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Evaluation and Management of the
Sexually Assaulted or Sexually Abused Patient
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Chapter 15
Bite Mark Guidelines
Ralph Riviello, MD, MS, FACEP
Bite marks can provide important forensic clues in criminal cases. Bite marks are often seen in rape and sexual assault
cases, assaults, homicides, and abuse crimes (child, elder, and IPV). For the emergency medicine provider, the most
important aspects of bite marks are to recognize their presence and to properly collect potential DNA specimens from
them. A forensic odontologist through the use of impressions, casts and overlays of the bite mark can potentially
identify and confirm the rapist. Those techniques are beyond the scope of this handbook.
A bite mark will typically present as a semi-circular injury, which compromises two separate arcs (one from the
upper teeth and one from the lower teeth) with either a central area absent of injury or with a diffuse bruise. It is not
uncommon to see only one arch of teeth, usually from the lower teeth. The amount of bruising present depends on the
amount of suction force applied during the bite. Several factors influence the severity of a bite-mark injury:
• The force by which the original injury was inflicted;
• The anatomical location bitten;
• The time elapsed between infliction and presentation.
Scrape marks from the teeth may be seen. Factors such as clothing and any movement or struggle while biting, can
affect the appearance and depth of a bite wound.
Bite marks can be both attack injuries (present on the victim) and defensive wounds (present on the attacker). A
study of 148 bite marks showed that females were four times more likely to be bitten than males, and over 50% of the
males in the study were the suspects. Females were more likely to be bitten on the breast, arm and legs; and children
on their genitals, legs, and back. Males were most commonly bitten on the hand, back, or face. Overall location rates
were, breast (28%), arm (18%), genitalia (8%), back (7%), and thigh (6%). (Pretty 2000)
Researchers have developed a bite mark severity scale to describe the forensic significance of the injury and whether
or not it can be compared with the suspect. However, for the emergency clinician, any bite mark has the potential to
yield forensically important evidence (DNA).
The Bite Mark and Severity Scale
Increasing wound
Very mild bruising, no individual tooth marks present, diffuse arches visible
may be caused by something other than teeth—low forensic significance.
2. Obvious bruising with individual, discrete areas associated with teeth. Skin
remains intact—moderate forensic significance.
3. Very obvious bruising with small lacerations associated with teeth on the
most severe aspects of the injury. Likely to be assessed and definite bite
mark—high significance.
4. Numerous areas of laceration, with some bruising, some areas of the
wound may be incised. Unlikely to be confused with any other injury
mechanism—high significance.
High Forensic
5. Partial avulsion of tissue, some lacerations present indicating teeth as the
probable cause of the injury—moderate forensic significance.
6. Complete avulsion of tissue, possibly some scalloping of the injury margins
suggesting that teeth may have been responsible for the injury. May not be
an obvious bite injury—low forensic significance.
Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient | ACEP
Bite Mark Guidelines