Current Trends and Challenges in Forensic Odontology Among Indian Dental Practitioners: A Questionnaire-Based Study

INTRODUCTION

Forensic odontology (FO) has a long history that extends from the Roman Empire to the 21^st century and continues to evolve. Due to his efforts in identifying fire victims in Paris, France, in 1898, Dr. Oscar Amoedo is often regarded as the founder of FO. According to the Federation Dentaire Internationale, FO is the area of dentistry that deals with the appropriate handling, analysis, and presentation of dental findings as well as the proper appraisal and presentation of dental evidence in the interest of justice.^[1]

Each individual’s dental pattern is unique, shaped by the various treatments and procedures performed by dentists. This distinctiveness makes dentition a vital tool in FO, providing essential information for identification, investigation, and analysis.^[2] In cases like mass disasters, civil and criminal investigations, child abuse, and other activities, forensic odontologists and dentists actively participate in a variety of FO purposes. They use dental features such as anatomy, tooth number and position, palate, prosthetic restoration, bite marks, and lip prints as a key for their investigations. In the realm of forensic dentistry, the mouth provides a wealth of evidence that can be used to identify the victim.

It is essential to FO because it can be used to compare dental images to existing records, analyse dental evidence for leads in investigations, examine dental features for age, sex, and ancestry, record dental evidence for court proceedings, and analyse dental and skeletal remains to determine a person’s biological sex. It calls for proficiency in forensic science and statistical analysis.^[3] By comparing the distinctive features of a person’s teeth and dental work to bite marks discovered on victims, items, or other evidence, as well as in situations of abuse and assault, it is used to identify the individual. To determine DNA type, a variety of biological samples are used, including blood, bones, teeth, hair, and saliva. The DNA tests that are now being conducted are trustworthy and offer details regarding physical characteristics, ethnicity, and sex of a person and place of origin.^[4,5]

With the help of interdisciplinary cooperation and technological improvement, FO has enormous growth and development potential in the future. Analysis of bite marks and lip prints will be transformed by the combination of AI and MI. Online courses, certifications, workshops, and fellowship programs will be the mainstay of education and training to keep forensic odontologists abreast of emerging methods and technologies.^[6-8]

We evaluated the knowledge, awareness, and attitude of dental practitioners towards FO.

The study aimed to assess the trends, awareness, practices, and challenges related to FO among dental practitioners in India. Specifically, the objectives were to evaluate their knowledge and awareness levels, understand their involvement in forensic-related activities, and identify the key barriers limiting their implementation in clinical and legal settings. The study also examined practitioners’ training, educational exposure, and professional readiness.

MATERIAL AND METHODS

The approval was granted by the Institutional Ethics Committee (KVV/IEC/10/2024, dated 03.08.2024). An 11-question survey was created following ethical approval. Using Google Forms, 230 dental practitioners were randomly chosen to take part in the survey. The goal of the study was communicated to each participant, and their informed consent was acquired. The study targeted general dental practitioners in western Maharashtra. Data collection employed a convenience sampling technique, where participants were selected based on ease of access and willingness to participate.

RESULTS

A total of 230 dental practitioners were enrolled as study participants, among them 201 (87.39%) were given information of demography where 90 (44.77%) were males and 111 (55.22%) were females. The average age of study participants was 25.81 ± 4.67 years.

Among the 201, 98% had responded by using Google Forms, where this study was distributed in three important sections. The 1^st section dealt with awareness, interest, and perception, followed by 2^nd section consisting of knowledge, application, and challenges, and 3^rd section related to the future scope of FO.

Table 1 delves into student awareness, interest, and perception towards FO. After asking them about how familiar they were with the subject, it was observed that almost 69.7% of students had responded to somewhat familiar, followed by 51 (25.4%) had very familiar, and 10 (5%) were not familiar with the study term FO. However, 115 (57.2%) dental practitioners were partially interested, 75 (37.3%) were fully interested in participating in the study and agreed that it would adequately prepare them for potential involvement, whereas 5.5% expressed no interest. Among the 201(100%) dental practitioner, 109 (54.2%) were somewhat confident, 63 (31.3%) were very confident, and 29 (14%) were not confident at all in showing their ability in FO knowledge and skills if required for their practice. The majority (170, 84.6%) of dental practitioners were sure, and 15.5% were not sure, to join a diploma or degree course related to FO in India. Most (165, 82.1%) of the dental practitioners attended either conference or workshop, or both, related to the term studied in this study. Only 3% were not interested in learning FO, whereas the remaining were interested or somewhat interested.

Table 2 gives the details and insights on knowledge, applications, and challenges among the dental practitioners regarding FO. The majority (163, 81.1%) had responded that FO could have been used but was not. Almost 90% of participant students believed that there was a need for standard protocol or guidance, or both, as dental practitioners in India. As per 70% of the participants who experienced the biggest challenge towards FO, which was found in this study, were insufficient legal support and recognition, lack of newer technologies and skilled professionals, lack of standardisation, limited research, and training opportunities.

In Table 3 while discussing about the future scope of FO whenever we discussed about how do they perceive the future scope of that in India among the participant students (71, 35.3%) were pressing on growing awareness, demand and importance, followed by 38 (18.9%) who showed limited impact and relevance and same proportion was unsure, whereas on the contrary 25 (12.4%) favoured all the options for the future scope of FO. Also, when we asked about future direction, almost 100% agreed that greater collaboration with other disciplines followed with some improved standardisation, increased awareness among dentists and the general population, and also increased use of digital technologies.

DISCUSSION

Identification of victims of mass disasters (such as earthquakes, tsunamis, and airplane crashes), crime investigations, ethnic studies, and the identification of decomposed and disfigured bodies, such as those of drowning victims, fire victims, and victims of auto accidents, have all benefited greatly from FO.^[9]

As per Prajapati et al.,^[10] 12 (57.14%) of the 20 disasters that were considered were unintentional, five (23.8%) were natural, and three (19.04%) were criminal. The tsunami in Japan claimed the greatest number of lives (15892), followed by the tsunami in Thailand (4280) and the Estonian ferry accident (852). Among the 23654 victims, 20569 (86.96%) who were reported were positively identified. The use of FO in victim identification was reported by 17 MDs [3025 (14.70%) cases]. Additionally, utilising FO in conjunction with other approaches, 1094 victims (5.31%; from 7 papers) were identified. FO was used to identify the largest percentage of casualties after the Kentucky air disaster (47; 100%), Newark air crash (38; 76%), Nepal air crash (10; 71.42%), France air crash (56; 65.88%), and the Australian air crash.

A relatively recent field of study called FO uses dentists’ expertise to support the legal system. Human identification using dental records, bite marks, lip prints, teeth prints, and palatal rugae patterns is the focus of FO. The accuracy of dental records at the office is crucial to human identity. Documents pertaining to the current illness’s history, clinical examination, diagnosis, therapy, and prognosis are all included in the dental record. High-quality dental records are helpful for legal reasons, including insurance and consumer behaviour, in addition to forensic science. The main goal of this article is to educate general practitioners on the significance of maintaining different kinds of dental records and how they relate to FO.

Violent situations, including sex-related crimes, child abuse cases, and crimes involving physical altercations, such as homicide, can leave bite scars on human tissues. It can happen when the victim bites the attacker or when the victim bites the attacker in self-defence, but it’s important to keep in mind that the victim of the bite may be the suspect in these cases. Female victims are typically bitten on the breasts, arms, and legs, whilst male victims are typically bitten on the arms and shoulders.^[1-3,11]

The Department of Oral Medicine and Radiology (32.6%) in JFDS had the most articles out of all the published ones, with cheiloscopy (46.7%) being a more focused area, and the Department of Prosthodontics (25.7%) in JFOS having a more focused area with bite mark analysis (66.7%).^[12]

Both genomic and mitochondrial DNA (mtDNA) are utilised in the forensic sciences. The nucleus of every cell in the human body contains the genomic DNA. A great source of genomic DNA is the teeth. When the retrieved DNA samples, such as those from skeletonised tissues, are too little or deteriorated, mtDNA may be utilised. Following that, the amplified DNA is compared to antemortem samples, including cervical smears, hairbrushes, clothing, preserved blood, and biopsy tissues.

Using pressure-sensitive cellophane or scotch tape, lip prints can be captured. Because biometric techniques require patterns that are naturally found in the human body and don’t require anything to be learned or carried with them, they have recently attracted a lot of attention.^[13]

This study explores students’ orientation and current knowledge regarding FO. We observed that a majority (115, 57.2%) were partially interested, while 75 (37.3%) were completely interested and agreed that training in this field would adequately prepare them for potential involvement. Only 5.5% expressed no interest. Additionally, 163 (81.1%) respondents reported that FO could have been utilised in certain situations but was not applied. Almost 90% of participant students believed that there was a need for standard protocol or guidance, or both, as dental practitioners in India. Almost 100% agree that greater collaboration with other disciplines, followed by some improved standardisation, increased awareness among dentists, the general population, and also increased use of digital technologies. The similar kinds of studies help in making policy to adopt such techniques in the field of dentistry and later on extend it to evidence-based medicines.

In addition to having extensive dental expertise, forensic dentists should approach situations methodically, with patience, and with careful attention to detail. Emotional stability and personal integrity are also crucial. The majority of forensic odontologists with the most experience reported the least discomfort. Stress management was easier for males than for females; 19.2% (n = 5) of the students reported experiencing stress after mortuary sessions, while 80.77% (n = 21) reported no behavioural changes. Every respondent is in favour of adding a psychology or stress management module to forensic dentistry training programmes. Respondents take into account ideas for preserving mental health, and psychologists recommend subjects for instruction.^[14]

The FO plays a crucial role in human identification, age estimation, bite-mark analysis, and assisting the legal system during criminal investigations and mass disasters. Understanding the current level of awareness and preparedness among Indian dental practitioners helps identify gaps in knowledge and practice. This in turn, will contribute to improving clinical competence, enhancing medico-legal documentation, and ensuring that dental professionals can effectively support forensic investigations when required.

The findings of this study can guide the development of training programmes, dental education workshops, and standardised protocols in FO. It can assist academic institutions in strengthening the forensic component of the dental curriculum. Future research may include larger, region-specific studies, evaluation of skill-based competency, and the creation of national guidelines to integrate dental practitioners more effectively into forensic and disaster-response teams.

CONCLUSION

The study indicates that while most Indian dentists are aware of and interested in FO, its actual use in routine practice remains limited. Although many acknowledge its significance in legal investigations, inadequate training and minimal representation in the dental curriculum continue to be major barriers. When applied correctly, forensic techniques achieve high accuracy due to the unique characteristics of oral anatomy and individualised dental restorations. Therefore, in order to help forensic investigations and give the best possible patient care, it is essential that all dental operations be accurately documented and maintained.