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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
B. Salivary swabbing
1. Whenever possible, bite mark trace evidence should be collected as guided by the patient history and/or
the use of an alternative light source using the most up to date technology possible
2. Use the double-swab technique to collect the saliva
a. Immerse the tip of the first swab in water
b. Roll the tip of the swab over the skin using moderate pressure and circular motions
c. Air dry the swab
d. Do not moisten the second swab, but use it dry
e. Roll the tip of the swab over the skin using moderate pressure and circular motions
f. Air dry the swab
g. Package both swabs together according to jurisdictional policy
h. Do not lick the evidence envelope because it will contaminate the sample
C. Medical Treatment
1. The wound should be assessed for the potential of developing infection and disease transmission (10–
15% become infected). The greater the amount of skin disruption, the more likely that an infection may
2. Consider prophylaxis with oral antibiotics that cover typical oral pathogens/flora.
3. Clinicians should also consider the possibility of Hepatitis B and, less likely, HIV transmission from the
bite and provide prophylaxis when appropriate.
Emergency Department Evaluation
A systematic evaluation of all bite marks should be conducted. Standard demographic information should be recorded
and a complete forensic history should be taken. The patient should be specifically asked about potential areas that
were bitten. A head-to-toe survey should be performed looking for potential and/or obvious bite marks. When a bite
mark is discovered, the following steps should be taken:
I. Description of bite mark
A. Location of bite mark
1. Describe anatomic location
2. Describe surface contour: flat, curved, irregular
3. Describe tissue characteristics
a. Underlying structure: bone, cartilage, muscle, fat
b. Skin: relatively fixed or mobile
B. Shape
Describe as essentially round, ovoid, crescent, irregular, double
C. Color
Note the color, such as red, purple, and so on
D. Size
1. Vertical and horizontal dimensions of the bite mark should be noted, preferably in the metric system.
2. The distance between canines should be documented, if clear. The circular arc should be documented
(preferably with a metric scale such as the ABFO #2 scale; if a metric scale is not available, a quarter
next to the wound in one picture can be substituted).
3. The presence or absence of suction applied to the bite area should be documented when possible.
F. Type of injury
1. Petechial hemorrhage
2. Contusion (ecchymosis)
3. Abrasion
4. Laceration
5. Incision
6. Avulsion
7. Artifact
G. Other information
1. Note whether the skin surface is indented or smooth
2. Any other wound characteristics or findings
3. Consider the need for evaluation of a forensic odontologist to assess the bite wound
II. Collection of evidence from patient
Gathering bite mark evidence should be done with authorization from the patient (and/or the proper authorities).
Note whether the bite mark has been affected by washing, contamination, lividity, change of position, and so on.
A. Photography
1. Orientation and close-up photographs with and without a metric scale marker, and containing
identifying information (case number, date, initials, and so on)
2. Photographic resolution should be of high quality (a macro lens with ring and point flash)
3. If color film is used, accuracy of color balance should be ensured
4. In using the scale, ensure that it is on the same plane and adjacent to the bite mark. It is desirable to
include a circular and a linear scale. The ABFO #2 scale incorporates both of these elements.
5. All of the photographs should be taken with the camera at 90o (perpendicular) to the injury
6. Ultraviolet light can be used to photograph bite wounds that are fading, even when the overlying skin
appears totally normal. This method should be used when historically indicated.
7. The most critical photographs should be taken in a manner that will eliminate distortion. Some
cameras have interchangeable focusing screens. Use of an architectural grid screen in conjunction with
the ABFO #2 scale will help reduce distortion.
8. It is beneficial to obtain serial photographs of the bite mark over a period of time
Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Figure 1: AFBO #2 Scale
The American Board of Forensic Odontology.
Barrett J. Human bites. Emedicine. Updated 9/20/12. Available at:
Sweet D, Lorente J A, Lorente M, Valenzuela A, Villanueva E. An improved method to recover saliva from human skin: the double swab technique.
J Forensic Sci 1997; 42: 320–322.
Pretty IA. Forensic Dentistry: 2. Bite marks and bit injuries. Dental Update 2008; 35:48–61.
Pretty IA, Sweet D. Anatomical location of bite marks and associated findings in 101 cases from the United States. Journal of Forensic Science
2000; 45(4): 812–814.
Pretty IA, Sweet. Development and validation of a human bite mark severity and significance scale. Journal of Forensic Science 2007; 52(3):
Pretty IA, Sweet D. A paradigm shift in the analysis of bite marks. Forensic Science International 2010; 201:38–44.
Bite Mark Guidelines
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