Knowledge, Attitude and Practice of Forensic Odontology among Graduates and Post Graduate Students at Dow University of Health Sciences (DUHS)

 

Anwar Ali1                     -                      BDS, FDSRCS
Khurram Parvez Sardar2            -          BDS, MDS
Saqif Nasir3                         -                       BDS
Syeda Maliha Wakar4                 -           BDS

ABSTRACT:

INTRODUCTION: Forensic odontology is the recognition discipline based upon the revealing of inimitable characteristics exists in each individual’s dental structures. The rationale of this research was to evaluate knowledge, attitude and practice of forensic odontology amongst dental graduates and post graduate students at DUHS.

METHODOLOGY: This hospital based cross sectional study was executed at Dow University of Health Sciences. Over a 3 month period, from 1 August 2015 to 1 November 2015, questionnaires containing 18 questions were hand out to the dental professionals of all dental departments including Dr Ishrat Ul Ibad Khan Institute Of Oral Health Sciences, Dow International Dental College And Dow Dental College.

RESULT: In this study, 83.7% participants had no formal training in the field of forensic odontology. 84.8% concurred that their present knowledge and awareness about forensic odontology is not adequate. 87% respondents agreed that dental records are useful in identifying the deceased and crime suspect, while 69.9% maintained their dental records, of which only 17.4% maintained dental records for more than 3 years while 53.3% maintained for less than 3 years. 54 % had no awareness how to identify bite mark.

CONCLUSION: This study reveals that there was lack of knowledge and awareness of forensic odontology amongst the participants and very few of them had awareness regarding forensic odontology. Majority of the participants did not sustain records for longer time.

KEYWORDS: Forensic Odontology, Knowledge, Attitude and Practice.

HOW TO CITE: Ali A, Sardar KP, Nasir S, Wakar SM. Knowledge, Attitude and Practice of Forensic Odontology among Graduates and Post Graduate Students at Dow University of Health Sciences (DUHS). J Pak Dent Assoc 2016; 25(3): 110-114.

Received: 17 May 2016, Accepted: 28 September 2016

INTRODUCTION

Forensic dentistry is a contemporary along with emanating division of forensic medicine. Forensic odontology is the recognition discipline based upon the revealing of  inimitable characteristics exists in each individual’s dental structures. According to the Federation Dentaire Internationale (FDI), forensic dentistry deals with the appropriate conduct and assessment of dental verification and with the accurate conclusion and management of dental findings1 .

The broadly recognized classification of forensic dentistry is supported on the main fields of activity i.e. civil, criminal and research by Avon2 . The civil field deals with mass disasters such as airline accidents, earthquakes or train accidents which involve identification of the victims in complex stages of corporeal destruction. The criminal field deals with the identification of persons from their dental remains alone in cases of homicide, rape or suicide through bite mark analysis, palatal rugoscopy and cheiloscopy. Finally, the research field is palatal rugoscopy and cheiloscopy. Finally, the research field is acted to forensic odontology training for medical and dental professionals. In recent times, the author has introduced a latest effective categorization for forensic dentistry which shows dependency up on the association of different dental specialties with forensic dentistry3.
Forensic Odontologist delve in identifying unknown human remains, victim’s identification in mass disaster, assessing sex of skeletal remain, age estimation of both living and deceased analysis, evaluation of cases of violence such as adolescent, conjugal partner and family and recognition of bite marks at crime scenes.

Teeth have the capability to endure decomposition and tolerate intense changes in temperature, due to which dental validation assessment and evaluation is amongst the most reliable and consistent way of identification4. It can be conquered by evaluating characteristics of an unidentified entity (post-mortem dental records) with an identified entity (ante-mortem dental records).

Despite of the fact that forensic dentistry is one of the establishing modern field of dentistry in all over the world but in Pakistan, this subject is included as a topic in oral and maxillofacial surgery with five didactics lectures as showed on the website of Pakistan Medical and Dental Council (PM&DC). PM&DC is the dictatorial body in Pakistan regarding the medical and dental education. Regulations given by PM&DC are followed by the universities; awarding BDS degrees in Pakistan5. With the introduction of forensic odontology in the undergraduate curriculum, its teaching to undergraduate students is now necessary6.

METHODOLOGY

This hospital based cross sectional research was performed at DOW University of Health Sciences through a structured questionnaire7. SPSS 16 version was used for statistical analysis. Descriptive statistics was used to report frequency and percentages. Former to the collection of data; a concise introduction was given to all the participants about this study as well as the related information of the research and the informed consent was obtained from the subjects recruited for this study.

The research included 200 participants, among which were dental house officers and postgraduate trainees. In order to assess the knowledge, attitude and practice on forensic odontology, this structured questionnaire consists of eighteen (18) variables having multiple choice options, from which the participants chose answer nearer to their own verdict, which includes socio-demographic distinctiveness, comprising age, gender, experience and designation. The questionnaire was divided into three components, in which first section was on demographic profile of study population, second section was on knowledge and last section was on practice and attitude evaluation.

Table 1. Demographic Specifics.

RESULT

A total of 200 questionnaires were circulated amongst dental professionals, 184 were completely filled and included in the analysis. Sociodemographic details are shown in Table 1.

The result showed that the identification of child abuse was mainly made by monitoring behavioral changes of child (54.3%), physical injuries (29.3%) followed by scars (10.9%) while 5.4% practitioners didn’t know how to identify a child behavior. Age estimation was done by dental age (66.3%) and chronological age (27.2%) by examining the teeth, 6.5% respondents did not know how to examine the teeth. 65.2 % knew that they can present dental evidence in court , while 18.5% denied and 15.2% did not know if they can present any evidence in court or not.

84.8% respondents agreed that there present knowledge regarding forensic odontology is not adequate while 15.2% were contented with their knowledge. The accurate and absolute way to recognize a person was DNA comparison (54.3%) followed by fingerprints (29.3%), visual identification (8.7%), serological comparison (2.2%) while 5.4% did not know the accurate method. 59.8% were aware of bite mark of teeth, 54 % had no awareness how to identify bite mark. Regarding the age and gender identification of deceased, 52.2% respondents said that they can identify age and gender by erupted teeth examination, while 17.4% by DNA examination of tooth, 15.2% by jaw examination and 15.2% didn’t know how to identify. (Table 2) 87% respondents agreed that dental records are useful in identifying the deceased and crime suspect, 6.5% didn’t find it useful while 6.5% didn’t know whether maintaining records are useful for crime suspect or not .69.9% sustained their dental records, of which only 17.4% maintained dental records for more than 3 years while 53.3% maintained for less than 3 years.

Table 2. Knowledge based questions.

83.7% participants had no formal training in the field of forensic odontology, while only 16.3% participants had studied forensic odontology (Table 3).

DISCUSSION

Recognition of persons who are sufferers of criminal acts, assassinating analysis, mass victims or missing people can be done by the aid of dental records2 .The verification of a deceased individuality is essential for several reasons. It is imperative in bringing closure to the immediate family members when catastrophic and unanticipated actions occur4.

The officially authorized settlements of domains where a deceased record is required is a further motive4. For issuance of death certificate, a confirmation of individuality is required4. It is due to these causes, dental identification acquires a prime liability for detecting remains when changes in postmortem occurs, damage to traumatic tissue occurs or not having fingerprint verifications which invalidate the use of visual or fingerprinted2.

The comparison of dental substantiation is one of the most unfailing and consistent approaches of detection because the teeth can tolerate intense changes in temperature, and have the capability to endure decomposition4. However, the condition of an individual’s teeth varies during his life and the information of decayed, missing and filled teeth can be assessed and compared at any fixed instance8,9.

The application of dental records for identification appears in dispersed situations throughout documented history even in archaic forms in pre-historic times. According to the ancient testimony of the Bible, Adam was persuaded by Eve to put a ‘bite mark’ on the apple. This was the first reported evidence of bite mark in the history of mankind10. General Zia-ul-Haq, the late president of Pakistan, died due to explosion in a plane smash, in the year 1988. Mr. Rajiv Gandhi , the late Indian Prime Minister, was executed in a terrorist attack in 1991. They both were recognized from their dentition11.
According to the World Health Organization (WHO), the aggression is a main and emergent civil health dilemma across the planet12. Fracture of anterior teeth or alveolar bone, lacerations to the frenum or mucosa either labial or buccal, contusions to the lips, face and neck are the injuries due to violence in the oro-facial region. There are certain characteristics of non accidental injuries which facilitate in their identification13.

Comparison of dental records (ante-mortem with postmortem) for detection, there are three categories to inspect which include the teeth, periodontal tissue, and anatomical features14.

The dental tissues and dental restorations are resistant in nature , due to which the changes caused by ecological extremes such as temperature and decomposition , make them the most appropriate source of DNA, which will be of an immense aid to recognize a person15. The logical assertion concerning bite mark examination is stemmed from the actuality that the dentition of human being is not indistinguishable from individual to individual. Bite marks are as definite to an individual as DNA or fingerprint study; similarly, no two individuals will have the accurate identical dentition in regards to contour, dimension and arrangement of teeth16. Human bite marks are depicted as an elliptical or spherical wound that records the exact uniqueness of the teeth17. The success of identification depends on the accessibility and accuracy of these records. Unfortunately, due to dentists’ negligence of maintaining proper records, resulting in uncertainty, creates dental recognition impossible9.

CONCLUSION

This study divulges that there was a lack of knowledge and awareness of forensic odontology amongst the participants and very few of them have awareness regarding forensic odontology. It can be enhanced by instigating forensic dentistry as subject in dental curriculum at both undergraduates and postgraduates levels. Formal training should be offered in forensic odontology in all dental institutes and to upgrade the knowledge of graduates and post graduates, periodic CDE Program, conferences and workshops should be arranged.

Action, in terms of Positive Academic Support at all levels needs to be taken by all leading stake holders, in order to upgrade our current dental education & Profession, to meet our society & International standard. This is only possible by providing a positive & supportive learning environment for the new dental graduates to foster “Critical thinking & their development as Academic Leaders, to train them to think & act out of the box18.

AUTHORS’ CONTRIBUTION

Article has been revised and rechecked by Anwar Ali and Khurram Parvez Sardar. Article writing, data collection, result compiling has been done by Syeda Maliha Wakar and Saqif Nasir.

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1. Professor, Department of Oral and Maxillofacial Surgery, Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
2. Assistant Professor, Department of Science of Dental Materials, Dr.Ishrat-ulEbad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
3. House Officer, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
4. House Officer, Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Corresponding author: < dr_khurramparvez@hotmail.com >