Journal of Forensic Dental Sciences

REVIEW ARTICLE
Year
: 2019  |  Volume : 11  |  Issue : 2  |  Page : 64--72

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


Jayasankar Purushothaman Pillai1, Thamarai Selvan Chokkalingam2, Balamurugan Aasaithambi3, Emilio Nuzzolese4,  
1 Department of Oral Pathology, Government Dental College and Hospital, Ahmedabad, Gujarat, India
2 Department of Forensic Odontology, Maulana Azad Institute of Dental Sciences, New Delhi, India
3 Forensic Odontologist and Dental Practitioner, Thanjavur, Tamil Nadu, India
4 Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy

Correspondence Address:
Dr. Jayasankar Purushothaman Pillai
Department of Oral Pathology, Government Dental College and Hospital, Ahmedabad - 380 016, Gujarat
India

Abstract

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.



How to cite this article:
Pillai JP, Chokkalingam TS, Aasaithambi B, Nuzzolese E. Establishment of the forensic odontology department: A proposed model for the basic infrastructure and forensic odontology kit.J Forensic Dent Sci 2019;11:64-72


How to cite this URL:
Pillai JP, Chokkalingam TS, Aasaithambi B, Nuzzolese E. Establishment of the forensic odontology department: A proposed model for the basic infrastructure and forensic odontology kit. J Forensic Dent Sci [serial online] 2019 [cited 2020 Feb 23 ];11:64-72
Available from: http://www.jfds.org/text.asp?2019/11/2/64/276637


Full Text



 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[3],[4] 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]

The following components are necessary for an ideal forensic odontology department:{Figure 1}

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 [Figure 2] and [Figure 3].{Figure 2}{Figure 3}

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[11],[12],[13],[14]

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 instituteField 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 researchDisplay/demo kit – those which are kept on display for teaching purposes. Some of the components are replicas of the original specimensTraining 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 kitIllumination kitPersonal protection equipment (PPE) kitDocumentation/stationery kitCraniofacial Anthropology kit.

1. Investigative kit

a. Kit for DVI

Protective clothing (see section 3)Clipboards plainMagnifying glassesAluminum storage clipboards with integrated pen and pencil trayPlastic box with lids for collection of specimens such as dentures and teeth.Scene evidence number (yellow)Ready adhesive stickers/labelPlastic transparent bags of various sizesYellow measuring tapeCompassAzimuth boardSketching templatesThermometerAmerican Board of Forensic Odontology No. 2 scaleDigital single-lens reflex camera with external flashlightIntraoral mirrors for photographyDental explorersToothbrushesAutopsy twineSilk suturesMallet and chiselPruning shearsPortable X-ray machine/handheld X-raysSensor holders (Rinn and XCP)DVI antemortem and postmortem dental data recording formsTable for examining the resected anatomic and/or skeletonized specimensLaptops with DVI software installedScene paper evidence bags (6 × 9 inches)Evidence box or cover sealing tapes and labelsBattery-operated ultraviolet ( UV) flashlight light-emitting diode (LED)Rechargeable 25W LED torchlightMagnifier/4x UV LED lighted handheld magnifierMagnets/telescopic pen magnetsDental impression trays – dentulous and edentulousDenture storage box with evidence labelsImpression materials and stone plasterCamel hairbrush setCyanoacrylate or nail polish to stabilize on the burnt teeth specimensTongue blades/retractorsHydrogen peroxideBiohazard labelsHand and surface sanitizerExtra batteries (for all battery-operated devices)Permanent markersStorage boxes for small equipmentCleaning and sterilizing substances

b. Kit for lifting latent prints (lip print)

Laminated fingerprint cardsLipstick (brown and red)Lipstick applicatorLipstick remover liquidCotton balls/rollsScissorsExecutive bond paper2” × 2” white hinge latent print lifter2” × 4” white hinge latent print lifterInkpadCompact fingerprint cardsBlack powder for enhancing the printPowder brushPrint lifting tape/cellophane tapeMagnetic powderUV lampNitrile glovesMicroscopes – stereomicroscope and comparison microscopePPEHandheld magnifierLaminated fingerprint type's identification cardsLaminated lip print type's identification cards.

c. Kit for bite mark investigation

Rubber-based impression materialNitrile glovesImpression traysModeling wax.ABFO No. 2 scale [Figure 4]Nuzzolese-Neri-DiVella No. 2 scale (colorimetric scale)2” Photo scalesSterile cotton swab/applicatorsStopwatchUniversal buffer solutionBottled saline solution20–200 μLStandard reference manuals pipettes and pipette tipsTweezersVortexesSaliva test stripsColored Eppendorf® tubesMicrocentrifugesMicrofuge tube racksDigital cameraLaptops 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 scannerInkpad to highlight the incisal/occlusal surfaces of the teeth on models.Inkjet color printersTracing paperThermometer{Figure 4}

d. Kit for forensic facial reconstruction

Reusable skulls with tissue-depth measuring pegsSmall metric rulerGlueScalpel or knifeNonhardening clay, tools, and materialsStorage containersSuper Sculpey (beige/red/yellow)26-mm prosthetic eyesClay tool (wood/rubber finish)

e. Kit for age estimation

Guidelines and standards manualsDental anthropology manualDental age atlasesX-ray with radiovisiography compatibilityX-ray viewer for orthopantomogramComputer with photo editing softwareMicromotor with straight and contra-angled handpieceCarbide and diamond tooth cutting discsArkansas stone for tooth sectioning (coarse and fine)Bench lathe machine for tooth grindingAdjustable light sourceGlass slides with coverslipsMicroscopes – phase contrastDigital Vernier calipersLaminated chart showing stages of tooth development.

2. Illumination kit:[15]

Torchlight/Flashlight455 nm blue LED lightAC chargers, 100–240 VACBattery-operated UV light source (495 nm)Magnifier with LED lightAltered light source for viewing bite marks and latent printsForensic filters – clear, general, blue, orange, and greenYellow goggle to view fresh bite markOrange goggles to view teeth and bone samples.

3. PPE kit

Tyvek cover coatLaboratory apronTyvek sleevesOvershoesMob cap/hairnetNitrile glovesFace masks/eye protectorsDispenser for gloves and masksForensic GogglesN95 particulate respiratorsAntimicrobial surface wipesAntiseptic handwashBiohazard trash bagsGreen safety vestTyvek hair covers

[INLINE:1]

4. Documentation kit

a. Stationery kit

ClipboardsTemplates for sketchPermanent marker penColor pencils for documenting the bite mark or any other injuryHB pencilsLark for sealing the report coversDepartmental letterhead mentioning the complete contact detailsSeal of the forensic odontologist mentioning the degree and designationsEnvelopes bearing the department and institutes detailsPen drivesDVI antemortem (Yellow) and postmortem (Pink) forms (hard and soft copy)Odontogram sheetsChain of custody sheetsLogbookCountertop paper roll (21“, 225 ft long)Departmental files for individual casesChain of custody labels (3½” × 5”)Document cabinetMultifunctional flip chart.

b. Photo documentation kit

1–15 number photo markers6” scale (white, gray, black, transparent, fluorescent, blue, and yellow)Photomacrographic scales2” adhesive scales12 ruler tapeField caseAdhesive arrow bookletAuxiliary flashEvidence tape (1 3/8” 108 ft)Evidence labels (3½ ” × 5”).

5. Craniofacial anthropology kit

Tooth development charts12 × stainless steel small finds archeology tools4 × tweezers to allow to handle delicate findsPlastic rulersProtractorsMagnetic compassSkull boxMeasuring tapeOsteometric boardComparative bone setsGoniometerPalatometerASUDAS plaques or Turner–Scott dental anthropology system [Figure 5]aZipper closure bagsComparative maxilla setComparative mandible setHuman skeleton – male and femaleSkull – male and female, neonates' skull, primate skullSkull – Mongoloid, Caucasoid, NegroidAnimal skulls (originals and replicas)Animal teeth set{Figure 5}

Laboratory equipment

Biotech laboratory

Bunsen burnerLaminar hoodGlasswaresRefrigerator with deep freezePipettes and pipette tipsChemicals and reagentsCentrifuge/ultracentrifugeWeighing balance (digital)Microscope – stereomicroscope, comparison microscope, and compound microscopeHard tissue microtomePhotomicrographic cameraDisposal containerFirst aid kitsPortable fire extinguisherWater bathOvenHot plateIncubatorsAutoclavepH meterDistilled water plantRotary shakerElectric heaterPetri dishConical flasksCulture tubesBeakersFunnelsMeasuring jarsGraduated and bulb pipettesBurettesReagent bottlesGlass slides and coverslipsNonabsorbent cottonTissue paperAluminum foilTest tube standsGlass marking pencilCabinets for storing chemicals and glassware.DisinfectantsMicromotor and carbide discs for tooth sectioningBench lathe machine for tooth grindingMortar and pestle for tooth crushing (Ceramic or Metal)Digital Vernier caliperHandheld or stand-mounted digital microscope (10×– 80×).

Prosthetic laboratory

Model trimmerDental articulatorsVacuum mixer cum vibratorModelling waxCyanoacrylate cementBase formerDie stoneDental plasterImpression materialsTeeth shade guideDental laboratory 3D scanners (Benchtop) and 3D printerSlow set alginate for replicating skull in facial reconstruction.

Anthropology laboratory

Stainless steel table with individual water hoses for the wet analysis of the skeletal specimensWooden 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 authors4–6 international journals

Forensic Science InternationalJournal of Forensic OdontostomatologyInternational Journal of Legal medicineJournal of Forensic Dental SciencesJournal of Forensic Sciences8–10 volumes of back issues of at least three international journals50% in the print formComputers with internet connection for online access.

Seminar room

LCD projector/digital screenNotice boardSeating arrangementsMicrophones and speakersComputerAudio-Visual (AV) adaptersEducational videos/tubesFacility for webinars and live AV communicationsFacility for Mock court.

Museum section

Dental models and charts showing different dental nonmetric traitsSkull modelsHuman skeleton – male and femaleHistology images of neonatal lines and cemental annulationsRecorded bite mark images of different domestic animals and wild animalsTable models for DVI phasesFacial reconstruction models in different stagesSkulls and teeth of different animalsSkulls of neonatesCharts or bone replicas illustrating different age estimation methodsCharts illustrating different dental notations system and dental codesPortrait or photographs of eminent forensic odontologistsManuals and guidelines released by forensic odontology associations or organizations.

Radiology section

Handheld X-ray machineRVGSkull positioning devicesComputer for imaging observation and archiveLead apronsLead glovesThyroid collarLead screenDarkroom facilityDosimeter badgesAutomatics X-ray developerX-ray viewer box with adjustable illumination.

Engineering section

Fire protectionElectricalAir conditioningRefrigerationWater supplyDisposal systemPower backupsFire 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/logbookRefrigeratorCupboardLoupesSkinfold caliperWeighing machineHeight measuring tapes, StadiometerMid-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.

Acknowledgment

The authors wish to acknowledge the efforts of Ar. Saravana Balaji (M. Arch), Architect, based in Chennai for designing a suitable plan for the department of Forensic odontology. The subject inputs based on the first author's personal interaction with some renowned forensic experts/authors such as Dr. Ashith Acharya (India), Dr. Jayanie Weeratna (Sri Lanka), Dr. Marin Vodanovic (Croatia), Dr. Khalid (Sudan), Dr. Vilma Pinchi (Italy), Dr. Vijay Reesu (Scotland), Dr. Hemalata Pandey (India), Dr. Samantha Thakur (India), Dr. Sudhir Bhalla (India), Dr. Prabhakaran Nambiar (Malaysia), Dr. Jayakumar Jayaraman (Malaysia), Dr. Adarsh Kumar (India), Dr. Anil Agarwal (India), Dr. Roberto Cameriere (Italy), Dr. Patrick Thevissen (Belgium), and Dr. Sigrid Kvaal (Norway) during the forensic odontology conferences held in India were also very useful during the preparation of this manuscript. The authors thank them for sharing their valuable expertise on forensic odontology.[16]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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