A comprehensive survey output was obtained from 206 FOs and FO students who completed the questionnaire. The results of our online survey are presented in Table 2, which provides a detailed overview of the responses collected from participants.

One hundred and sixty-one participants indicated they were currently practicing in FO (78.2%, 95% CI [72.1%, 83.4%]). Among them, the proportion of females was greater (55.3%, 95% CI [48.5%, 62.0%]) than that of males. This finding is noteworthy given the historical context of FO, where foundational figures such as Dr. Oscar Amoedo, regarded as the "father" of forensic odontology [6], and Dr. Keiser-Nielsen, who coined the term "forensic odontology" [7], were both male. However, a recent study [8] has highlighted the growing historical contributions of female practitioners in FO and explored how their roles have evolved in the field over time.

As shown in Fig. 1, the majority of FOs were located in the United States of America (22.8%, 95% CI [17.5%, 28.9%]), India (11.2%, 95% CI [7.4%, 16.0%]), and the United Kingdom (6.3%, 95% CI [3.6%, 10.3%]). According to a recent study [5] analyzing postgraduate and training programs in FO globally, some countries identified in their analysis were not represented in our survey responses. This discrepancy can likely be attributed to the lack of standardization in the curriculum or the fact that some countries do not offer FO training at the master’s degree level, which typically requires a longer commitment. The absence of a standardized educational path results in varied perspectives on FO practice. In some countries, practitioners are permitted to engage in FO with only basic training, while others mandate a master's degree for professional practice [5].

Number of survey participants by country

The results of the survey showed that the age of FOs was not normally distributed (W = 0.98, p = 0,005). It ranged from 25 to 88 years, with a median age of 49.5 years (IQR: 40–62, 95% CI [47, 53]). The age range of survey participants spans both novice and experienced professionals, which can facilitate valuable knowledge transfer and succession planning within the field of FO. However, the upper end of the age spectrum underscores the importance of targeted recruitment and the development of younger professionals. As depicted in Fig. 2, the age distribution relative to years of experience shows a gradual increase in age, from those with one to five years of practice to those with over twenty-five years of experience. Interestingly, respondents with no experience or less than one year of experience were found to have ages comparable to those of specialists with six to ten years of experience. This pattern suggests that some specialists may be entering the FO field later in their careers, possibly due to career transitions or the completion of extended academic programs.

The distribution of age across the experience spectrum of FO groups

Among the forty-five participants who reported not currently engaging in the practice of FO (21.8%, 95% CI [16.6%, 27.9%]), the majority were either enrolled in master’s programs (22.2%, 95% CI [12.0%, 35.8%]) or did not specify their occupational status (48.9%, 95% CI [34.7%, 63.2%]). Even so, a significant portion of respondents (53.0%, 95% CI [47.1%, 60.6%]) reported that FO was not included in their undergraduate training or was omitted from the dental curriculum. This observation highlights the critical need for a more comprehensive integration of FO into the curriculum, starting as early as undergraduate dental education, as emphasized by other studies [5, 9].

At the European University Cyprus (EUC) School of Dentistry, FO has been successfully integrated into the undergraduate curriculum, even within the context of a newly established dental program [10]. As part of their forensic training, dental students participate in anthropological analysis sessions, where they learn to establish biological profiles for unidentified individuals. However, the incorporation of FO into dental curricula remains limited in many developing countries, where awareness of the specialty is generally low [11,12,13,14]. Currently, no globally standardized training pathway exists for those seeking to become experts in FO, which highlights the urgent need for international efforts to standardize and expand training opportunities in this critical field.

Nonetheless, regarding actual occupation and current practice, the vast majority (75.2%, 95% CI [69.0%, 80.8%]) of the surveyed sample reported holding a certification in FO. Our findings shed light on an important aspect of the FO profession: a significant majority (75%) of FO practitioners surveyed have pursued additional postgraduate courses or specialized training to enter the field. However, this statistic also carries a dual interpretation. It suggests that 25% of current FO practitioners may have gained expertise through self-teaching or mentorship from more experienced colleagues, without having attended formal postgraduate programs. While structured postgraduate programs have existed for some time, they remain relatively limited in number, serving as the primary pathway for individuals interested in specializing in FO. A recent study that reviewed websites of FO training programs identified 56 programs across 18 countries [5]. Given the diverse paths into the field, there is an urgent need for the global standardization of both undergraduate and postgraduate training in FO. It is crucial that aspiring FOs hold a dental degree as their foundational education before pursuing specialization in this field. Standardization would not only ensure a more uniform level of expertise but also elevate the credibility and recognition of FO worldwide.

Respondents had a wide range of work experience, with a total of 40.7% having over 16 years of working experience. This finding suggests that the field of FO is predominantly composed of experienced professionals. However, it is important to note that 25.2% of the respondents had less than five years of experience or were new to the field. This indicates a growing influx of newer practitioners. Addressing these discrepancies is crucial as the profession progresses, particularly in terms of knowledge transfer and facilitating smooth transitions.

To achieve this, it is essential to implement mechanisms that facilitate the documentation and sharing of the expertise held by experienced professionals. These mechanisms could include mentorship programs, where seasoned professionals guide newcomers; interviews and oral histories to capture invaluable insights and experiences; written guides and best practice documents that serve as educational resources; and transitional roles, such as part-time consulting, that allow for a gradual shift from full-time responsibilities. By establishing such frameworks, the knowledge and skills of veteran practitioners can be effectively passed down, ensuring the continuity and evolution of best practices within FO.

These full-time responsibilities can largely be transferred to academic institutions, which represent the largest group of respondents’ primary workplaces (36.9%). This growing interest in academia is also reflected in the respondents' reading habits: only 1% reported never reading scientific articles, with the majority (34%) indicating that they read at least one scientific article each week. A Brazilian study [15] that examined the reading habits of FOs involved in dental age estimation found that most practitioners read at least one scientific article per month. In addition to academia, other primary employment settings included government agencies, independent consultancy roles, and police or military agencies. This diversity of employment settings highlights the multifaceted and interconnected nature of FO, encompassing areas such as education, investigations, and legal expertise, each of which plays a vital role in the practice of FO.

The primary areas of practice for FOs include a number of specialties. Analysis of human remains was a predominant area, with 85.4% (95% CI [80.1%, 89.7%]) of FOs engaged in this work. Dental age estimation was also widely practiced, with 73.8% (95% CI [67.5%, 79.4%]) of FOs involved. Additionally, 42.7% (95% CI [36.1%, 49.5%]) of FOs worked with bite mark analysis. Other areas of practice included dental malpractice (29.1%, 95% CI [23.2%, 35.6%]) and dental negligence (26.2%, 95% CI [20.6%, 32.5%]). A small percentage of participants (2.9%, 95% CI [1.2%, 5.9%]) indicated that none of the above areas were applicable.

The casework frequency among respondents was mainly occasional (27.2%, 95% CI [21.5%, 33.5%]), with 17.5% rarely engaging in casework. This aligns with the finding that many FOs work in academic settings. However, FO activities are highly varied, often extending beyond the classroom to include crucial roles such as providing court testimony or being deployed in disaster victim identification (DVI) operations. These diverse functions underscore the versatility and critical nature of the profession, with FOs often bridging the gap between science, law enforcement, and humanitarian efforts.

A notable number of respondents (45.6%, 95% CI [38.9%, 52.5%]) reported involvement in court testimony. The number of cases in which FOs were requested to appear in court was not normally distributed (W = 0.71, p < 0,001). The median number of cases was 6 (IQR: 2–15, 95% CI [4, 10]). As illustrated in Fig. 3, the median number of court testimonies remained consistent across experience groups. This observation may suggest that the skills necessary to testify effectively in court are typically acquired early in an FO's career. Subsequent experience likely contributes more to an FO’s ability to handle more complex or challenging cases rather than increasing the frequency of testimony.

The number of court testimonies across the experience spectrum of FO groups

The involvement of FOs in court testimony was driven by a range of factors. Among the FOs who provided testimony (n = 94), 50.0% (95% CI [40.0%, 60.0%]) of their statements were for identification purposes. Another notable proportion (25.5%, 95% CI [17.6%, 35.0%]) pertained to bite marks. Furthermore, 21.3% (95% CI [13.9%, 30.3%]) of FOs’ court testimonies pertained to dental age estimation. Other reasons included dental malpractice (14.9%, 95% CI [8.8%, 23.1%]), as well as lesser frequencies of various injuries (7.4%, 95% CI [3.4%, 14.1%]), and each of child abuse, liability, and sexual assault (2.1%, 95% CI [0.4%, 6.6%] each). These factors underscore the diverse and essential role of FOs in the legal process, particularly in cases where dental expertise is vital. Their work often carries significant legal weight, as FOs may be called upon to provide expert testimony in both civil and criminal cases [16]. The necessity of this expertise highlights the importance of well-rounded training for FOs, with mock trial exercises being an essential part of their preparation [17].

Additionally, many FOs have actively participated in DVI efforts during mass disasters. The results of the survey indicated that approximately half of the FOs surveyed (50.5%, 95% CI [43.7%, 57.3%]) had participated in DVI teams at the national level, while only 27.2%, 95% CI [21.5%, 33.5%] had participated in international DVI teams. A recent systematic review and meta-analysis emphasizes the critical role of FOs in DVI operations, demonstrating that dental identification can be used to identify at least 32% of victims in mass disaster scenarios [18]. This statistic underscores the importance of FOs in disaster response, where rapid and accurate identification is essential for providing closure to affected families and facilitating the legal and humanitarian aspects of disaster management.

The recognition of FO as a distinct dental specialty differs across countries. In some regions, it is formally recognized as a specialty, while in others, it remains a sub-discipline within broader dental or forensic science.

It is concerning that only 40.3% (95% CI [33.8%, 47.1%]) of respondents indicated that FO is recognized as an independent specialty in their countries. This finding is reflected in the respondents' satisfaction levels, as only 16.5% expressed strong satisfaction regarding the support and recognition of FO in their respective countries. Nevertheless, the majority of participants expressed a favorable opinion of FO as a career choice, albeit with some reservations (59.2%, 95% CI [52.4%, 65.8%]).

Despite these challenges, multiple professional associations support the development of FO globally, with most FOs being members of such associations (75.6%, 95% CI [69.4%, 81.1%]). Among FOs who reported membership (n = 155), 38.7% (95% CI [31.3%, 46.5%]) were affiliated with the International Organization for Forensic Odonto-Stomatology (IOFOS), while 41.9% (95% CI [34.4%, 49.8%]) were part of the American Society of Forensic Odontology.

According to the IOFOS website (https://iofos.eu/member-of-iofos/), several FO associations and member organizations exist, as shown in Table 1. While the activity status of all these associations remains uncertain, their existence underscores a sustained interest in the field of FO. Generally, scientific associations play a crucial role by offering networking opportunities, fostering professional development, and providing platforms for advancing the discipline. National organizations play an important role in guiding dentists through approved pathways to gain experience in FO and practice within the legal frameworks of their respective countries. By adhering to recommended guidelines for good practice, these associations ensure that practitioners meet the standards expected in the field. Membership in these associations provides aspiring FOs with invaluable opportunities to learn from seasoned professionals, gaining practical insights into the profession.

An analysis of responses from FOs reveals the most pressing challenges hindering the advancement of the field A lack of recognition and awareness was identified as a significant concern by 21.8% (95% CI [16.6%, 27.9%]) of respondents. This issue is closely tied to limited career and job opportunities, highlighted by 18.4% (95% CI [13.6%, 24.2%]) of FOs. Other major challenges include education and training deficiencies (13.1%, 95% CI [9.0%, 18.2%]), resource and funding limitations (9.7%, 95% CI [6.2%, 14.3%]), and the pursuit of collaboration and standardization (10.7%, 95% CI [7.0%, 15.4%]). Specific technical challenges such as bite mark analysis (8.3%, 95% CI [5.1%, 12.6%]), dental age estimation (3.9%, 95% CI [1.9%, 7.2%]), and identification (2.9%, 95% CI [1.2%, 5.9%]) also emerged as key concerns.

Respondents expressed apprehension about the integration of technology and the future trajectory of FO, with 7.3% (95% CI [4.3%, 11.4%]) identifying these as significant issues. A small but noteworthy group (3.9%, 95% CI [1.9%, 7.2%]) did not provide any specific challenges.

The feedback gathered underscores several critical barriers that impede progress within FO, touching on issues such as recognition, career opportunities, education, funding, collaboration, and technical practice. A central theme emerging from the responses is the lack of both public and institutional recognition, which severely limits support, visibility, and overall credibility for the field. This lack of awareness, in turn, leads to a shortage of career opportunities, as many institutions and employers fail to fully recognize the specialized skills that FO professionals offer. Addressing these gaps by promoting greater recognition and creating clearer career pathways is essential. By doing so, the field can attract and retain skilled professionals, ensuring its continued growth, sustainability, and relevance in the global forensic landscape.

Education and training deficiencies emerged as significant obstacles in the field, with respondents highlighting gaps in the quality and accessibility of specialized programs, which aligns with findings from a recent study [5]. These deficiencies hinder practitioners’ ability to effectively manage complex cases and stifle the overall progress of the field. The challenges are further exacerbated by resource and funding limitations, which restrict not only research and professional development but also access to advanced technologies that could enhance the accuracy and innovation in FO.

Collaboration and standardization were identified as additional key priorities. A unified and standardized approach to methodologies would significantly enhance the reliability and consistency across practices, ensuring more accurate and dependable results. The absence of well-defined standards and a lack of coordinated collaboration could lead to variability in practices, potentially affecting case outcomes and hindering the broader acceptance of FO within the forensic community.

Specific technical challenges, particularly in bite mark analysis, dental age estimation, and identification, also demand significant attention. These areas require specialized skills, and in the absence of robust frameworks, their efficacy can vary greatly. Such inconsistencies raise concerns about the accuracy and reliability of FO techniques, especially in legal, humanitarian, and investigative contexts. Furthermore, the integration of emerging technologies presents both opportunities and challenges. Respondents emphasized the need for clear strategies to effectively harness technological innovations. Artificial intelligence (AI), for example, holds the potential to revolutionize dental record analysis, bite mark analysis, and dental age estimation. However, without careful and strategic integration, the full benefits of these advancements may remain untapped, limiting their impact on the field.

Expanding research into these critical areas could significantly broaden the scientific foundation of FO, enhancing its practical applications in law enforcement and disaster response efforts. The opinions expressed by academic members teaching FO, as highlighted in a recent study [19], emphasize the necessity of adopting a balanced approach—one that seamlessly integrates technological advancements with rigorous training and hands-on practical application.

In interpreting the results of this pilot survey, it is important to acknowledge the potential limitations associated with the validation and sampling method employed. Validation is a step in survey-based research to assure the survey’s accuracy to answer the research question. Even so, this pilot study provides an initial exploratory overview of forensic odontologists' perspectives and lays the groundwork for future, more comprehensive research efforts.

The response rate obtained from the survey, although valuable for understanding the perspectives of participants reached through FO professional associations, closed WhatsApp® groups, professional LinkedIn® network and ResearchGate® network may not fully represent the diversity and distribution of FO on a global scale. The reliance on these specific channels for participant recruitment could have introduced selection bias, as individuals who are not affiliated with such groups or associations may not have been reached by our survey. Therefore, caution should be exercised in generalising the findings to the broader population of FOs worldwide.

During the process of survey dissemination, several limitations were encountered that influenced the outreach strategy. Despite our attempt to engage certain professional associations in disseminating our online survey, we encountered limitations in utilising their mailing lists for distribution. In response to our request for assistance, they clarified that their mailing lists are reserved exclusively for messages of organisational importance. Consequently, direct distribution of our survey through their channels was not feasible.

In the process of reaching out to potential respondents for our online survey, we encountered significant communication challenges. Despite our best efforts to connect with individuals via the INPAFO email list (https://www.inpafo.in/our-members), we faced a notable obstacle: many of our messages were returned undelivered, indicating that the intended recipients could not be reached. Numerous websites of Associations and scientific societies related to FO are no longer accessible, and some of these organisations may no longer be operational. (Table 1). In 2007, the Japanese Society of Forensic Dental Science (JSFDS) was established with over 750 members [20]. Despite this, our survey reached only two FOs in Japan. Similarly, although France has 85 judicial experts in FO listed on the official experts' site (www.cours.appel.justice.fr), we received only four responses from colleagues in that country.

It's important to acknowledge that our dissemination strategy for the online survey did not utilise any social media platforms, including Meta® (formerly Facebook®), X® (formerly Twitter®), or Instagram®. While social media platforms are commonly employed to reach diverse audiences and facilitate widespread participation in online surveys, our decision to forgo their use may have constrained the reach and diversity of our sample. By not tapping into the potential of social media channels, we may have missed opportunities to engage with specific demographic groups or scientific communities that are active on these platforms. As a result, the generalisability and representativeness of our findings may be limited. In addition to the limitations associated with the sampling method, it is important to note that not all FOs may be accessible through online professional networks such as LinkedIn® and ResearchGate®. The reliance on online platforms for participant recruitment may have excluded individuals who are not actively engaged or registered on these platforms.

The distribution method used via WhatsApp® may have constrained the survey's visibility to a narrow audience within the initiator's immediate network, potentially limiting exposure to a broader demographic of FOs. Additionally, the specialised nature of the survey topic focusing on demographics within FO could have deterred participation from individuals with limited interest or expertise in this specific area. Time constraints related to professional commitments, ongoing research projects, or personal obligations may have further restricted participant engagement during the survey period.

Moreover, certain recipients might have been unaware of the survey or perceived the topic as unrelated to their specific interests within FO. Survey fatigue, resulting from frequent survey requests in the field, may have also diminished willingness to participate.

Furthermore, the informal communication style inherent to WhatsApp® and concerns regarding privacy and confidentiality associated with personal messaging platforms likely contributed to respondent hesitation or non-participation. Finally, the considerable volume of messages and potential distractions on WhatsApp® could have caused respondents to overlook or postpone responding to the survey amidst competing activities on the platform. These challenges underscore the importance of refining survey design and distribution strategies to optimise participant engagement and response rates in future research endeavours focusing on demographics within FO.

Addressing these multifaceted challenges holistically could significantly strengthen FOs role and impact within forensic science and the broader justice system. Increasing the inclusion of FO in undergraduate dental programs could provide a more solid foundation for future practitioners. Additionally, enhancing support and recognition within the broader scientific community is crucial for the field’s growth and development. Standardizing educational pathways and fostering international collaboration will ensure FO professionals are better equipped to meet the growing demands of this vital field. To maximise the global collection of FO demographics, future research should forge partnerships with international FO associations, utilise diverse communication channels and social media platforms to enhance outreach, incentivise participation with access to findings or workshops, implement multilingual and user-friendly survey designs to ensure inclusivity, and adopt longitudinal data collection strategies to track demographic trends over time.