Establishment of the forensic odontology department: A proposed model for the basic infrastructure and forensic odontology kit.

The importance and the application of dental science and forensic odontology in the legal system are gradually increasing in India. In a long-term vision, there is a need for a specialized forensic training curriculum not only for the undergraduate and postgraduate dental students but also for the experienced dental surgeons. Dental experts opinion is sought most commonly in forensic casework of human identification, age estimation, and sexual assault cases with patterned injury, by the legal and forensic authorities. As a consequence, there is a demand for dentists trained in forensic and legal dentistry and experienced in forensic, capable of dealing and managing medicolegal cases in dental institutes or state hospitals. Several guidelines and protocols for forensic odontology procedures are drafted and proposed by forensic odontology organizations. However, there are no specific guidelines or recommendations for the establishment of a specialized forensic odontology department or unit in dental institutes. Hence, this article addresses the necessity and requirements for a forensic odontology unit, proposing a model to follow. A comprehensive list of forensic odontology armamentarium and case dependent forensic odontology kits is also highlighted here. Copyright:

Introduction

The Federation Dentaire Internationale defines forensic odontology as that branch of dentistry which, in the interest of justice, deals with the proper handling and examination of dental evidence, and with the proper evaluation and presentation of dental findings.[1] It is a subdiscipline of dental science which involves a multidisciplinary approach while handling forensic dental evidence and presenting the report to the court of law. In India, there are 313 dental institutes with nearly 1.3 lakhs dental students and more than 2.7 lakhs dentist workforce[2] and no dental institute is yet offering a council-recognized master's program for forensic odontology. However, there are several certificates, diplomas and fellowship programs in forensic odontology, being offered by some organizations and associations regularly throughout the country. To address the dearth of qualified forensic odontologists in the country, some Indian universities are also offering postgraduate (MSc.) course[34] and postdoctoral fellowship[5] training in forensic odontology with curriculum covering the dental, forensic and legal disciplines. Besides, there are some foreign-trained forensic odontologists, mostly graduating from countries such as Australia, Belgium and UK, who are offering forensic services and giving new dimensions to the science of forensic odontology in India. Currently, forensic odontology has not been introduced as a separate subject in undergraduate curriculum.[6] The revised bachelor of dental surgery (BDS) course regulation of 2007 included forensic odontology as a syllabus of study (No. 20) with 10–12 h of didactic sessions and 20–25 h of practical sessions.[7] The syllabus is being covered in two separate streams with the first preclinical stream in the 1st and/or 2nd BDS years by the oral pathology department and the clinical stream in the final year by the oral medicine and radiology department. Qualifying is the key step in the development of professional expertise in any field of dentistry and the same may be applicable for forensic odontology, too. Unfortunately, the masters or diploma courses in forensic odontology currently offered in India and abroad are not recognized by the dental apex body of the country. It is because the duration of the course is not on par with the master's course (3 years) or diploma (2 years) offered in India. Due to rising demand for the forensic dental services in the present Indian social conditions,[6] there is mushrooming of training and continuing dental education (CDE) programs in forensic odontology through dental institutes and associations. Even though this is the stand on one side, on the other hand, some of the dental institutes including the premier dental institutes of the country are establishing a separate forensic odontology unit or department under the aegis of oral pathology and oral medicine departments. The forensic odontologists trained in India and abroad are recruited as faculty in such departments. The first of its kind in India, an exclusive department of forensic odontology, was commenced in 2006 at SDM College of Dental Sciences, Dharwad, which is headed by an Australian-trained forensic odontologist.[8] The first three authors of this article had an opportunity to visit the department and got trained under the same forensic odontologist. Such a department not only teaches the subject to the undergraduate and postgraduate students but also handles forensic cases referred from the home/legal department and the forensic medicine departments of medical colleges. Few forensic odontologists trained in India and abroad are also posted in the forensic medicine departments of the medical colleges and as a team perform the biological profiling of the deceased during postmortem examination and also render their expert service in other areas of forensic odontology. A multidisciplinary approach along with the forensic medicine department, forensic science laboratories (FSLs), forensic anthropology department and the legal department is mandatory for the successful evolution of forensic odontology in any country. Most dental institutes do not have the necessary proficiency to deal with forensic cases and their students are not practically exposed to the legal proceedings in the court of law, unlike the medical institutes. The qualified dental surgeons were also not practically trained to handle dental evidence in forensic cases during their dental curriculum. This gap needs to be addressed by establishing an exclusive forensic odontology department or unit in all the dental institutes and by recruiting qualified forensic odontologists that may impart forensic odontology knowledge to the dental students. The department can also provide training to the external candidates highlighting the forensic attributes of dental evidence. In a dental institute, the forensic odontology unit is recommended to function under the aegis of the oral pathology and oral medicine departments with forensic support from the medical institute [Figure 1]. However, the infrastructural facilities of almost all the clinical and nonclinical departments in a dental institute are recommended to be utilized for the proper functioning of the forensic odontology unit. Thus, the evolved forensic odontology units need to deliver core theoretical knowledge and intellectual skills to the dental students and the trainees to prepare them competent enough to handle forensic cases, whenever consulted by the forensic and legal authorities. The infrastructure facilities of the department need to be sufficient enough to impart the practical hands-on experience and also to handle real-life forensic case works and represent the same to the court of law. To this end, the facility must establish operative agreements on specific multidisciplinary medicolegal evaluations, among which human identification process of decomposed, carbonized and skeletonized human remains. The unit must be ready to collaborate with all or some of the following specialists, holding experience, education and training in the forensic process: medical examiner or forensic pathologist, forensic anthropologist, forensic photographer, police crime scene investigator, evidence technician/gatherer, fingerprint expert, DNA analyst, radiologist and radiographic technician, toxicologist and also dental hygienist/assistant.[9]

Figure 1

Linking of forensic odontology branch with other related branches

The following components are necessary for an ideal forensic odontology department:

Theoretical or academic component: to impart theoretical knowledge on various aspects of forensic medicine, odontology, disaster victim identification (DVI), and anthropology to the students and trainees in the form of lectures, seminars, and assignments as per the revised 2007 BDS course regulations. Some informative sessions on Civil and Penal Code and Judicial proceedings, specific to medical or dento-legal aspects may be highlighted.

Practical component: to impart practical skill and train the dental students and the trainees on the methodological approaches in age estimation, gender determination, bite mark analysis, dental identification, and report writings and also to handle the real-time forensic cases. The department may be associated with the medicolegal/forensic medicine department of the nearby medical college and the state forensic sciences laboratories (FSLs). A training in the dental autopsy, forensic radiology, and teamwork with law enforcement agencies and other forensic experts may also be included.

Research component: to assist the postgraduate students and independent researchers to take up research projects on the topics related to forensic odontology and forensic radiology.

Infrastructure

The basic design of the forensic odontology department and the forensic odontology kit was prepared bearing in mind the syllabus for the undergraduate and postgraduate students in dental colleges, conditions of the various forensic dental specimens (living and deceased) to evaluate and observe, and to have a clean and safe working environment [Figures 2 and 3].

Figure 2

An example of a proposed plan for establishing the forensic odontology department in a dental/medical institute

Figure 3

An architect's model plan of a forensic odontology department

The department may be located in the dental college or near the mortuary of the medical college or hospital within the campus. The primary circulation or the exit corridor leading to the department may be of 6 ft wide, minimum and the secondary circulation or non exit corridor may be of 4.5 ft wide, minimum. Considering the evolving trends in the conventional methods used in forensic odontology,[10] a basic infrastructure and armamentarium list for a forensic odontology unit is proposed here. It may include the following:

1. Administrative area

Reception (12 × 14 sq. ft)

Record room (12 × 10 sq ft)

Waiting room for police, non-governmental organizations representatives, media personnel and families (12 × 12 sq. ft).

2. Dental operatory area

Odontologist's cabin (12 × 20 sq. ft)

Odontologist's changing room having bath with shower and locker facility (12 × 10 sq. ft)

Operatory cubicle/workspace (30 × 30 sq. ft)

Evidence (specimen/victim/accused) examination room with dental chair (150 sq. ft)

Storeroom (12 × 10 sq. ft)

Radiology area (300 sq. ft)

Sterilization area (250 sq. ft)

Solid disposal area (250 sq. ft)

Rest area (200 sq. ft).

3. Academic area

Seminar hall (600 sq. ft)

Departmental library (300 sq. ft)

Departmental museum/display area (600 sq. ft).

4. Dental and anthropological laboratory area

Biotech laboratory with high-efficiency particulate air filter and laminar hood (400 sq. ft.)

Plaster/prosthetic laboratory (100 sq. ft)

Human remains and anthropology laboratory (dry laboratory and wet laboratory) with intraoral and extraoral X-ray facilities (400 sq. ft.)

Forensic Odontology Kit

Equipment and kits for forensic odontology department[11121314]

This article provides a basic classification and a comprehensive list of necessary equipment and kit that are required for the establishment of a forensic odontology department or unit.

The forensic odontology kit is a set of articles or equipment related to forensic odontology that is needed for a specific purpose.

Based on the place of application, the kit may be classified as follows:

Inhouse kit – the kit that is used indoor, within the organization, or institute

Field kit – the kit required at the crime scene or disaster site

Based on the application, the kit may be classified as follows:

Functional kit – those which are routinely used in real forensic cases and for research

Display/demo kit – those which are kept on display for teaching purposes. Some of the components are replicas of the original specimens

Training kit – those which are used for giving hands-on training to the students

The proposed armamentarium for the forensic odontology department is categorized as follows:

Investigative kit

Illumination kit

Personal protection equipment (PPE) kit

Documentation/stationery kit

Craniofacial Anthropology kit.

1. Investigative kit

a. Kit for DVI

Protective clothing (see section 3)

Clipboards plain

Magnifying glasses

Aluminum storage clipboards with integrated pen and pencil tray

Plastic box with lids for collection of specimens such as dentures and teeth.

Scene evidence number (yellow)

Ready adhesive stickers/label

Plastic transparent bags of various sizes

Yellow measuring tape

Compass

Azimuth board

Sketching templates

Thermometer

American Board of Forensic Odontology No. 2 scale

Digital single-lens reflex camera with external flashlight

Intraoral mirrors for photography

Dental explorers

Toothbrushes

Autopsy twine

Silk sutures

Mallet and chisel

Pruning shears

Portable X-ray machine/handheld X-rays

Sensor holders (Rinn and XCP)

DVI antemortem and postmortem dental data recording forms

Table for examining the resected anatomic and/or skeletonized specimens

Laptops with DVI software installed

Scene paper evidence bags (6 × 9 inches)

Evidence box or cover sealing tapes and labels

Battery-operated ultraviolet ( UV) flashlight light-emitting diode (LED)

Rechargeable 25W LED torchlight

Magnifier/4x UV LED lighted handheld magnifier

Magnets/telescopic pen magnets

Dental impression trays – dentulous and edentulous

Denture storage box with evidence labels

Impression materials and stone plaster

Camel hairbrush set

Cyanoacrylate or nail polish to stabilize on the burnt teeth specimens

Tongue blades/retractors

Hydrogen peroxide

Biohazard labels

Hand and surface sanitizer

Extra batteries (for all battery-operated devices)

Permanent markers

Storage boxes for small equipment

Cleaning and sterilizing substances

b. Kit for lifting latent prints (lip print)

Laminated fingerprint cards

Lipstick (brown and red)

Lipstick applicator

Lipstick remover liquid

Cotton balls/rolls

Scissors

Executive bond paper

2” × 2” white hinge latent print lifter

2” × 4” white hinge latent print lifter

Inkpad

Compact fingerprint cards

Black powder for enhancing the print

Powder brush

Print lifting tape/cellophane tape

Magnetic powder

UV lamp

Nitrile gloves

Microscopes – stereomicroscope and comparison microscope

PPE

Handheld magnifier

Laminated fingerprint type's identification cards

Laminated lip print type's identification cards.

c. Kit for bite mark investigation

Rubber-based impression material

Nitrile gloves

Impression trays

Modeling wax.

ABFO No. 2 scale [Figure 4]

Figure 4

A customized kit of the principal author showing the different types of scales/rulers used in forensic odontology

Nuzzolese-Neri-DiVella No. 2 scale (colorimetric scale)

2” Photo scales

Sterile cotton swab/applicators

Stopwatch

Universal buffer solution

Bottled saline solution

20–200 μL

Standard reference manuals pipettes and pipette tips

Tweezers

Vortexes

Saliva test strips

Colored Eppendorf® tubes

Microcentrifuges

Microfuge tube racks

Digital camera

Laptops with image analysis softwares like Adobe Photoshop (Adobe Inc., San Jose, California, U.S.), GNU Image Manipulation Program (GIMP), ImageJ (NIH, Bethesda, Maryland, USA.), and AUTOCAD (Autodesk, San Rafael, California, USA)

Flatbed scanner

Inkpad to highlight the incisal/occlusal surfaces of the teeth on models.

Inkjet color printers

Tracing paper

Thermometer

d. Kit for forensic facial reconstruction

Reusable skulls with tissue-depth measuring pegs

Small metric ruler

Glue

Scalpel or knife

Nonhardening clay, tools, and materials

Storage containers

Super Sculpey (beige/red/yellow)

26-mm prosthetic eyes

Clay tool (wood/rubber finish)

e. Kit for age estimation

Guidelines and standards manuals

Dental anthropology manual

Dental age atlases

X-ray with radiovisiography compatibility

X-ray viewer for orthopantomogram

Computer with photo editing software

Micromotor with straight and contra-angled handpiece

Carbide and diamond tooth cutting discs

Arkansas stone for tooth sectioning (coarse and fine)

Bench lathe machine for tooth grinding

Adjustable light source

Glass slides with coverslips

Microscopes – phase contrast

Digital Vernier calipers

Laminated chart showing stages of tooth development.

2. Illumination kit:[15]

Torchlight/Flashlight

455 nm blue LED light

AC chargers, 100–240 VAC

Battery-operated UV light source (495 nm)

Magnifier with LED light

Altered light source for viewing bite marks and latent prints

Forensic filters – clear, general, blue, orange, and green

Yellow goggle to view fresh bite mark

Orange goggles to view teeth and bone samples.

3. PPE kit

Tyvek cover coat

Laboratory apron

Tyvek sleeves

Overshoes

Mob cap/hairnet

Nitrile gloves

Face masks/eye protectors

Dispenser for gloves and masks

Forensic Goggles

N95 particulate respirators

Antimicrobial surface wipes

Antiseptic handwash

Biohazard trash bags

Green safety vest

Tyvek hair covers

4. Documentation kit

a. Stationery kit

Clipboards

Templates for sketch

Permanent marker pen

Color pencils for documenting the bite mark or any other injury

HB pencils

Lark for sealing the report covers

Departmental letterhead mentioning the complete contact details

Seal of the forensic odontologist mentioning the degree and designations

Envelopes bearing the department and institutes details

Pen drives

DVI antemortem (Yellow) and postmortem (Pink) forms (hard and soft copy)

Odontogram sheets

Chain of custody sheets

Logbook

Countertop paper roll (21“, 225 ft long)

Departmental files for individual cases

Chain of custody labels (3½” × 5”)

Document cabinet

Multifunctional flip chart.

b. Photo documentation kit

1–15 number photo markers

6” scale (white, gray, black, transparent, fluorescent, blue, and yellow)

Photomacrographic scales

2” adhesive scales

12 ruler tape

Field case

Adhesive arrow booklet

Auxiliary flash

Evidence tape (1 3/8” 108 ft)

Evidence labels (3½ ” × 5”).

5. Craniofacial anthropology kit

Tooth development charts

12 × stainless steel small finds archeology tools

4 × tweezers to allow to handle delicate finds

Plastic rulers

Protractors

Magnetic compass

Skull box

Measuring tape

Osteometric board

Comparative bone sets

Goniometer

Palatometer

ASUDAS plaques or Turner–Scott dental anthropology system [Figure 5]

Figure 5

The plaques of 10 nonmetric dental traits of the Turner–Scott dental anthropology system

Zipper closure bags

Comparative maxilla set

Comparative mandible set

Human skeleton – male and female

Skull – male and female, neonates’ skull, primate skull

Skull – Mongoloid, Caucasoid, Negroid

Animal skulls (originals and replicas)

Animal teeth set

Laboratory equipment

Biotech laboratory

Bunsen burner

Laminar hood

Glasswares

Refrigerator with deep freeze

Pipettes and pipette tips

Chemicals and reagents

Centrifuge/ultracentrifuge

Weighing balance (digital)

Microscope – stereomicroscope, comparison microscope, and compound microscope

Hard tissue microtome

Photomicrographic camera

Disposal container

First aid kits

Portable fire extinguisher

Water bath

Oven

Hot plate

Incubators

Autoclave

pH meter

Distilled water plant

Rotary shaker

Electric heater

Petri dish

Conical flasks

Culture tubes

Beakers

Funnels

Measuring jars

Graduated and bulb pipettes

Burettes

Reagent bottles

Glass slides and coverslips

Nonabsorbent cotton

Tissue paper

Aluminum foil

Test tube stands

Glass marking pencil

Cabinets for storing chemicals and glassware.

Disinfectants

Micromotor and carbide discs for tooth sectioning

Bench lathe machine for tooth grinding

Mortar and pestle for tooth crushing (Ceramic or Metal)

Digital Vernier caliper

Handheld or stand-mounted digital microscope (10×– 80×).

Prosthetic laboratory

Model trimmer

Dental articulators

Vacuum mixer cum vibrator

Modelling wax

Cyanoacrylate cement

Base former

Die stone

Dental plaster

Impression materials

Teeth shade guide

Dental laboratory 3D scanners (Benchtop) and 3D printer

Slow set alginate for replicating skull in facial reconstruction.

Anthropology laboratory

Stainless steel table with individual water hoses for the wet analysis of the skeletal specimens

Wooden table for the dry analysis of specimens.

Note: The additional specialized equipment may be made available through cooperative agreements with associates within the institute or on the campus.

Library

15–20 titles of renowned authors

4–6 international journals

Forensic Science International

Journal of Forensic Odontostomatology

International Journal of Legal medicine

Journal of Forensic Dental Sciences

Journal of Forensic Sciences

8–10 volumes of back issues of at least three international journals

50% in the print form

Computers with internet connection for online access.

Seminar room

LCD projector/digital screen

Notice board

Seating arrangements

Microphones and speakers

Computer

Audio-Visual (AV) adapters

Educational videos/tubes

Facility for webinars and live AV communications

Facility for Mock court.

Museum section

Dental models and charts showing different dental nonmetric traits

Skull models

Human skeleton – male and female

Histology images of neonatal lines and cemental annulations

Recorded bite mark images of different domestic animals and wild animals

Table models for DVI phases

Facial reconstruction models in different stages

Skulls and teeth of different animals

Skulls of neonates

Charts or bone replicas illustrating different age estimation methods

Charts illustrating different dental notations system and dental codes

Portrait or photographs of eminent forensic odontologists

Manuals and guidelines released by forensic odontology associations or organizations.

Radiology section

Handheld X-ray machine

RVG

Skull positioning devices

Computer for imaging observation and archive

Lead aprons

Lead gloves

Thyroid collar

Lead screen

Darkroom facility

Dosimeter badges

Automatics X-ray developer

X-ray viewer box with adjustable illumination.

Engineering section

Fire protection

Electrical

Air conditioning

Refrigeration

Water supply

Disposal system

Power backups

Fire and rescue tools and equipment.

Miscellaneous

Letter of permissions or memorandum of understanding by the Government for handling forensic dental evidence and cases (mandatory for private dental institutes)

Record book/logbook

Refrigerator

Cupboard

Loupes

Skinfold caliper

Weighing machine

Height measuring tapes, Stadiometer

Mid-arm circumference measuring tapes.

The above model and the armamentarium list have been prepared by the authors based on their experience in the field of forensic odontology. The corresponding author has 5 years of experience in forensic odontology case works, plus over 21 years of teaching experience in Government dental institute. The coauthors are trained forensic odontologists. The last coauthor is a forensic odontologist with huge international experience in several DVI teams and international law enforcement agencies, including Interpol, with 17 years of experience.

Conclusion

All domains of forensic odontology need to be taught by trained and qualified forensic odontologists who are familiar with the medico-legal criteria, methodologies, standards, international guidelines, civil and penal responsibilities. Forensic odontology is the unique branch of dentistry that bridges the Ministry of Health, Ministry of Home affairs in any state government with interaction from military and foreign affairs, too. For this reason, a forensic odontology specialized unit shall be recognized by state home ministry and gain an affiliation with the state FSL. The forensic odontology department or unit in any dental institute may require infrastructure and technical support with experienced dentists having training or postgraduate degree in forensic odontology and forensic sciences experiences. The dental education system in our country needs to ensure that the training in forensic odontology to the dental students meets the standards appropriate to the future needs of dental professions by establishing a dedicated department for forensic odontology at dental institutes. This present article for the first time addresses the need for the establishment of a forensic odontology unit in dental institutes along with a proposed infrastructure model. It is wise to mention that not all the above-mentioned list of equipment and infrastructure are essential to establish a forensic odontology department, but some may consider many of them as being important. It may also provide a readymade checklist to help forensic odontologists wishing to establish a specific unit or department in any academic set up.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.