
with suspects, may lead to criminal identification thereby resolving the crime. This article aims at providing
complete review on formation, collection and identification of bitemarks.
KEY WORDS: Bite mark, forensic odontology, teeth

Introduction occurred in 1692 which is termed Salem Witch Trials.[2,3] A

piece of cheese in the scene of robbery registered with a bite

R ecent world shows changes in social, economic,

educational, and developmental technologies. As there
are newer advances, man is getting more and more selfish
in his demands. The advent of new thinking has involved all
fields, and the field of crime is no exception. As the saying by
Winston Churchill goes, “The victim shapes and molds the
criminal” newer advances in other fields especially medicine
and dentistry is essential in solving the mysteries of death due
to crime. Each dentition, including the number of teeth, their
position, occlusion, and the restorations are unique for each
individual. This makes forensic odontology play a key role in
identifying the deceased. A bite mark may be defined as having
occurred as a result of either a physical alteration in a medium
caused by the contact of the teeth, or a representative pattern
left in an object or tissue by the dental structures of an animal
or human.[1]
History
Although the field of forensic odontology appears to be a new
one, it is probably as old as Human kind itself as supported by
the Bible which says, Eve persuaded Adam to put a “bite mark”
in an apple.[2] The first incident of bite mark identification
mark played a role in revealing the thief’s identity and thereby
solving the case in America.[1] The most highly publicized bite
mark case which paved the path for bite mark evidence to be
used in courts was the case involving serial killer Theodore (Ted)
Bundy, who was convicted based on bite‑mark analysis by the
US judicial system.[1]
Appearance
A classical human bite mark is circular or oval patterned
injury consisting of two opposing symmetrical, U‑shaped
arches separated at their bases by open spaces. [1] The
periphery of the arches can have abrasions, contusions,
lacerations, etc., indicative of distinctiveness of the occlusal
surfaces of the biting dentition. [2] Usually, mandibular
anterior teeth are detected more obviously than the
maxillary teeth in bite marks, which is owed to mandibular
jaw movement during bite infliction. [1]The bite mark is
produced due to teeth pressure and starts with mandibular
closure, followed by suction on the skin (as a negative
pressure). Tongue thrusts can accompany the opposite
action of mandible which are seen as tongue projections on
teeth incisor and lingual surfaces.[1,4] About 11 kg pressure

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DOI:
10.4103/2348-2915.180115 How to cite this article: Rao DS, Ali IM, Annigeri RG. Bitemarks - A review.
J Dent Res Rev 2016;3:31-5.

© 2016 Journal of Dental Research and Review | Published by Wolters Kluwer ‑ Medknow 31 

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Rao, et al.: An overview of bitemarks
is exerted from the incisors and along with the tongue, it
may reach up to 8 lb/square inch. Suction may produce a
negative pressure of 20 mmHg.[3]
Bite mark is unique
The scientific foundation of bite mark analysis is entrenched
in the idea of the distinctiveness of the human dentition,
the conviction that no two humans have identical dentition.
The unique characteristic of a suspected individual’s
dentition is compared with the pattern observed over the
bitten skin, and two simultaneous and opposite paths
develop: [5]
• The inclusive path where the suspected biter’s dentition can
be positively identified due to strong and consistent tooth
and arch comparison with the pattern recorded
• The exclusion path where the suspected biter’s dentition
does not match with the patterns recorded in the bite mark
injury and the suspect can be excluded as being the cause
for the bite mark. Exclusion is usually accomplished more
frequently than the inclusion.
Variations in Bite Mark
1. A central ecchymotic area or “suck mark” surrounded
by radiating linear abrasions resembling a “sunburst”
found usually after sexually oriented crime.[2] The central
ecchymosis is due to the negative pressure during biting,
leading to leakage or rupture of the small vessels and
capillaries and linear abrasions caused by the movement of
the teeth. Imprint of the inner surface of teeth against the
skin is called lingual marking or drag marking[5]
2. The second type closely resembles a “tooth mark” pattern.
This is an “attack” or “defense” bite mark seen most often
in “batteral” child homicide.[2]
Furthermore, double bite can be seen when two bites are
done quickly in the same location on the skin whereas partial
bite marks can be seen in situations when the victim moved
during the bite.[5]
Classifications of Bite Marks
Camerons classification:[6]
1. The agents that produced the mark
2. The materials and substances that have exhibited the marks.
McDonald's classification
• Tooth pressure marks: By incisal edges of anterior teeth –
stable with minimal distortion
• Tongue pressure marks: Tongue pressure on palatal surfaces
of the teeth, cingulae or palatal rugae causes distortion of
marks
• Tooth scrape marks: Caused due to irregularities in teeth
due to fractures, restorations, etc.
• Complex marks: Combination of above marks.
 32 Journal of Dental Research and Review ● Jan-Mar 2016 ● Vol. 3 ● Issue 1
Websters classification
• Type I: Bites in chocolate which fracture easily with limited
depth of penetration. Most prominent are incisal edges of
upper and lower anterior teeth
• Type II: Good grip of material obtained by teeth and then bitten
piece is fractured from main material. For example, Apple; The
outline of labial aspect of upper and lower incisors are recorded
• Type III: Bite mark produced by biting through cheese. Here,
an advantage is that it indicates relative position of upper
and lower incisors in centric occlusion.
Bite Variables Affecting Bite Marks
Patterns of distribution of bite marks are based on the type of crime
involved and the age,sex and site mentioned in Table 1.
Terms used to describe bitemarks are:
1. Unique: Here, the bite mark is distinctive and unusual in
such a way that no other individual could have made an
identical pattern with their dentition
2. Distinctive: Highly specific and individualized, varies from
normal, i.e., unusual or infrequent
3. A definite (positive) bite mark is termed when there is
no doubt that the mark was caused by teeth, and other
conditions have been considered and eliminated
4. Highly probable suggests with virtual certainty of the mark
being a bite mark, but there is room for possibility of another
cause, although this is highly unlikely
5. Possible/similar to/consistent with/conceivable/maybe/
cannot be ruled out/cannot be excluded: These terms imply
that the bite mark could be produced by teeth or could be
created by something similar which produces marking that
looks like a bite mark
6. Unlikely/inconsistent ‑ used when it is unlikely that the
injury pattern is bite mark
7. Incompatible/excluded/impossible implies that it is not a
bite mark but something else
8. Indeterminable/should not be used/insufficient. The pattern
is such that it could be related to teeth or a tooth as a cause
of injury.
Terms describing the injury are: Point (match point or a
consistent point): Used for comparison or evaluation. This
term does not imply any degree of specificity but represents a
focus in comparison.
Table 1: Variables affecting bitemarks
Structure and vascularity Bruising in loose and highly vascular tissues is
of tissue injured more pronounced
Children and elderly Bruise more easily due to loose, delicate skin in
former, and loss of subcutaneous tissue in latter
Victims health status Hypertension, coagulation disorders, liver
dysfunction, may affect extent of bruising
Medications Aspirin: Increases bleeding
Steroids: Alters dispersion rate of bruising
Mass and velocity of Influences depth and surface of injury and rate
impact of healing
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A concordant point (also called as matching point/unit of
uncertainty) is a point of comparison seen in both the bite
mark and the suspect’s exemplariness. It could also represent
on an area that can be linked to a particular tooth and an area
of injury which could have caused the bite mark.
The area of comparison is a specific region to be compared. It
may also represent a group of features, that impart themselves
to exact or merely exact correlation.
Match or positive match is a nonspecific term suggesting
some degree of similarity between a single feature, groups of
characteristics or a majority of the entire case, but there is no
degree of known specificity.
The term consistent with means that there is a “match” between
two or more things in a bite mark, but there is no degree of
presences implied in the use of the term.
The term reasonable medical/dental certainty implies that the
investigator is extremely confident that the suspect matches
the bite. This also implies that any other expert with similar
training, experience, and background when evaluating the same
evidence would come to the same conclusion and any other
opinion would be unreasonable.[5]
American Board of Forensic Odontostomatology (ABFO)
Guidelines for Evidence Collection – The ABFO launched
standardized guiding principle in 1986:[7]
History followed by description of bite marks[5] including the
demographics, location, shape, color, surface, and size of the
bite mark should be described.
Photographs – extraoral photographs involving profile and
facial views, intraorals including, lateral views and occlusal
views of each arch should be taken and preserved. Along
the bite mark, a standard scale like ABFO 2 should be used
[Figure 1].
Figure 1: Bite mark measurement using American Board of Forensic
Odontostomatology scale
Journal of Dental Research and Review ● Jan-Mar 2016 ● Vol. 3 ● Issue 1 33 
Rao, et al.: An overview of bitemarks
Extraoral examination – soft tissue and hard tissue factors
influencing biting dynamics should be recorded. Maximal opening
and any alterations on opening or closing should be measured.
Intraoral examination – salivary swabs needs to be used. The
periodontal status should be noted. Tongue position can be
recorded. A dental chart should be prepared if possible.
Impressions – using ADA‑specified materials two impressions
of both arches should be taken. Occlusal relationship needs to
be recorded. ABFO guidelines state that “Impression should
be taken on the surface of the bite mark evidence, whenever it
appears that this may provide useful information.” Impression
provides the current relationship with reference of curvature.[3,5]
Bite samples – sample bites should be made using a suitable
material, simulating the type of bite Study casts – type II stone
is used for cast preparation [Figure 2]. Additional casts can be
made by duplicating the master casts.
Photography
The standard protocol should include photographing the
evidence, both in color and black and white, first without scales
and then with them and also a location photograph to show
where exactly in the body the mark is found.
The size consideration in using the scale is in positioning it
relative to the bite mark and to the portion to be depicted,
so as to avoid parallel distortion for accuracy. An ABFO no
2 scale is used.[4] Since a photograph is flat representation of
three‑dimensional object camera must be oriented for successive
photographs to be taken over the curved surfaces with principal
object plane parallel to film plane and at right angles to long
axis of lens[3] [Figures 1 and 2].
Conventional 35 mm photography is usually used, and both
color and black and white photos can be taken.[5] In visible
light photography, the slowest speed film is appropriate.
(American Society of Anesthesiologists speed ≤100), because
greater will be the grain density and sharply detailed photo
Figure 2: Cast procured using bite marks
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Rao, et al.: An overview of bitemarks
will be obtained which is not lost even when photo is enlarged
to life size.
Other that visible light photography, ultraviolet (UV) light
and infrared (IR) light photography can be used. UV light
photograph produces greater details of the surface of the injury;
the IR light photograph captures the bleeding pattern below
the skin of the bite mark.
Epiluminescence microscopy (used for dermatologic evaluation
of pigmented skin lesions) also can be used which renders
stratum corneum translucent and aids visualization and
photographic documentation of bite marks.[5]
Digital photography
Here, digital camera captures image in charged couple device’s
that can be transferred to computer for processing and printing.
Image softwares like DIMS etc., have to be used.[5] Bite mark
analysis digitized helps in:
• Sharpening out of focus shots
• Correcting poor contrast and brightness value
• Color balance correction
• Cropping of unwanted elements
• Correction of improper photographic reproduction and
distortions.
Swabs
Swabbing of the bite injury is done to recover trace evidence. It
is estimated that 0.3 ml of saliva is deposited when making a bite
mark and spread over 20 cm2 Double swab method is followed
wherein the first swab is moistened with distilled water and run
over the surface after which a dry swab is used to absorb the
extra moisture and then air dried.
Bite print recording
Bite mark is brushed with fingerprint lifting powder and then
fingerprint lifting tape can be used to record.
Tissue samples
In the living individual, a biopsy could be considered if there
were sufficient scientific reasons and some contributions to the
case could be gained.[7] In deceased the entire area of bite mark
is excised. Whenever possible it should be removed with proper
anatomic condition. Excised tissue can be transilluminated by
shining light from dermal side or inner aspect of tissue. This
aids in the enhanced viewing of bleeding patterns caused by
teeth.[3,5,7]
Distortions of Bite marks ‑ Sheasby and MacDonald (2001)
recommend a classification to emphasize the need of a scientific
approach for the interpretation of the types of distortion.
• Primary distortion is defined by the dynamics of the bite
• Secondary distortions have three categories: Time‑related
distortion when a bite changes with time elapsed subsequent
 34 Journal of Dental Research and Review ● Jan-Mar 2016 ● Vol. 3 ● Issue 1
to the bite being made, posture distortion, and photographic
distortion.
Bite mark evaluation
Image sizing, accurate measurement, distortion correction,
color isolation, and contrast enhancement can be done using
Adobe software.
DNA in bite marks
With the advent of the DNA sequencing in 1977, followed by the
development of polymerase chain reaction (PCR) in 1983, DNA
technology has an outstanding position in forensic sciences.[1]
Saliva deposited during biting has DNA present which can be an
important alternative hub in bite mark analysis. DNA from the
cellular material present in the biter’s saliva can be differentiated
from the DNA of the victim’s skin. It has been reported that
this evidence is stable on intact skin for at least 60 h following
deposition.[8] David Walsh et al. did the first separation of DNA
from saliva and saliva‑stained materials in 1992.[1]
Bacteria Recovery from Bite Marks
Brown et al. in 1984 gave the concept of utilizing oral bacteria
from bite marks for forensic purposes.[1] Streptococcal DNA is
used to match a bite mark to the teeth of the biter based on the
streptococcal sequence data.[1] In a study done based on DNA
extraction followed by PCR for Streptococcus salivarius and
Streptococcus mutans detection in bite marks, 100% and 90%
cases respectively showed their presence.[9] In another similar
study, it was seen that S. salivarius and S. mutans DNA were
positive in 83.5% and 67.1% cases respectively and were not
detected in other body fluids.[10] In another study done based on
genotypic matching of oral streptococci, the biter was identified
among 8 individuals, as none of the bacterial genotypes were
shared among the participants.[11]
Medicolegal Aspects
Sex‑related crimes, domestic abuse, and child abuse are most
probable cases for bite mark formation. It is important to realize
that all members of the dental team have an exclusive chance and
a legal commitment to support the victims. These injuries may be
observed during the course of dental treatment. Determination of
the evidentiary value of the bite mark involves a cascade of complex
and interrelated events beginning with the collection of bite mark
evidence from the victim, subsequent analysis of the bite mark and
the eventual comparison with dental evidence collected from any
potential biter. An analysis was done in the USA to know if dentists
were aware of their legal role in cases of child abuse. Among the
group of general dentists, oral surgeons, and pediatric dentists
including a total of 537 participants, 242 (45%) knew about their
role in suspected child abuse, 149 (28%) knew the name of the
agency to which to report, 403 (75%) had seen cases of orofacial
trauma, and 45 (8%) had suspected cases of child abuse in their
practice. However, only four cases (<1%) were actually reported
reason being, difficulty to confirm the suspicions.[12]
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Though bite mark analysis remains the most controversial and
questioned entity. There is few fundamental tribulations integral
in bite mark analysis and interpretation:[7]
1. Scientific evidence for establishing uniqueness of human
dentition is not yet published
2. The ability to transfer the dentition pattern is not very
accurate as distortion, and its effects are not fully understood
3. A standard for the number and quality of individual
characteristics required to reach validation standards in
legal justice system is absent
4. Standardized terminology and coverage are not yet there
5. Accuracy, reliability, and bias in bite marks are not
satisfactorily studied.
Conclusion
Human bite mark analysis one of the most challenging and
intricate part of forensic dentistry. Bite marks can be distorted
by the elastic properties of the skin or by the anatomic location.
The greatest challenge in Forensic Dentistry is analyzing bite
marks found in human skin, because of the distortion presented
and the time elapsed between the production and the analysis.[13]
Furthermore, though the individuality of human dentition is
observed commonly in practice, there is no database to express
quantitatively the uniqueness of the human dentition. There
is a demand on the field of bite mark analysis for research to
adhere to more stringent scientific regulations in order for it to
be more resilient to scientific scrutiny. Hence, bite mark analysis
by itself should not be permitted to lead to a guilty decree, but
it will proffer the opening to eliminate a suspect from crime
when the data do not correspond.
Financial support and sponsorship
Nil.
Journal of Dental Research and Review ● Jan-Mar 2016 ● Vol. 3 ● Issue 1 35 
Rao, et al.: An overview of bitemarks
Conflicts of interest
There are no conflicts of interest.
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