Images in Clinical Medicine

Human Bites versus Dog Bites

Howard Fischer, M.D., Pamela W. Hammel, D.D.S., and L.J. Dragovic, M.D.

N Engl J Med 2003; 349:e11September 11, 2003

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A six-year-old boy was admitted to the hospital with an acute abdomen. He had a rectal perforation and two groups of lesions on his right leg. Neither he nor his foster parents had an explanation for the perforation, but all three of them said the marks on his leg were from dog bites. Human bite marks (Panel A) are usually superficial abrasions or contusions. Humans have four incisors in each dental arch and short canines. The incisors leave rectangular marks, and the canines leave triangular marks. The arch is elliptical or oval. In contrast, dogs have six incisors and long, curved canines. Their arch is long, with a short, straight anterior segment. The bite configuration is not oval. Dogs' canines can leave deep punctures, with tissue tearing (Panel B).

Child Protective Services was notified of the boy's inadequately explained injuries, and he was moved to a different foster home. The ability to recognize human bite marks is important for all physicians.

Howard Fischer, M.D.
Children's Hospital of Michigan, Detroit, MI 48201

Pamela W. Hammel, D.D.S.
L.J. Dragovic, M.D.
Oakland County Medical Examiner's Office, Pontiac, MI 48341

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