Knowledge and Attitudes of the Public in Saudi Arabia about Forensic Odontology during COVID-19

Khalid T Aboalshamat^1*, Doaa S Alghamdi², Fatmah A Almaqboul², Duaa A Almarhabi³, Hala Aleissa², Tahani Alattas², Aljawharah A Aqely² and Rawan N Albishry²

^*Correspondence: Khalid T Aboalshamat, Dental Public Health Division, Preventive Dentistry Department, Faculty of Dentistry, Umm Al-Qura University, Saudi Arabia, Saudi Arabia, Email:

Author info »

Introduction

Forensic odontology, also known as forensic dentistry, is a challenging branch of forensic science that the World Dental Federation (FDI) defined as a specialized field of dentistry dealing with the proper handling and examination of dental evidence and with the accurate interpretation and preservation of dental findings in the interests of justice [1]. It involves the application of dental sciences in the identification of unknown deceased individuals through the comparison of ante- and postmortem records [2]. In particular, forensic odontology deals with the recognition of injuries to soft and hard oral tissue as a result of crime, rape, murder, or child abuse. But the primary applications for forensic odontology in bringing criminals to justice [3] are the identification of human remains through dental records and bite mark identification. This field of science provides the ability to determine the age, gender, and race of a victim, which can be used as evidence in resolving criminal cases [4]. Furthermore, dental tissue provides an important source of DNA material, which is now becoming the gold standard in the field of forensic identification [5].

It is common for dental professionals to face malpractice cases in their practice. And in Saudi Arabia, during 2007– 2008, over 600 cases of medical error litigations were recorded. Out of these, 6% occurred in dentistry [6]. Thus, an individual’s dental records, including radiographs, models, photographs, and clinical correspondence, are essential legal documents that serve as sources of information for dentists and patients, and which may be utilized as forensic evidence [7]. Therefore, these records should be securely retained by general practitioners for the purposes of justice [8], but dental records have not received the same attention as fingerprints and facial photographic records by governmental registries [9]. However, the development of a national dental registry would provide researchers with a large amount of data regarding the prevalence and correlations of different dental disorders. In addition, these data could be used by legal authorities as evidence if the need for a forensic dental investigation arises [10].

Despite the significance and numerous applications from this field to facilitate post-mortem confirmation of a victim’s identity, the literature indicates that forensic odontology is underdeveloped in many countries around the world, and action is needed to improve the utilization of this science [11]. For example, A systematic review of recent cross-sectional studies regarding the levels of knowledge and practical application of forensic odontology among dentists in India revealed inadequacy and considerable variation in the practice of forensic odontology among dentists [12]. In Saudi Arabia, studies have been conducted over the last few decades aimed at defining the level of knowledge and awareness about forensic odontology among dental professionals. This research included one study on a national scale [13], and other local studies in Riyadh [14–17] and the eastern region of Saudi Arabia [18]. These studies indicated that dental professionals had low awareness and poor knowledge and attitude about forensic dental sciences, in addition to lack of practice of forensic odontology among dental professionals.

Despite all of these studies, there are limited data regarding public awareness about forensic odontology in Saudi Arabia on a national level. The only study was conducted in Riyadh city [10] and assessed the willingness of the public to register in a national dental registry. The results indicated that two-thirds of the respondents were willing to register. In fact, there has been an urgent press to investigate this aspect, especially during the COVID-19 pandemic, which has highlighted the beneficial aspects of forensic odontology today. One study highlighted the handling of dental tissues for forensic evidence during COVID-19 [19]. However, in this regard in comparison to other publications in forensic medicine related to COVID-19 [20,21], there is a scarcity of articles focusing on the dental area, and researchers concluded that the importance of forensics has been underestimated during the COVID-19 pandemic. Consequently, the aim of this study was to assess the general public’s levels of knowledge and attitudes about forensic odontology during COVID-19 in Saudi Arabia.

Materials and Methods

This was a cross-sectional study design that was conducted between October and November 2020. A questionnaire measured the extent of knowledge and awareness among the public about forensic odontology during the COVID-19 pandemic in Saudi Arabia as part of a large research project on forensic dentistry. Inclusion criteria included male and female participants older than 18 years who lived in Saudi Arabia. Dental students, interns, and dentists were excluded. Using a convenience sampling methodology, a precision level of 5%, estimated prevalence of 50%, and confidence level of 95% yielding 385 participants were needed for this research. To overcome the non-response rate, a total of 1,000 participants were invited. Due to the current circumstances due to the COVID-19 pandemic, data collection was performed by sharing a Google link to a self-administered Arabic-language online questionnaire via social media platforms (WhatsApp, Twitter, Facebook, Instagram, and Snapchat) to a large segment of society in Saudi Arabia.

Questions were adopted from previous a questionnaire [10], and the questionnaire was tested and validated by the authors, with Cronbach’s alpha measured at 0.78 and 0.75. The questionnaire was validated through expertise research and by interviewing 10 participants in a pilot application to test the syntax, grammar, language, comprehension, flow, and organization, and then the questions were modified accordingly. The questionnaire can be answered in five to ten minutes.

Seven research assistants were responsible for distributing the questionnaire. In order to participate in this study, all participants were asked to indicate their approval of the informed consent by clicking on a button labeled “next” before being able to move on to completing the questionnaire. The questionnaire took about 10 minutes to complete. All data were treated anonymously, and any information about participants was eliminated. Participants who did not agree to the consent for this study were excluded. The questionnaire contained four parts and had a total of 55 questions. Part one consisted of 13 demographic items gathering the participant’s age, gender, nationality, occupation, level of education, marital status, dental information, the frequency of use of dental services, and whether they had been infected with COVID-19. Part two comprised 21 statements measuring the person’s level of knowledge about forensic dentistry. The questions were answered with “yes,” “no,” or “I do not know.” Each correct answer was given one point, and the answers were totaled for a maximum total score of 21 correct answers and a minimum of zero. Part three contained four questions to assess the participant’s attitudes about forensic odontology and its relationship to COVID-19. Part four had 16 questions aimed at assessing attitudes about forensic dentistry. The final question was about the participant’s willingness to enroll in a national dental registry. Ethical approval for this study was received from the research ethical committee for the Faculty of Dentistry, Umm Al Qura University, with the number 193-20.

Data analysis was conducted using Excel software and SPSS v.15 (IBM Inc., Armonk, NY, USA). Also calculated were descriptive statistics (count /percentages for categorical variables; mean/standard deviations or medians/inter-quartile ranges for continuous variables). Statistical significance was assessed via linear regression, chi-square, ANOVA, and t-test. The statistical significance level was set at a p-value of 0.05.

Results

This study involved data from 784 participants, with a response rate of 78.4% from Saudi Arabia. Demographic data, including gender, age, nationality, city, region, marital status, education level, working status, existence of oral problems, usual treatment provider, frequency of dental visits, and history of infection with COVID-19 are shown in Table 1.

Table 1: Participants’ demographic data.

Participants were asked 21 questions related to forensic odontology to assess their levels of knowledge, and the total knowledge score was 9.35 and standard deviation (SD) of 4.68. The items and participants’ answers are shown in Table 2.

Table 2: Forensic odontology knowledge items.

When participants were asked in one question to rate their perception of their general level of knowledge about forensic odontology on a scale of 10 points (where 10 was the highest level of knowledge), participants had a median score of 4.64 (SD=2.81). Simple linear regression showed that there was a significant relationship between participants’ perception of knowledge and actual total knowledge score (p < 0.001, r-squared=0.429).

Using t-test and ANOVA, the total score of knowledge was assessed in relation to gender, age, nationality, marital status, working status, and history of oral problems, usual care provider, and history of COVID-19. The results showed relationships with the total knowledge score only for the age group and work status, as shown in Table 3.

Table 3: The relationships between forensic odontology knowledge scores and demographic variables.

Participants’ answers to the attitude questions are displayed in Table 4. The attitudes toward the establishment of a national dental registry are shown in Table 5. A total of 585 (74.62%) were willing to register in a national dental record if one were to be established.

Table 4: Participant attitudes about forensic odontology during the COVID-19 pandemic.

Table 5: Participant attitudes about statements related to establishing a national dental registry for use in forensic dentistry.

Conclusion

This study revealed that the public in Saudi Arabia have relatively little knowledge about forensic dentistry but have good attitudes about participating in a national dental registry. There was a considerable proportion of participants who agreed on the importance of forensic odontology’s use in global public health disasters such as the COVID-19 pandemic. Nevertheless, forensic odontology still needs to be introduced to the public via more efforts aimed at educational and health promotional activities.

Acknowledegements

We would like to thank participants to answer the study questionnaire.

Lists of Abbreviations

• Coronavirus disease 2019 (COVID-19).

• World Dental Federation (FDI).

• Standard deviation (SD).

References

1. Rajendran R. Shafer's textbook of oral pathology. India: Elsevier 2009.
2. Preethi S, Einstein A, Sivapathasundharam B. Awareness of forensic odontology among dental practitioners in Chennai: A knowledge, attitude, practice study. J Forensic Dent Sci 2011; 3:63.
3. Singh K, Anandani C, Bhullar R, et al. Teeth and their secrets-Forensic dentistry. J Forensic Res. 2012; 3:141.
4. Harchandani N, Marathe S, Hebbale M, et al. Awareness of forensic odontology among general dental practitioners in Pune-A cross-sectional study. J Adv Med Dent Sci Res 2014; 2:10–6.
5. Kirchhoff S, Fischer F, Lindemaier G, et al. Is post-mortem CT of the dentition adequate for correct forensic identification?: Comparison of dental computed tomography and visual dental record. Int J Legal Med 2008; 122:471–9.
6. AlJarallah JS, AlRowaiss N. The pattern of medical errors and litigation against doctors in Saudi Arabia. J Family Community Med 2013; 20:98.
7. Charangowda B. Dental records: An overview. J Forensic Dent Sci 2010; 2:5.
8. Sweet D, Pretty I. A look at forensic dentistry–Part 2: Teeth as weapons of violence–identification of bitemark perpetrators. Br Dent J 2001; 190:415-8.
9. Avon SL. Forensic odontology: The roles and responsibilities of the dentist. J Can Dent Assoc 2004; 70:453-8.
10. Salam M, Al-Rawashdeh N, Almutairi AF. Public awareness of forensic odontology and willingness to enroll in a prospective dental registry: A survey conducted in Saudi Arabia. Saudi Dent J 2020; 32:21–8.
11. Kumar S, Dagli N. Forensic odontology-An area unexplored. J Int Oral Health 2014; 6.
12. Gambhir RS, Singh G, Talwar PS, et al. Knowledge and awareness of forensic odontology among dentists in India: A systematic review. J Forensic Dent Sci 2016; 8:2.
13. Alghamdi DS, Alboalshamat FT, Almaqboul FA, et al. Knowledge and attitudes of health care workers about forensic dentistry during COVID-19 in Saudi Arabia. EC Dent Sci 2021; 20:86–94.
14. Abdul NS, Alhazani L, Alruwail R, et al. Awareness of forensic odontology among undergraduate, graduate, and postgraduate dental students in Riyadh, Saudi Arabia: A knowledge-, attitude and practice-based study. J Forensic Dent Sci 2019; 11:35.
15. Al Shareef A, Al Mohsen H, AlQahtani FH, et al. Forensic dentistry and its Importance in general dental practice: Knowledge and attitude of undergraduate and postgraduate dental students of Riyadh Elm University. Donnish J Dent Oral Hyg 2019; 5:93–8.
16. Al Sheddi M, Al Asiri A. Awareness of the scope and practice of forensic dentistry among dental practitioners. Aust J Forensic Sci 2015; 47:194–9.
17. Alshaqaq M, Albekairi M, Almakhlafi L, et al. Knowledge and awareness of forensic odontology among the dental practitioners in Riyadh City: A survey-based study. Donnish J Dent Oral Hyg 2018; 4:54–62.
18. Nazir MA, Al‐Ansari A, Al‐Khalifa K, et al. Determinants of knowledge and practice of forensic dentistry amongst dental practitioners. Eur J Dent Educ 2019; 23:491–7.
19. Sarode SC, Augustine J, Sarode G, et al. Perspective on forensic odontology and COVID-19. J Contemp Dent Pract 2020; 21:819–21.
20. Bogdanović M, Atanasijević T, Popović V, et al. Is the role of forensic medicine in the COVID-19 pandemic underestimated? Forensic Sci Med Pathol 2021; 17:136–8.
21. Cattaneo C. Forensic medicine in the time of COVID 19: An editorial from Milano, Italy. Forensic Sci Int 2020; 312:110308.
22. Adams C, Carabott R, Evans S. Forensic odontology: An essential guide. John Wiley & Sons 2013.
23. Kruger MM, Martin LJ, Maistry S, et al. A systematic review exploring the relationship between infection and sudden unexpected death between 2000 and 2016: A forensic perspective. Forensic Sci Int 2018; 289:108-19.
24. Ward P. Trust and communication in a doctor–patient relationship: A literature review. Arch Med 2018; 33:36.
25. Friesen LR, Williams KB. Attitudes and motivations regarding willingness to participate in dental clinical trials. Contemp Clin Trials Commun 2016; 2:85–90.
26. Singh J, Singh J. COVID-19 and its impact on society. Electronic Res J Social Sci Humanities 2020; 2.
27. Bostan S, Erdem R, Öztürk YE, et al. The effect of COVID-19 pandemic on the Turkish society. Electron J Gen Med 2020; 17.