Creating Awareness Regarding Forensic Odontology Among Non-Forensic Persons for Successful Dental Identifications

Visual Identification by next of kin is the most common method of identifying unknown bodies in India. However, this technique is unscientific and unreliable, especially if the remains recovered are decomposing, skeletonized, charred, mutilated, saponified. Primary identifiers recommended by higher authorities for scientific identification of unknown bodies include comparison of fingerprints, DNA, odontology or unique medical records such as implants. Forensic Odontology has played a major role in identifying victims of mass disasters around the world, and few examples of successful application of dental data in DVI situations include the South Asian Tsunami, 2004, Black Saturday bushfires, 2009, Australia, Christchurch earthquake, 2011, etc. However, the application of forensic odontology for positive identifications is extremely limited. A major reason for this is the unavailability and inaccessibility to quality dental records and ante mortem data. To improve the collection of ante mortem data, it is urgent that we create awareness among local on-ground investigating agencies, and stakeholders. For this purpose, an awareness campaign iDENTifyme from the University of Turin, Italy was launched in India in local languages, and has since successfully assisted in collection of ante mortem data for positive identification.


Introduction
Identification of human remains forms a significant aspect of medico-legal investigation. It is based on matching scientific information of the unidentified dead body with information obtained about the missing person. Human identification is pertinent not only from the legal point of view but also for social and humanitarian reasons. A positive identification fulfills legal requirement and enables the families to find closure and move on. Anonymous burial or cremation is akin to a life which was unremembered and without consequence, it also goes against the belief of many cultures, religions and ethical systems.
According to data published by the national crime record bureau, 34592 unidentified dead bodies were recovered and an inquest was conducted during the year 2015 1 . As per data on missing persons in Crime in India, a total of 2,90,439 people in 2016, 3,05,267 people in 2017, and 3,47,524 people in 2018 have been reported as missing 2 .
In India, one of the most common technique for identifying an unknown or unclaimed body is by visual recognition by the next of kin. Visually identifying a body can prove to be extremely difficult in cases of decomposing, skeletonized, charred, saponified, mutilated or dismembered human remains. Mutilation of bodies is often done by criminals to destroy any trace of identity by slashing, gouging, pounding, dismemberment, burning or use of corrosives. Visual Misidentification by relatives may also be deliberate for malafide intentions. To avoid misidentification of unknown bodies, it is recommended that standardized policies and procedures developed by the authorities should be applied for identifying such bodies. The Interpol guidelines recommended primary identifiers which include fingerprint, DNA and odontology.

Forensic Odontology
There are many aspects of forensic odontology which are often discussed and routinely used for medico-legal work such as dental age estimation in living as well as deceased, bite mark analysis, cranio-facial trauma analysis, assessment of patterned injuries in cases of child abuse, domestic violence, dental malpractice, dental negligence, dental fraud, dental manifestations of child abuse, etc.
Forensic odontology plays a major role during the process of identification, however, unlike fingerprints or DNA, the investigating officers are not always aware regarding odontology or techniques employing teeth for the purpose of scientific identification. It is important that the investigating agencies and clinical dentists be made aware and trained regarding various aspects of forensic odontology and the techniques employed for dental identification. Comparative dental identification depends on the recognition, availability, accessibility and quality of the dental records of the missing person or the presumed deceased victim. The dearth of antemortem records is a major concern among practicing forensic odontologists while performing dental identifications in India. Awareness and training among clinical practitioners will go a long way by recording vital information during dental examination for the purpose of maintaining dental records for forensic investigations.

Ante Mortem Data Collection
According to protocols laid down for Disaster Victim Identification by Interpol, the four steps to identification include scene examination, post mortem data collection, ante mortem data collection, and reconciliation with families after positive identification 3 . Dental data collected from the unidentified body is compared to the information obtained about the missing person. For comparison of this post mortem data, experts need access to all dental evidences left behind by the missing person including old dental appliances at home, removable prosthetics, bleaching trays, retainers, old dentures, medical or dental records, etc. It is also very helpful if the next of kin can provide photographs of the missing person showing other prominent features such as scars, tattoos, or a clear view of teeth. It should be noted that dignity and respect for cultural, religious and individual preferences while dealing with the families should be given utmost priority. Families are often under distress while they await news regarding their missing loved ones, and they may not be able to comprehend scientific technicalities explained by the experts. Delay in identification and the uncertainty surrounding this process affects mourning rituals, additional frustration and psychological stress. For this purpose, posters and videos explaining the process in local languages have proven to be helpful in practice by first author, it also helps justify the demands for ante mortem data, which may seem irrelevant and unreasonable at the offset to family members.

Awareness Campaign
Since investigating agencies are at the forefront of collecting records of missing persons from their family, friends, relatives, colleagues, and other relevant contacts, it becomes crucial that they be well versed with what constitutes useful antemortem dental data. iDENTifyme campaign was launched by the Human Identification Laboratory at University of Turin, Italy 4 . It has since been introduced in India and has proven to be successful for collection of ante mortem records for identification of unknown remains. The purpose of iDENTifyme campaign is to create awareness among non-forensic personnel, like investigating officers, clinical practitioners, families of missing people, regarding retrieval of data of missing persons to aid in dental identification. This campaign is in the form of informative posters and video which are easy to comprehend by non-dentists or non-forensic personnel. The campaign is designed for digital platforms for wider circulation through social media, and ease of conversion to multiple languages.

Translation into Local Languages
The purpose and nature of identification process should be explained to the police officer on ground and the next of kin in local, easy to understand languages. For collection of ante mortem data, media can be used as an effective tool for communication. These posters and video can be translated into local languages for wider circulation. Examples of these posters after conversion to Hindi language created for awareness among police officers in the author's most frequent region of practice can be referred to.

Conclusion
The robust nature of teeth and the well protected environment in which they are located means that they are often found intact in decomposing, mutilated, saponified, even charred bodies. They become a rich source of information for creating a biological profile of the unknown remains with the help of age estimation, sex estimation, racial profiling, and other hints regarding habits such as tobacco chewing, occupational features such as notching, or any pathologies 5 .
Using dental data for scientific identifications is a reliable, quick, economical and universally accepted method. For this reason, it is often the "go to" method in disaster victim identifications including high impact accidents such as plane crashes. The unavailability and inaccessibility to ante mortem dental data is a major hindrance in performing dental identifications and further, justifying the role of forensic odontologists as a part of forensic team in medico-legal investigations.
Any information that could help identify a body or set of human remains should be collected by the police and handed over to the experts. A holistic approach towards forensic identifications will ensure that there are better chances of correctly identifying the unknown body, if the data is reliable, complete, detailed and specific 6 . The Forensic odontologists should always be involved in the human identification process, when jaws and teeth are present. Failure to perform a complete dental autopsy, with full X-ray imaging, can lead to a delay in positive identification and human rights violations 7 .
A multidisciplinary approach is the key to dissemination of knowledge and awareness about the utility of forensic odontology in investigations. In recent times, due to extensive interactions between forensic odontologists, forensic medicine experts, forensic scientists and senior police officers at workshops, conferences and other such forums, odontology has been recognized as a vital aspect of identification procedures. But for forensic odontology to truly become a technique of choice for identifications, it is pertinent that this awareness also be created among personnel who work at ground level during investigations including constables, sub inspectors, clinical dentists, autopsy personnel, etc. iDENTify me campaign aims to bring about this awareness by visual aids in local languages for wider circulation through social media.