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Introduction
The objective of this manuscript is to examine and discuss an evidence-based rationale for the analysis and comparison of human bite marks in skin with teeth. The National Academy of Sciences (NAS) report stated that the scientific validity of bite mark analysis had not been established. Similarly, the President’s Council of Advisors on Science and Technology (PCAST) 2 found that bite mark analysis did not meet the scientific standards for foundational validity and was far from meeting such standards. The nature of skin and the action of biting create a distorted representation of the features of the anterior dentition. Human bite marks in skin are complex injuries that commonly demonstrate features of an ambiguous nature. The examination and interpretation of such features involves subjective judgements 2 that are liable to cognitive bias. The effects of distortion and bias are contributory factors in the empirical analysis and comparison of bite marks in skin with teeth.

Relatively few studies of bite marks in skin have applied the types of statistical methods, common in medicine and the biological sciences. Consequently, the scientific evidence in bite mark analysis and comparison is limited significantly compared to other forensic sciences. The challenges to the forensic analysis of human bite marks in skin and comparison with teeth relate to the lack of reliability of bite mark evidence. The limited scientific evidence on distortion and bias provide the basis for a rationale for the analysis and comparison techniques to achieve scientific reliability and subsequently scientific validity.

Bite Mark Evidence — United States of America The first bite mark case was reported in 1954.3 Historically, questions were raised concerning the reliability of bite mark comparisons and acceptance of the subject by the scientific community. 4 Hale4 suggested that bite mark evidence should not be admitted due to the lack of scientific reliability and the prejudicial nature of evidence that possibly failed to satisfy the Frye rule.^ The Frye case established guidelines for the admissibility of scientific evidence related to new techniques; namely, the scientific principle must be recognisable, be sufficiently established and have pained acceptance in the relevant field.° Similarly, admissibility depends on a forensic technique satisfying three criteria — the underlying scientific theory must be considered valid by the scientific community, the technique must be reliable and have been applied properly.7

Some bite mark analysis and comparison techniques had gained more acceptance than others, partly due to certain legal decisions.^ Using the rationale of the Frye and Kelly precedents, the admission of bite mark evidence had been based on the weight of evidence rather than the admissibility of bite mark evidence itself. Furthermore, the validation of new comparison techniques was facilitated by the scientific evidence that had previously validated the comparison of fingerprints.0 Subsequently, the techniques of bite mark analysis and comparison were accepted by the scientific and legal communities.^ By 1986, 192 bite mark cases had been cited in the legal literature and there were no references in the scientific or legal literature to a case in which bite mark testimony had not been allowed. However, a legal review stated that bite mark analysis had never progressed through the rigorous scientific examination that was common to other forensic sciences, to determine its accuracy or reliability.*

The admissibility of scientific evidence was ruled on in the landmark case of Daubert v Merrell Dow Pharmaceuticals.3 The court stated that in order for expert opinion to be admissible, the testimony must be both relevant and reliable; relevant opinion had a bearing on the facts of the case; reliable opinion was based on a scientific method. Reliability of scientific evidence was to be based on scientific validity. To guide in this matter, the Daubert court outlined four non- definitive factors regarding scientific evidence: whether the theory can be and has been tested; the theory’s error rate; whether the theory has been subjected to peer review and publication; whether the theory has met with general acceptance in the scientific community. The scientific literature and published research evidence relating to bite mark analysis lacked peer-reviewed publications supporting its use, including data on error rates and reliability; consequently, bite mark analysis was not able to satisfy the Daubert ruling. Despite this fact, bite mark evidence continued to be admitted in cases under Daubert.
 
The rules on the admissibility of expert witness testimony in the United States of America included the Frye rule, the Daubert ruling and the Federal Rules of Evidence. Unfortunately, the courts had not applied the rules on the admissibility of bite mark evidence and consequently, there had been a number of cases that relied on flawed bite mark analysis resulting in false convictions that were ultimately overturned following DNA analysis.^ Lawyers now argued that bite mark analysis and comparison techniques had never undergone scientific validation and had never been critically scrutinised to satisfy the appropriate rules for admissibility, such as Frye or Daubert.5 Clement and Blackwell suggested that the absence of scientific principles in bite mark analysis and comparison had been partly responsible for creating a divergence of expert opinions in bite mark cases as demonstrated in Torgersen.^
Differing opinions on bite mark analysis and comparison continued to be published; those who suggested re-evaluating the techniques, and those who stated that the techniques were not based on statistical data but on the identification and comparison of class and individual characteristics. Similarly, in common with other forensic comparative techniques, bite mark analysis and comparison relied on a number of variable characters that were interpreted in an inductive (experience based) rather than a deductive (mathematical) manner.

The NAS report referred to the judicial use of forensic science and the state of science itself. In terms of judicial responsibility, the report stated Much forensic evidence, including  bite mark, firearm and tool mark identification, is introduced in criminal trials without any meaningful scientific validation, determination of error rates or reliability testing to explain the limits of the discipline. This statement related to the failure of judges to ensure that only forensic evidence that satisfied the rules on the admissibility of expert witness testimony was admitted in court. Referring to bite mark identification, the report cited the lack of empirical evidence for the uniqueness of the human dentition, the movement of skin and its ability to record any asserted uniqueness and the nature of photographic analysis as problematic areas. The report noted Reliability is one of the pillars of scientific inquiry, that a scientists results can be reproduced by other scientists.

There are several studies in which bite mark experts plying their craft in controlled laboratory tests have shown widely differing results and a high percentage of false positive matches. Referring to bite mark evidence, the report concluded Although the majority of forensic odontologists are satisfied that bite marks can demonstrate sufficient detail for positive identification, no scientific studies support this assessment and no large population studies have been conducted. In numerous instances, experts diverge widely in their evaluations of the same bite mark evidence. The NAS report highlighted two major concerns regarding bite mark analysis. Firstly, the lack of reliability of bite mark evidence and secondly, the failure to ensure that the evidence satisfied the rules on the admissibility of expert witness testimony. Ironically, the lack of scientific reliability of bite mark evidence has been a concern since it was first reported in 1978;4 significantly, this concern endures to the present day.

Distortion of Human Bite Marks in Skin Primary distortion occurs during the episode of contact between the dentition and skin and consists of tissue distortion and dynamic distortion.20 Primary distortion is a complex, unpredictable phenomenon that is difficult to recognise and interpret and is intrinsic in bite marks in skin. Tissue distortion is due to the visco-elastic nature of skin, capable of distorting under pressure and reconstituting its original contour when pressure is relieved.2 22 Tissue distortion can also arise due to oedema produced in response to biting. Dynamic distortion may be produced by the action of biting.23 The variations in force and movement between the dentition and skin constitute a potentially unique episode of contact, resulting in variations in the degree and type of tissue injury. Accordingly, a single dentition may produce bite marks in skin that exhibit significant variations in appearance due to different episodes of contact.2^

Secondary distortion occurs subsequent to a bite mark being made and comprises of time- related distortion, posture distortion and photographic distortion.2* Time-related distortion refers to changes in the appearance of a bite mark with time. In living victims, time-related distortion can take different forms, a bruise may migrate to a slightly different location and may also diffuse variably giving an altered shape. A healing laceration or avulsion can modify the dimensions and detail of a bite mark. Time-related distortion is usually easily recognised, however, interpretation may be complex. Posture distortion occurs when a bite mark is photographed in a body position that is different from the position  at the time of biting. The degree of posture distortion depends on the variation in body position and the anatomical site. In order to minimise posture distortion during photography, it is necessary to recreate a victim’s body position at the time of biting.25

As this is not always possible, it is suggested that bite marks are photographed in a range of positional possibilities .2^ However, when the victims body position at the time of biting cannot be determined, photographic superimposition comparison is meaningless. 25 Certain anatomical sites are more susceptible to posture distortion than others, for example, female breast,27 limbs.2 Photographic distortion arises as a result of the angle of the film to the bite mark and body curvature.2 The ideal angle is 90 degrees, the camera being perpendicular to the centre of the bite mark produces parallelism between the film/digital plane and bite mark plane; the planes of the scale and bite mark must also be parallel and coincident.30 If the body curvature obscures part of the bite mark, multiple photographs should be taken of the various parts of the bite mark. Bite marks occur in three dimensions and are routinely recorded in two-dimensional images that create additional photographic distortion.
 
A review of trial transcripts reveals that distortion and the interpretation of distortion are the main factors in contentious cases.30 A bite mark in skin may demonstrate more than one type of distortion. An unknown degree of distortion is present in all bite marks and may be produced by a variety of factors.2 2^ 303 The degree of distortion present in a human bite mark in skin is variable and unquantifiable.20 In view of the absence of systematic statistical studies into distortion of bite marks in skin, established geometric morphometric methods were applied to study multiple marks impressed by a single dentition and to study variations in impressed tooth positions in human cadaver skin.3* 33 The results showed alteration of arch width and varying displacement of non-aligned teeth, indicating the inability to differentiate between similar dentitions. The finding of arch width as the principal variable in a bite mark, limits the significance of conclusions based on arch width measurements. It was also noted that the increased number of factors in an actual biting episode would possibly cause more distortion in a forensic bite mark than under thecontrolled conditions of the study.

Bias in Bite Mark Analysis and Comparison Cognitive bias is a natural subconscious element of the human psyche.3^ Consequently, the analyst is unable to consciously control bias when making a judgement. The interpretation of the dental features observed in a human bite mark in skin and the comparison with a persons teeth are cognitive processes, involving objective and subjective judgements.35 3^ In keeping with all forensic sciences, it is important for odontologists to recognise and limit cognitive bias during the analysis and comparison techniques.

Cognitive bias is defined as a pattern of deviation in judgement whereby inferences about other people and situations may be drawn in an illogical fashion.3^ Accordingly, there are numerous categories of cognitive bias that relate to specific aspects of a forensic investigation. Two types of cognitive bias, contextual bias and confirmation bias, are particularly relevant to the analysis of human bite marks in skin and comparison with a persons teeth. Contextual bias is the tendency for a consideration to be influenced by background information; contextual information may be either task-relevant or task-irrelevant.37 Confirmation bias is the tendency to test hypotheses by looking for confirming evidence rather than potentially conflicting evidence. Biasibility and reliability are two fundamental properties of decision making.37 Biasibility refers to the effects of task-irrelevant contextual information and other biases on observations and conclusions. Reliability refers to the consistency, reproducibility or repeatability of previous observations and conclusions. Validity refers to the results being correct.3 Consequently, reliability is a prerequisite for considering validity.

The risks of cognitive bias in forensic science are lower when results are clear and unambiguous and greater when results are complex, of poor quality and there is an increased reliance on subjective opinion.34 The nature of human bite marks in skin are invariably complex, of poor quality and require increased reliance on subjective judgement. Consequently, the analysis of bite marks in skin and comparison with a persons teeth are susceptible to cognitive bias. This relates to the natural human tendency of seeing what one wants to see, thereby tempting odontologists to over-interpret bite marks. 5 The absence of studies on the influence of cognitive bias in bite mark analysis and the unknown effects of bias, limit an evaluation of the odontologists evidence.3 Subsequently, a study demonstrated that bite mark comparisons are susceptible to contextual influences, although the mechanisms by which this occurs are unclear.40 The evidence supporting a biased judgement must be sufficient to form the  judgement since a desired outcome cannot be rationalised with irrefutable, contrary evidence; this is precisely why ambiguous stimuli are particularly susceptible to confirmation bias and why many forensic judgements are subject to bias.4 The term forensic confirmation bias was introduced to summarise the class of effects through which an examiners beliefs, expectations, motives and contextual information influence the collection, perception and interpretation of evidence.

Research on expert performance and decision making has been conducted in many branches of forensic science. Studies demonstrated that contextual information undermined the reliability of fingerprint experts making identifications.4* 43 A meta-analysis of these two studies implied that the fingerprint experts’ judgements involved a considerable degree of subjectivity.4^ These findings are likely to apply to branches of forensic science that are based on the visual comparison of crime scene evidence with a suspects sample, for example, bite marks.45 Even the interpretation of certain complex DNA mixtures requires judgement that is subject to bias. The absence of biasing contextual information in a complex DNA mixture interpretation showed that  confirmation biases may influence expert DNA analysts. 4^ Clearly, the research evidence regarding the significance of cognitive bias in the forensic sciences also applies to forensic odontology. However, due to the lack of specific bite mark analysis and comparison research, the significance of cognitive bias has not been appropriately considered by odontologists.

Research has also demonstrated the significance of the sequence of information distribution in forensic science. 47 Controlling the flow of task-irrelevant information to DNA analysts was referred to as sequential unmasking; the evidentiary samples are examined and documented, before the reference samples are examined.4 Similarly, a procedure termed Linear Sequential Unmasking (LSU) was suggested that requires examiners to first examine the crime scene evidence and document their confidence levels before examining the reference material. 4 LSU specifies a linear reasoning process, from evidence to suspect, that minimises bias by regulating the flow and order of information thereby ensuring decisions are based on crime scene evidence and task-relevant information. The rationale of LSU is due to the relative low quality and quantity of information in crime scene evidence being more ambiguous and susceptible to bias, compared to the reference material.

LSU ensures that crime scene evidence drives the comparative decision by limiting the potential for circular reasoning by working backwords from reference material. The limitation of cognitive bias in comparative decisions between crime scene evidence and reference material is clearly applicable to the analysis of human bite marks in skin and comparison with a person’s teeth. Currently, LSU is only applicable to forensic domains that compare evidence against specific reference materials. However, because many forensic decisions are not based on comparing two stimuli, Linear Sequential Unmasking-Expanded (LSU-E) was introduced to apply to all forensic decisions, not only comparative decisions. 47 Dror and Kukucka 47 concluded that experts should first form an initial opinion based solely on the raw data/evidence, devoid of any reference material or context, even if relevant. Only thereafter can they consider what other information they should receive and in what order based on its objectivity, relevance and biasing power. The conclusions revised the statement that the most powerful means of safeguarding against the introduction of contextual bias is to ensure that the practitioner  conducting the analysis only has information  about the case that is relevant to the analysis 34

Rationale or Bite Mark Analysis and Comparison

The nature of skin and the action of biting create a potentially unique, three-dimensional episode of contact that precludes  the accurate recording of the incisal/cuspal features of the anterior dentition in skin. The causal factors prevent the reliable differentiation of bite marks in skin caused by similar dentitions.3*0 This finding limits the identification of the biter in a closed population, to all similar dentitions present at the time of biting. Additionally, the incidence of matches in the positions of the six anterior mandibular teeth precludes statements of dental uniqueness in an open population.^The scientific evidence demonstrates that the biological concept of dental uniqueness is not applicable to human bite marks in skin in closed and open populations and that it is not possible to reliably differentiate between marks caused by similar dentitions. The evidence is supported by the few studies in bite mark analysis that apply the types of statistical methods, common in medicine and the biological sciences. The studies are conducted under controlled conditions that contrast with the additional factors in an actual biting episode. This would suggest that distortion in experimental bite marks is less complex than distortion in actual bite marks in skin. In the absence of new statistical research, the nature of the causal factors in bite marks in skin will ensure that the limitations to the identification of the biter constitute an abiding principle in bite mark analysis and comparison.

The incidence of distortion in bite marks in skin is well recognised. However, it is not possible to quantify distortion present in scaled, life-size photographs of human bite marks in skin.20 Studies applying geometric morphometric methods to impressed tooth positions in human cadaver skin found variation in dental arch width as the principal variable in a bite mark, thereby limiting the significance of conclusions based on arch width measurements. 32 33 Non-distorted, life- size transparencies of the biting edges of the suspect biters anterior dentition are incomparable scientifically with distorted, life- size bite mark photographs; consequently, the results of superimposition are unreliable. Correspondence and non-correspondence in arch size and shape, between the transparencies and photographs are meaningless and conclusions, either identifying or excluding the suspect biter, are unreliable.25 Furthermore, the cognitive processes of superimposing transparencies of the biting edges of the anterior teeth on the bite mark photographs exemplifies confirmation bias due to the biasing power of viewing either correspondence or non- correspondence between the images. The technique of superimposition based comparison is not scientifically valid and is biased, rendering the technique invalid.

The distinction between optimal and suboptimal bite mark photographs is a significant factor in the analysis of bite marks in skin and comparison with teeth. The use of optimal photographs may strengthen the validity of the analysis and comparison. The use of suboptimal photographs limits the validity of the analysis and comparison. It is recommended that the status of the bite mark photographs is noted in the expert report as a significant factor in the analysis and comparison techniques. The distinctions between limiting/not limiting all sources of contextual bias and confirmation bias and between determining/not determining the order and timing of the release of contextual information and knowledge of the biters teeth to the analysing odontologist are significant factors in the preparation of a predictor of the causal dentition and in the analysis of bite marks in skin and comparison with teeth. The attested production of an unbiased predictor of the causal dentition, limiting all sources of contextual bias and confirmation bias, determining the order and timing of the release of contextual information and knowledge of the biters teeth may strengthen the validity of the analysis and comparison techniques.The attested production of a biased predictor of the causal dentition, not limiting all sources of contextual bias and confirmation bias, not determining the order and timing of the release of contextual information and knowledge of the biter’s teeth limit the validity of the analysis and comparison techniques. It is recommended that the entire management of contextual bias and confirmation bias in the analysing odontologist is noted in the expert report as significant factors in the analysis and
comparison techniques.
 
Conclusions
A study of the current scientific evidence provides the basis for a rationale for the analysis of human bite marks in skin and comparison with teeth to achieve scientific reliability and subsequently scientific validity. The evidence shows that distortion limits the identification of the biter and limits the significance of conclusions based on arch width measurements. The evidence also demonstrates that cognitive bias is limited by applying a methodology that completely manages contextual bias and confirmation bias. The scientific evidence on distortion and cognitive bias support the view that the technique of superimposition based comparison is invalid. Until further scientific evidence is validated, it is important to accept that the current evidence can only support limited conclusions in the analysis and comparison of human bite marks in skin with teeth.
 
Corresponding Author:
Douglas R Sheasby
Honorary Clinical Senior Lecturer in Forensic Odontology, University of Glasgow, Glasgow G1 2 8QQ, UK.
Email: [email protected]

Conflicts of interest: None 
Funding Statement: None

Acknowledgement: None 

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