I. Personal Identification
a)Identification of Ethnic origin (Race)
II. Role of Dental team in mass fatality incidents
III. Bite marks
IV. Recognition and reporting of Domestic Violence, Abuse & Neglect
a)Child abuse, neglect
b)Domestic violence; intimate partner violence, spousal abuse
& battered women
c)Recognition of elder abuse & neglect
VI. Lip prints
VII. Palatal rugae patterns
VIII. Identification from Dental DNA
The word Forensic is derived from the Latin words ‘forum’,
which means ‘court of law’ & ‘forensic’ which means public.
Odontology refers to the study of teeth.
Forensic odontology, therefore, has been defined by
Federation Dentaire International (FDI) as “that branch of
dentistry which, in the interest of justice, deals with the proper
handling and examination of dental evidence and with the
proper evaluation and presentation of dental evidence”.
Forensic dentists are responsible for
following main areas of practice.
Identification of found human remains (age, sex, race)
Identification in mass fatalities.
Assessment of bite mark injuries.
Assessment of cases of abuse.
Civil cases involving malpractice.
Lip prints in identification.
Palatal reguae pattern in identification.
Identification from dental DNA.
In 2500 BC, two molars linked together by gold wire found by
Junker in a tomb at Giza.
Tooth impressions were deliberately utilized for legal personal
identification as far back as 900 years.
First formally reported case of dental identification was that of 80
years old warrior JohnTalbot, who fell in the battle of Castillon in
In 1775 Dr. Paul reverse identified JosephWarren with help of a
bridge made of silver ivory.
First time, the dental evidence was accepted in US courts was
Webster Parkman case in 1849.
The first treatise on forensic odontology as a subject was done by
Dr. Oscar Amoedo. His publication was entitled L’Art Dentaire En
Medicine Legale and acquired worldwide recognition and he is
recognized as the Father of Forensic Odontology.
In 1967 Russian source reported that dental evidence was
responsible for identification of badly charred bodies of Adolf
Hitler & Eva Braun.
I. PERSONAL IDENTIFICATION
Identification is the establishment of a person’s individuality.
Acharya &Taylor defined identity as “the characteristics by
which a person may be recognized.
Proper identification of the dead / living persons is required for
both legal and humanitarian reasons. It may help in the
settlement of property, facilitate remarriage of a surviving
spouse and allow the cremation or burial of the body,
according to relevant religious and cultural customs.
The positive identification of living or deceased persons using
the unique traits and characteristics of the teeth and jaws is a
corner stone of forensic odontology.
•Traditional methods of identification have included visually
recognizing the body, and personal property such as clothing, jewelry
etc.These methods, however are not very reliable in establishing the
identity of a person. For example, visually identifying a body that is
burned or decomposed can be very traumatic experience for relative
•The better option for identification is for forensic experts to analyze
physical features present in the body. Physical features may be
inherited or acquired.
•Therefore the use of dental evidence is the method of choice in
establishing the identity of badly burned, traumatized, decomposed
and skeletonized remains.
BASIS FOR IDENTIFICATION
The basis for dental identification is the theory that human
dentition is never the same in any individuals. Morphology and
arrangement of teeth vary from person to person.
Teeth may have restorations, which may after their original
The number of combinations, 16 missing teeth can produce is
approximately 600 million.
Four missing and four filled teeth in a mouth combined can
produce more than 700 million combinations.
Every tooth has five surfaces, if, instead of considering the
whole tooth, the surface were taken individually, the
variations produced would be astronomic.
Fillingham and co-workers, calculated that there are 1.8x1019
possible combinations of 32 teeth being intact, decayed,
missing or filled.
DENTAL IDENTIFICATION PROCEDURES
There are 2 forms of dental identification procedures.
1) Comparative identification
2) Reconstructive identification or dental profiling.
1. COMPARATIVE DENTAL IDENTIFICATION
This method involves the comparison of ante mortem and
post mortem dental records to determine if the body is that of
the person of interest.
It includes 4 steps:
1) Oral autopsy
2) Obtaining dental records
3) Comparing post and ante mortem dental data and
4)Writing a report and drawing conclusions.
(I) ORAL AUTOPSY:
Autopsy also known as necropsy or post mortem, involves
examination of the deceased, usually with dissection to
expose the organs to determine the cause of death.
Autopsy has a systematic protocol starting with critical
examination of the external features of the body such as
gender, ethnicity, build, wounds, scars, tattoos and body
piercing photographs, radiographs, finger prints, fingernail
scrapings and hair sample.
Oral examination is an essential part of the post mortem
procedure.The forensic dentists who conduct oral autopsy
should have adequate knowledge about common post
mortem findings such as Rigor mortis, Livor mortis,
Decomposition, and post mortem artifacts.
Rigor Mortis:This is a state of stiffening of muscles, sometimes
with slight shortening of the fibres. Individual cell death takes
place at this stage.
Rigor mortis render the jaws rigid and the use of mouth gags or
intra oral myotomy is essential for jaw separation.
Teeth may become brittle in burned cases, they need to be
reinforced with cyanocrylate cement, polyvinyl acetate or clear
acrylic spray paint prior to examination.
Access for radiography in incenerated bodies can obtained by
removing tongue and contents of the floor of the mouth in a
‘tunneling’ fashion from beneath the chin.
The status of each tooth (whether intact, carious, restored or
missing) should be noted.
A thorough examination of soft tissue injuries, fractures and
presence of foreign bodies is under taken and samples of hard
and soft tissues should be obtained.
All post mortem information pertaining to the body must be
entered on to the standard ‘Interpol Post mortem Form’ which
is color coded in pink.
(ii) OBTAINING DENTAL RECORDS
Dental records contain information of treatment and dental
status of a person during his / her life.
Dayal and colleagues state that dental records may be
obtained from the treating dentist, specialist or hospital
Whenever possible, the original record should be examined,
such records may in the form of dental charts, radiographs,
casts and / or photographs.
The contents of all available dental records should be
transcribed onto the standard ‘Interpol Antemortem Form’
which is colour coded in yellow.
(iii) COMPARING POST AND ANTE
MORTEM DENTAL DATA
Once the post mortem evidence and dental records are
available, the data can be compared.
Features compared include tooth morphology and associated
bony structures, pathology and dental restorations.
An individual with multiple dental treatment and unusual
features has a better likelihood of being identified. However,
that does not imply that identification relies on extensive
dental treatment, comparison should take into account quality
rather than quantity.
PROBLEMS WITH DENTAL IDENTIFICATION
1)Absence of antemortem records.
2)Absence of acquired dental tracts for identification.
3)Limitations for storing dental records for certain period.
4)Poor quality dental records.
5)In post mortem situation, all of the teeth may not be
6)recovered as a result of post mortem trauma or loss of Pdl.
7)Fire can result in irreversible changes to restorations and teeth
which can reduce the amount of information available for
Despite these problems, teeth and dental tracts are one
for the most valuable individualizing features of human body.
2.RECONSTRUCTIVE POST MORTEM DENTAL
Dental profiling includes extracting a triad of information.
1)The decedent’s ethnic origin (Race).
Dental profiling is used in cases in which there is no suspection
as to who the decedent may be.
According to pretty and sweet, “the information from this
process will enable a more focused search for ante mortem
a) IDENTIFYING ETHNIC ORIGIN FROMTEETH:
Physically, humans are a diverse species.This diversity is
a result of genetic influences, as well as environmental
factors such as climate and geographic location.
Therefore, the people of the world look different.
Traditionally, the human species has been categorized
into three ‘races’ – Caucasoid, Mongoloid, Negroid.
Many of the best traits of estimation of race are found in
the mid facial skeleton, including the area of nose, mouth
and cheek bones. Landmarks such as shape of the
cranium, lateral projection of zygomatic arches, shape
and contour of the orbits and nasal aperture, shape of
the arches can provide information about racial
Harvey has delineated some social and ethnic characteristics
1. Wide arch Narrow arch and crowding
2. Enamel extension between roots of
Cusp of carabelli
3. Five cusped third molars
4. Three rooted deciduous molars
S. No. Australian American Indians
1 . Large arch and large teeth Marked attrition
2. Marked attrition Shovel shaped incisors
3. Midline diastema Large teeth
S. No. Mongoloid Negroid
1. Occlusal enamel pearls in
Lower 1st premolar has two or three
2. Missing mandibular incisors
3. Shovel shaped incisors
It is of limited value,The skin is brown in Indians, fair in
Europeans and black in Negroes.
Skin color is changed by decomposition, burning etc.
Indians have dark eyes, a few brown eyes, Europeans have
blue or gray eyes.
Indians have black and thin hair.
Europeans have fair or light brown or reddish.
Indians, Negroes have wooly hair (i.e., arranged in tight
Mongolian hair is coarse and dark and uniform and usually
circular on cross section and has a dense uniform
pigmentation and dark medulla.
Negro hair is elongated, oval on cross section and has a
dense pigment with an irregular distribution.
Caucasian hair has round or oval shape on cross section
with uniform distribution of fine or coarse pigmentation.
The dress may be helpful sometimes.
The cephalic index (C.I) or index of Breadth is important.
C.I. = Maximum breadth of skull x 100
Maximum length of skull
Racial Difference in the Skull
Type of skull Cephalic Index Race
70 to 75 Pure Aryans,
75 to 80 Europeans &
80 to 85 Mongolian
Racial Difference in the Skull
1. Skull Rounded Square Narrow &
2. Forehead Raised Inclined Small &
3. Orbits Triangular Higher,
4. Nasal Aperture Narrow &
5. Palate Triangular Large &
Teeth Poorly spaced
more or less
Face Small Large,
Jaw & molar
Small Legs longer in
wide & flat;
anterior by 5.8
Hindu males are not circumcised, sacred thread, necklace
of wooden beads, caste marks on forehead, tuft of hair on
back of head and piercing of ear lobes if present are helpful.
Hindu females may have vermilion on head, silver toe
ornaments, thali, tattoo marks, nose-ring aperture in
nostril, few openings for ear – rings along the helix.
Muslim females may have nose ring aperture in septum
only, several opening in the ears along helix and usually no
Muslim males are circumcised.
Dental features have a complex mode of inheritance and
are a combination of hereditary and environmental factors to
which a person is exposed. As a result, today different
populations show considerable diversity in their dentition. For
population identification, those dental features that have a
stronger genetic and weak environmental influence are useful.
Dental features used to describe population differences
are broadly categorized as metric (tooth size) and non metric
Metric features are based on measurements and non metric in
terms of presence or absence of a particular feature, eg:
whether carabelli’s cusp is present or not.
Townsend cites numerous studies which indicate metric
features are considerably influenced by local environmental
factors, eg: missing lateral incisors causes compensatory
increase in central incisor. Space constraints in the jaws result
in compression of third molars.
On the other hand, non metric features are more inheritable
and therefore, dependable in establishing the population
group to which and individual belongs.
NON METRIC DENTAL FEATURES:
Given by Scott &Turner .
(1) Crown Features:
Shoveling:The presence of prominent mesial and distal
marginal ridges on the lingual surface of the upper and lower
anterior teeth, usually the maxillary central incisor.
Double shoveling: Mesial and distal marginal ridges on the
labial and lingual surface of the upper central incisor.
Carabelli’s feature: Expressed as slight grooves or well-
developed tubercles on the mesiolingual cusp of the upper
Three cusped upper 2nd molar:The distolingual cusp of
(hypocone) of the upper molars is retained on the first molar
but, tends to be of reduced size or completely absent in the
Cusp 5: An occlusal tubercle on the distal marginal eidge of the
upper first molar.
Cusp 6: A supernumerary cusp on the distal aspect of the
lower first molar between the disto lingual and the distal cusp.
Cusp7:A supernumerary cusp expressed between the
mesiolingual and distolingual cusps of the lower first molar. It
appears wedge-shaped from the occlusal aspect, with the
base of the wedge placed lingually and apex towards the
Winging:This is an indirect crown trait. It is characterized by
the bilateral labial rotation of the distal margins of maxillary
central incisors.The incisal edge of the central incisors, taken
together, appears ‘V’ shaped from the occlusal aspect.
Five cusped lower 2nd molar:The lower 2nd molar can present a
distal cusp (hypo coneclid).
Lower molar groove pattern:Occlusal groove configurations
(‘X’, ‘Y’ and ‘+’) on the lower 1st and 2nd molars are also used in
Interruption groove: A developmental groove expressed on
the cingulum and lingual aspect of the root of upper lateral
Enamel extension: Seen on the upper and lower molars and
premolars. Here, the cervical margin of the enamel projects
apically. Such projections deviate 1-4 mm from the horizontal
axis of the cervical line. For population identification, the
upper or lower molar is considered.
Odontome: Conical projection on the occlusal surface of either
upper or lower premolar.The tubercle has enamel and dentin
components and involves pulpal extensions almost half the
time. It is an extremely rare feature.
Lateral incisal variants: Include peg shaped diminutive andT-
forms of the highly polymorphic upper lateral incisor. Scott
andTurner state that few studies have been done on these
Distal accessory ridge: An additional ridge between the lingual
ridge and distal marginal ridge of maxillary canine.
Premolar accessory ridge: Additional ridge between the
triangular ridge of the buccal cusp and mesial and / or distal
marginal ridges of premolars. Bothe maxillary and mandibular
premolars can be used for population identification.
Premolar accessory marginal tubercle: A tubercle on the
mesial and / or distal marginal ridges of upper premolars.
Premolar lingual cusp:The presence of two or more lingual
cusps on the lower second premolar.
Mesial marginal complex of upper molar:Tubercles observed
on the mesial marginal ridge of upper first molar.
Parastyle:Tubercle on the buccal surface of the upper molars.
Protostylid:The presence of a tubercle on the mesiobuccal
cusp of the lower molars. Population identification focuses on
the lower 1st molar.
2. Root features:
Two-rooted upper premolar: Although widely regarded as
having two roots the upper first premolar root number does
show population variations.
Two rooted upper molar:The absence of root furcation (either
one or both) in the upper second molar.
Two rooted lower canine: Presence of two rooted canines is a
rarity among humans, although typical in non human
Tomes root: Presence of extra root on the lower first premolar.
Three rooted lower molar: Presence of a third root, usually
lingual to the distal root, on the lower first molar.
Single rooted lower molar: Lower molars commonly have two
roots, but fused roots are not uncommon. Although this trait is
most common in the third molars, the 2nd molars are used for
The range of dental variation among humans is so great that
several characteristic features must be considered together
before concluding on ethnic group) origin.The high and low
frequency of a given non metric feature is important in
Example: People of European,West & South Asian origin may
exhibit four cusped lower 2nd molar, two rooted lower canine,
Carabelli’s feature and three cusped upper 2nd molar, in
relatively high frequency.
But, features like winging, shoveling, double shoveling,
odontomes, cusps 5, 6 & 7, Enamel extension, ‘Y’ groove
pattern,Tomes root, and three rooted lower 1st molar do not
occur often among them. But most of these features are
commonly seen among East-Asians.
b) SEX DIFFERENTIATION:
Determining the sex of unknown human remains is the
second step in the triad of building a dental profile. Sex has to
be determined in cases of heir ship, marriage, divorce,
legitimacy, impotence, rape etc., sex can be determined by
characteristics of body, morphology of different bones, metric
features, as well as DNA analysis of teeth.
S.No. Traits Male Female
1. Gonads A functioning testis, penis,
A functioning ovary, uterus,
2. Build Larger with greater
Small with less muscular
3. Shoulders Broader than hips Narrower than hips
4. Waist ill defined Well defined
5. Trunk Abdominal segment smaller Abdominal segment larger
6. Thorax Dimensions more Dimensions less
7. Limbs Longer Shorter
8. Arms Flat on section Cylindrical on section
9. Thighs Cylindrical Conical, due to shorter femur
and greater deposition of fat
10. Gluteal region Flatter Full and rounded
11. Wrists and Ankles Not delicate Delicate
12. Breasts Not developed Developed
13. Pubic hair Thick and extends upwards to
the umbilicus (Rhomboidal)
Thin, horizontal and covers
mons veneris only
14. Body hair Present on face and chest Absent on face and chest
15. Head hair Shorter, thicker, coarser Longer, thinner, finer
16. Larynx Prominent, Length 4.8 cm Not prominent, length 3.8
Trait Diagnostic of sex from skeleton:
1. General Features:
S.No. Traits Male Female
1. General size Larger, more massive Smaller, slender
2. Long bones Ridges, depressions and
prominent, bone of arms
and legs are 8% longer
3. Shaft Rougher Smoother
4. Articular surface Larger Smaller
5. Metacarpal bones Longer and broader Shorter and narrower
6. Weight 4.5 kg 2.75 kg
S.No. 5.Traits Male Female
1. General appearance Larger, longer (dolicocrania) Smaller, lighter, wall thinner
rounder (brachycrania) and
2. Capacity 1500-1550 cc 1350-1400 cc
3. Architecture Rugged, muscle ridges more
prominent especially in occipital
and temporal area
4. Forehead Steeper, less rounded Vertical, round, full, infantile
5. Glabella More prominent Small or absent
6. Fronto nasal junction Distinct angulation Smoothly curved
7. Orbits Square, set lower on the face,
relatively smaller, rounded
Rounded, higher, relatively
larger, sharp margins
8. Supra orbital ridges Prominent Less prominent or absent
9. Check bones Heavier, laterally arched Lighter, more compressed
10. Zygomatic arch More prominent Less prominent
11. Nasal aperture Higher and narrower, margins
Lower and broader
12. External auditory meatus Bony ridge along the upper border
13. Frontal eminences Small Large
14. Parietal eminences Small Large
15. Frontal sinuses Much developed Less developed
16. Occipital area Muscle lines and protuberance
Muscle lines and
protuberance not prominent
17. Mastoid process Medium to large, round, blunt Small to medium, smooth,
18. Base Sites of muscular insertions more
Sites of muscular insertion
19. Digatric groove More deep Less deep
20. Condylar facet Long and slender Short and broad
21. Occipital condyles Large Small
22. Palate Larger, broader, tends more
Smaller, tends more to
23. foramina Larger Smaller
24. Foramen Relatively large and long Relatively small and round
S.No. Traits Male Female
General size Larger and thicker Smaller and thinner
Chin Square Rounded
Body height At symphysis greater At symphysis smaller
Ascending ramus Greater breadth Smaller breadth
Angle of body and ramus Less obtuse (under 125 )
prominent is everted
More obtuse, not prominent,
Condyles Larger Smaller
S.No. Traits Male Female
1. Bony frame work Massive, rougher, marked
Less massive, slender,
2. General Deep funnel Flat bowl
3. Ilium Less vertical, curve of iliac
crest reaches higher level and
is more prominent
More vertical, distance
between iliac crests is less,
iliac fossae, shallow, curves
of crest well marked
4. Pre auricular sulcus
(attachment of anterior
Not frequent, narrow, shallow More frequent, broad and
5. Acetabulum Large, 52 mm in diameter,
Small 46 mm in diameter,
6. Obturator foramen Large, often oval with base
Small, triangular with
7. Greater schiatic notch Small, narrower, deeper Larger, wider, shallower
8. Ileo pectineal line Well marked and rough Rounded and smooth
9. Ischial tuberosity Inverted Everted, more widely
10. Body of pubis Narrow and triangular Broad, square and pits on
posterior surface if borne
11. Ramus of pubis It is like continuation of body of
Has a pinched or
narrowed appearance and
is short and thick
12. Ischiopubic rami More everted Less everted
13. Symphysis High Low and distance
between two pubic
14. Sub pubic angle ‘V’ shaped, sharp angle 70-75 ‘U’ shaped, rounded
broader angle, 90-100
15. Pelvic brim / inlet Heart shaped Circular or elliptical, more
16. Pelvic cavity Conical and funnel shaped Broad and round
17. Pelvic outlet Smaller Larger
18. Sacro-illiac articulation Large, extends to 2 1/3 to 3
Small, oblique, extends to 2
to 2½ vertebrae
19. Sacrum Longer, narrower, with
more evenly distributed
well marked, body of 1st
sacral vertebrae larger
Shorter wider, upper
half almost straight,
curve forward in
marked, Body of 1st
20. Coccyx Less movable More movable
21. Ischio pubic index = Pubic
length in mm / Ishical length
in mm x 100
73 to 94 91 to 115
22. Sciatic notch index = Width of
sciatic notch / Depth of
sciatic notch x 100
4 to 5 5 to 6
S.No. Traits Male Female
1. Height More than 157 mm Less than 144 mm
2. Glenoid cavity Height greater (39.2 cm) Height less (32.6 cm)
It is a plano convex mass, lying near nuclear membrane (Barr
body). In the buccal smear, the percentage of nuclei
containing chromatic body ranges from 0-4 in males and 20-
80 in females. In females neutrophil leukocytes contains a
small nuclear attachment of drumstick form (Davidson body)
in upto 6% of cells.This is absent in males. In decomposed
bodies sex chromatin cannot be made out.
In normal cases, sex determination is easy from external
examination only, but it is difficult in cases of
2) Concealed sex.
3) Advanced decomposition.
SEX DIFFERENCES INTOOTH SIZE:
Teeth are useful for differentiating sex by measuring their
mesiodistal and buccolingual dimensions. Lund and Mornstad
state that “this is of special importance in young individuals
where skeletal secondary sexual characters have not yet
developed”.Tooth size or odontometrics are influenced by
environment and are therefore population specific and do not
apply to the world at large.
The canines consistently show the maximum sex
difference, premolars, first and second molars as well as
maxillary incisors are also have significant differences.
Incisor index (Ii) – Proposed by Aitcheson
Ii = [MDI2] x 100
MDI2 – Maximum mesiodistal diameter of maxillary lateral
MDI1 – Maximum mesiodistal diameter of maxillary central
This index is higher in males
Mandibular canine index – proposed by Rao & Associates
Mean mesiodistal canine dimension in female + S.D
Mean mesiodistal canine dimension in males – S.D.
The value obtained using this formula was 7.1 i.e., 7.1 mm is the
maximum possible mesiodistal dimension of mandibular
canines in females.The same dimension is greater in males.
Turner proposed that ‘Distal Accessory ridge”, a non metric
feature on the canine “is the most sexually dimorphic crown
tract in the human dentition, with males showing significantly
higher frequencies and more pronounced expression than
It is final step in the triad of dental profiling.
The estimation of age plays an important role in forensic
The dentition is one of the four systems used in estimating
physiologic age, the others being bone development,
secondary sex characteristics and stature and weight.
Dental age is one of the few measures of physiologic
development that is uniformly applicable from infancy to late
adolescence. After attaining maturity, teeth continue to
undergo changes, making age estimation possible among
DENTAL AGE ESTIMATION METHODS:
Dental age estimation makes use of morphologic,
radiographic, histological and biochemical methods to
examine age dependent changes in teeth. Age estimation
using the dentition may be grouped into 3 phases.
1. Aging in prenatal, neonatal and early post natal
2.Age estimation in children and adolescents and
3. Age estimation in adults
1. AGE ESTIMATION IS PRENATAL, NEONATAL
AND EARLY POSTNATAL CHILDREN:
The primary tooth germ begins to form at seven weeks in
utero (IU) and the enamel formation of all deciduous teeth is
usually complete by the first year.
Among the permanent teeth, the first molar shows germ
formation first at about 3.5-4 months IU. Age estimation in
this group of individuals can be very accurate. It makes use of
histological techniques, which enable observation of tooth
mineralization upto 12 weeks before it is actually apparent on
radiographs. However this requires specialist training.The
advantage that radiography has is that it is ‘non invasive’,
requiring no tissue dissection.
The neonatal line is considered as an indicator of birth.
Bowen’s attributes its formation to the slowing down of
enamel prism growth rate, this “creating an apparent line of
demarcation”. According to Ciapparelli, the neonatal line may
take upto three weeks after birth to form. Hence a false result
may be produced when one concludes that the absence of
neonatal line proves that the individual was ‘stillborn’.
In cases of age estimation of skeletal remains, where
histological and radiographic studies are not possible, an
alternative method is to measure the dry weight of the
mineralized tooth cusps – developed by stack.
The developing teeth in a child at six months IU weight about
60 mg, 0.5 g in a newborn and 1.8 g at 6 months post natal.
2. AGE ESTIMATION IN CHILDREN
Two events that may be used to measure dental age in
children and adolescents are tooth emergence or eruption and
Nystrom and colleagues consider the estimation of age by
study of tooth eruption as a convenient clinical method. It
involves visual assessment of teeth present in the mouth and
require little expertise or equipment.
The use of tooth emergence for age estimation should,
however, be limited to deciduous teeth.There emergence is
under genetic control and is relatively regular, commencing
approximately a 6 months and completing by 2.5 years.
On the other hand, emergence patterns of permanent teeth
are under the influence of the intra oral environment, being
affected by infection, arch space and premature tooth loss.
Therefore evaluation of radiographs to assess tooth
calcification is a much better alternative, since:
1) Calcification can be observed from radiographs for a
period of several years.
2) It is not altered by local factors such as lack of space,
3)The study of tooth calcification also let us assess age at
periods when no emergence takes place (2.5-6 years and > 12
Dental calcification is considered by Schmeling and associates
as one of the three most suitable methods of estimating age
in criminal procedures.
Age estimation in this group is accurate since a number of
teeth passing through various stages of calcification are
available. Hence dental calcification is accepted as a better
indicator of age in first two decades of life.
Schous and Massler’s Method:
Schous and Massler described 20 chronological stages of
tooth development starting from 4 months IU until 21 years of
age.This chart is based on histological sections which permit
direct comparisons with radiographs. Ubelaker included
additional data in this chart.
Dental development of males and females were combined
and each stage included the amount of age variation.
Demirjian and co-worker developed an age estimation
method that made use of a scoring system.The development
of seven mandibular teeth on the left side was divided into
eight stages each.These stages were named ‘A’ to ‘H’, while
third molars were not used in the original method, a recent
study by Chaillet and Dimiriian accommodates them.
Each tooth is assigned ‘maturity score’ that corresponds to its
developmental stage.The maturity score is assigned for each
tooth is added and a total maturity score.
The total maturity score is then plotted on a chronologic ‘age
conversion table’. Separate maturity scores and age
conversion tables developed for both sexes.
It is the most popular method for assessing age in children
and adolescents, probably due to the detailed description and
radiographic illustrations of tooth developmental stages and
its relative simplicity.
Third molars in Age Estimation:
Although the third molar is a valuable indicator of age in the
age group of 16-23 yrs.When all other teeth have completely
developed, its accuracy in age estimation in questionable due
to their variation in genesis, position, morphology and time of
Based on Kohler and coworkers 10 stage developmental
scoring method, Gunst and associates concluded that the age
of an individual, specifically whether the individual is 18 yrs old
or not can be reliably estimated using specific formulae.
When all 4 third molars have completely calcified, the chances
of the individual being 18 yrs old is 96.3% and 95.1% for males
and females respectively.
When only one or two third molars present, the lower third
molars are the best predictors of whether an individual is 18 yr
Growth variations exist between different population groups
due to dissimilar genetic and environmental factors. Ideally,
therefore, population specific developmental data is essential
for optimized age estimation.
3. AGE ESTIMATION IN ADULTS:
Age estimation in adults is challenging when compared to
younger age groups. Ritz and colleagues stated that following
completion of growth, changes in the dentition used to
estimate age “are influenced not only by the age of the
individual, but also by numerous endogenous and exogenous
factors, such as disease, nutrition and physical strain”.
a) Gustafson’s Method:
In 1950, Gosta Gustafson developed a method for age
estimation based on morphological and histological changes
of the teeth.This assessed regressive changes such as:
Amount of occlusal attrition (A)
Coronal secondary dentin deposition (S)
Loss of periodontal attachment (P)
Cementum apposition at the root apex (C)
Root resorption at the apex (R)
Dentine translucency (T)
For each of these regressive changes or variables,
different scores ranging from 0-3 were assigned.This meant
attrition could have any one of four scores (A0, A1, A2 or A3)
and similar one of four scores for the other variables.
Advantages of Gustafson method:
It used 6 variables. Each variable had its own effect on final
score, but since as many as six variables were used, a larger
variation is one of the variables would not influence the final
result to any great extent.
None of the variables could be used alone in the method
except dentin translucency, which gives the most acceptable
age estimates when used alone.
Training in histological techniques were necessary.
Equipment such as stereomicroscope was required.
When only one tooth is used, the age range increased
Age range also increased on teeth over 50 yrs old.
Bang and Ramm were the first to use dentin translucency
for estimating age.
Root translucency increases with increasing age.
Root dentin starts to become translucent during the third
decade of life beginning at the apex and advancing coronally.
It is due to the decreased diameter of dentinal tubules caused
by increased intra tubular calcification. Hence, the difference
in refractive indexes between intra tubular organic and extra
tubular inorganic material is equalized, resulting in increased
translucency of the affected dentin.
Disadvantages of using translucency included:
Irregular junction of translucent and non translucent zones,
thereby making it difficult to measure the length.
Under estimation of age in older age groups.This could be due
to slowing down of dentinal sclerosis, since most of the root
would already be sclerosed by old age, thus restricting further
increase in translucency.
c) Age estimation from incremental lines of cementum:
Acellular cementum incremental lines are used in estimation.
Mineralized unstained cross sections of teeth, preferably
mandibular central incisors and third molars are used.
The pathological state of the periodontium and / or
desmodontium may compromise the precision of aging.
d) Amino acid racemisation:
All humans use amino acids exclusively in protein synthesis.
Aspartic acid is an amino acid that has a rapid rate of
racemisation i.e., it gets spontaneously converted from one
type (L-Aspartic acid) to another (D-Aspartic acid) with
Therefore, there is a constant change in the ratio of L and D
aspartic acid at different ages and this ratio may be used for
Racemisation rate of aspartic acid is high in root dentine and
therefore teeth are valuable sources for ageing using this
GROWTH IN BONES:
The bones of the human skeleton are performed in
hyaline cartilage.This soft tissue model is gradually converted
into hard osseous tissue by the development of osteogenesis,
frequently in a central position from which the process of
transformation spreads, until the whole skeleton is ossified.
The appearance of such centres of ossification is spread over a
long period of time. A large number are seen first in embryonic
life, some appear much late in prenatal life and others appear
after birth.The earliest centres of ossification appear at the
end of 2nd month of pregnancy. At the 11th IU week there are
806 centres, at birth around 450.
II. ROLE OF DENTALTEAM
IN MASS FATALITY
II. ROLE OF DENTAL TEAM IN MASS
Dental team has a major part in resolution of mass fatality
Disaster:A disaster is a sudden occurrence that exceeds
the resources available in a community to deal with it.
Mass fatality incident: A mass fatality incident is an
occurrence that causes loss of life that exceeds death
investigation resources in a community
Team work and planning are two overlying principles
crucial to disaster management. Dental team preplanning for
mass fatality incidents includes training, formal agreements
with a medical examiner, supply sources and immunization.
An incident command system is used to coordinate the
activities of the many responders to promote the teamwork 75
An incident command system is used to coordinate the
activities of the many responders to promote the teamwork
needed for an effective incident response.
Important aspects of mass fatality incident management are
preparing post mortem and ante mortem records, using
computer programs and imaging.
The dental identification can be divided into several different
sections based on its missions including recovery, post
mortem examination, ante mortem records and comparison.
(i) RECOVERY TEAM:
The recovery team assists in recovery of remains on site, if
called for in the disaster protocol.
(ii) POST MORTEM SECTION:
The postmortem section is responsible for complete
analysis of all post mortem evidence.This analysis includes
examination of all dental structures, photographic
documentation of the remains as received, reconstruction and
stabilization of fragmented or burned remains and a complete
charting and documentation of all restorations, anomalies and
injuries evident on the dental structures recovered.
(iii) COMPARISON SECTION:
The comparison section compares ante mortem and post
mortem charts and radiographs and provides
recommendations through the dental section leader to the
identification center chief on identification of the victims.
(iv) COMPUTER SECTION:
Computer section assists in matching ante mortem and
post mortem data by using specialized softwares.
DENTAL IDENTIFICATION TEAM ORGANIZATIONS
FOR MASS FATALITY INCIDENTS:
There are 2 types of dental identification teams.
A)Traditional Identification Team:
It is a community based / state based identification team.
Team members include dentists, hygienists and dental
B) Disaster Mortality Operational Response team (DMORT):
The DMORT is a part of the national disaster medical system
under the US department of public health.
The DMORT team consists of a dental team, forensic
pathology team, anthropology, laboratory support,
photographic and communication support, logistics team and
mortuary science team.
BITE MARK EVIDENCE
Factors influencing bitemarks
Bitemark >>>> ‘Patterned injury’
Bitemark >>>> ‘Tool-mark’
Bitemark evidence admissible under Frye test
(Recognizable, Established & Acceptable -
DEFINITION OF BITEMARK
A representative pattern left in an object or tissue by the dental
structures, either alone or in combination with other oral structures of
an animal or human
Physical alteration in a medium caused by the contact of teeth
A mark made by the teeth either alone or in combination with other
mouth parts (Mc Donald)
Cutaneous human bitemark = Injury in skin caused by contacting teeth
(with or without the lips or tongue), which shows the representational
pattern of the oral structures
DEFINITION OF BITEMARK
Given by Jakobsen : -
Bitemark =Tooth marks produced by antagonistic teeth
Tooth mark = Mark left by a tooth
Arch mark = Mark produced by four or five adjacent teeth in the
Given by Mac Donald :
as “a mark caused by the teeth either alone or in combination
with other mouthparts”.
HISTORY OF BITEMARKS
William the Conqueror validated royal documents by biting into wax
‘Indentured’ servants from Britain or Europe
Earliest recorded bitemark case in U.S. - Ohio vs. Robinson (1870)
First recorded instance where expert guidance was given (1906) –
Bitemarks in cheese
First investigator of bitemarks : Sorup (1924)
First case involving admissibility of bitemark evidence : Doyle vs.
Texas State (1954)
First case involving bitemark that led to conviction : 1972 rape case,
Illinois vs. Johnson
DESCRIPTION OF BITEMARK
Prototypical Human Bitemark =
• Circular/oval patterned injury
• Two opposing symmetrical, U-shaped arches
• Separated at their bases by open spaces
• Diameter of the injury = 25-40 mm
• Central area of bruising (extra vascular bleeding caused by pressure
from teeth as they compress the tissue inward from the perimeter
of the mark)
• Periphery of the arches : Series of individual abrasions, contusions
and / or lacerations reflecting size, shape, arrangement &
distribution of the class characteristics of the contacting surfaces of
the human dentition
DESCRIPTION OF BITEMARK (continued)
Inflicted slowly & deliberately
Suction to tissue by tongue & lips
Central or peripheral ‘suck-marks’
Anterior teeth marks with good definition
Sexually Oriented bitemark =
Self Inflicted Bitemarks =
More on forearms of children
Mentally retarded or psychologically disturbed people
Lesch – Nyhan Syndrome (X-linked, recessively transmitted disease)
DESCRIPTION OF BITEMARK
Pressure exerted while biting
Incisors = 11 Kgs.
Tongue = 8 lb/sq. in.
Tongue negative suction = 20 mm Hg
Location of bitemarks on skin
Vale et al : Arms > Breasts > Legs > Abdomen > Back > Face > Shoulder
> Buttocks > Female genitalia > Hand > Chest > Neck > Nose > Male
genitalia > Ear > Foot
Vernon Geberth :
1. Homosexual homicides : Back, arms, shoulders, face, and scrotum of
2. Heterosexual aggression : Breast & thigh
3. Battered children : Randomly placed
CLASSIFICATION OF BITEMARKS
According to agents causing bitemarks : -
1. Human bitemarks : Adults, Children
2. Animal bitemarks : Mammals, Reptiles, Fish
3. Mechanical bitemarks : Dentures, Saw-blade
According to substrate in which bitemarks are made
1. Bitemarks in Skin & body tissues
2. Bitemarks in Food substances
3. Other materials
CLASSIFICATION OF BITEMARKS
Based on severity of injury
Hemorrhage : Small bleeding spot
Abrasion : Undamaging mark on skin
Contusion : Ruptured blood vessel, bruise
Laceration : Punctured or torn skin
Incision : Neat puncture of skin
Avulsion : Removal of skin
Artifact : Bitten-off piece of body
Based on degree of impression
Clearly defined : Significant pressure
Obviously defined : First-degree pressure
Quite noticeable :Violent pressure
Lacerated : Skin violently torn from body
CLASSIFICATION OF BITEMARKS
Dr. Lowell Levine’s Classification : -
Slowly inflicted bite : Show a ‘suck mark’ area with an abrasion pattern
that resembles a sunburst
Attack/Defensive bite : No clear pattern and difficult to identify
CLASSIFICATION OF BITEMARKS
Webster’s classification of bitemarks in inanimate objects
Type-1 : - Prominent incisal edges recorded; Ex. – Chocolate
Type-2 : - Labial aspect of incisors & scrape marks recorded; Ex. –
Type-3 : - Relative position of upper & lower teeth in centric
recorded; Ex. – Cheese
2. CLASSIFICATION OF BITE MARKS:
I. CAMERON AND SIMS CLASSIFICATION:
This is based on the type of agent producing the bite mark
and the material exhibiting it.
i) Agents ii) Materials
Human - Skin, body tissue
Animal - Food stuff
- Other materials
II. MAC DONALD’S CLASSIFICATION:
Mac Donald suggested an etiological classification.This is
pertinent to human bitemarks.
i)Tooth pressure marks:
Marks produced on tissue as a result of “direct application
of pressure by teeth”.These are generally produced by the
incisal / occlusal surfaces of teeth.
ii)Tongue pressure marks:
When sufficient amount of tissue is taken into the
mouths, the tongue presses it against rigid areas such as
lingual surfaces of teeth and palatal rugae.The marks thus left
on the skin are referred to as ‘sucking’. Since there is a
combination of sucking and tongue thrusting involved.
iii)Tooth scrape marks:
These are marks caused by scraping of teeth across the
bitten material.They are usually caused by anterior teeth and
present as scratches or superficial abrasions.
iv) Complex marks:
Combination of above types of marks
Bite marks are usually associated with sex crimes, violent
fights, child abuse and thefts, etc.
CRIMES INVOLVING BITE MARKS:
(i) Assault cases (Adult) (ii) Abuse cases (Children)
a)Non Sexual a) Multiple Incidents
b) Single Incident
- New injuries only
- Adult perpetrator
- Child perpetrator
FACTORS INFLUENCING BITEMARKS
Type of tissue
Number & type of teeth
Presence of tongue thrust
ANALYSIS OF BITEMARKS
Description of bitemark
Collection of evidence from victim
Collection of evidence from suspect
Evaluation of evidence
DESCRIPTION OF BITEMARK
2. Location of bitemark
3. Shape of the bitemark
6. Type of injury
7. Other information
COLLECTION OF EVIDENCE FROM
3. Salivary swabbing
4. Tissue samples
COLLECTION OF EVIDENCE FROM
3. Extra-oral examination
4. Intra-oral examination
5. Salivary swabbing
6. Sample bites
7. Impressions & Study casts
EVALUATION OF EVIDENCE
ABFO Scoring Sheet for Bitemark Analysis
(Gross features,Tooth position, Intra-dental
Comparison techniques : -
1. Direct methods
2. Indirect methods
HOW TO COMPARE SUSPECT TEETH
TO BITEMARK INJURY ?
Transparent Overlay =Transparent film with
edges of teeth which can be superimposed on
bitemark injury / photographic evidence
Methods of Overlay fabrication: -
1. Direct Cast Tracing
2. Wax Imprints method
3. Radiography method
4. Xerography method
5. Computer based method
6. Photography method
DIRECT CAST TRACING METHOD
RECOGNITION AND REPORTING
OF DOMESTICVIOLENCE, ABUSE
IV. RECOGNITION AND REPORTING OF
DOMESTIC VIOLENCE, ABUSE AND
Physical abuse is characterized by the infliction of physical
injury as a result of punching, beating, kicking, biting, burning,
shaking or otherwise harming a child.The parent or caretaker
may not have intended to hurt the child, the injury may have
resulted from over discipline or physical punishment.
Child neglect is characterized by failure to provide for the
child’s basic needs. Neglect can be physical, educational or
emotional. Rampant caries may be considered child neglect.
Sexual abuse includes fondling a child’s genital, intercourse,
incest, rape, sodomy, exhibitionism and commercial
exploitation through prostitution or the production of
i) RECOGNIZING CHILD ABUSE AND
According to statistics, 50-65% of all physical trauma
associated with abuse occurs in the head, face or neck.
Bald spots (traumatic alopecia)
Bruises behind ears (Battle’s sign)
Blackened eyes (Racoon eyes)
Angular abrasions (gag marks)
Palatal bruising (forced fellatio)
Residual tooth root
Maxilla / mandible
Fractures or improperly healed fractures
Malocclusion from previous fractures
Fractured, mobile, avulsed or discoloured teeth in the
absence of reasonable explanations
Untreated rampant caries
Untreated, obvious infections or bleeding
Interviewing the possible victim:
Recognizing the abuse is the first and earliest step in the
Asking probing questions to a young child about the behaviour
of a parent or caregiver is stressful.The interview should be
conducted in private.
The child should be asked if he / she feels safe at home or in
the care of a care giver and whether the injuries were caused
intentionally and by whom.
Permission should be sought to photograph suspicious
injuries. Any injury should be documented carefully. Injury
diagram and photographs may be valuable tools for possible
Reporting possible Abuse of neglect:
Individuals typically designated as mandatory reporters
include physicians, nurses, hospital personnel, dentist,
medical examiners, coroners, mental health professionals,
social workers, school personnel, Law enforcement officials
and child care providers.
Any person may report incidents of abuse or neglect however.
Reports should be made to the state child protective service
Prevent abuse and neglect through Dental
Awareness (PANDA) coalition is a public
private partnership committed to educating
dental professionals on how to recognize and
report suspected cases of child abuse.
ii) DOMESTIC VIOLENCE, INTIMATE PARTNER
VIOLENCE, SPOUSAL ABUSE AND BATTERED
Spousal abuse, also termed intimate partner violence (IPV) is
violent behaviour occurring between partners in an intimate
relationship regardless of their marital status.
The battered women syndrome has been defined as a
symptom complex occurring as a result of abusive actions
directed against a woman by her male partner.
Most definitions of IPV emphasize the physical abuse
component because of the severe physical injuries that may
occur but, the health care provider should be aware of the
mental abuse and intimidation are integral components of the
Physical injuries often seen in non accidental trauma may
include soft and hard tissue injuries of the maxilla facial
complex. Fractures of nasal bones, jaws, orbital structures and
zygomatico maxillary complex are common in battered
women. Fractures, avulsed or subluxated teeth also can be
indicators of non accidental trauma. Lacerations and
contusions of the facial soft tissues can be seen.
Not withstanding valuable information gained from the
physical examination, the patient history can be an equally
important indicator of abuse.
Patients with a positive history screen for domestic violence
should be documented in the permanent medical record. A
suspected victim of non accidental trauma should be
interviewed in a private setting because the abuser often tries
to remain close to the victim, answering questions that are
directed to the victim.
Every dentist should be aware of state requirements for
reporting domestic violence in all its various forms.
iii) RECOGNITION OF ELDER ABUSE
The concept that neglect is less damaging and less likely to
cause injury or impairment of the elderly individual is not
always true. Active neglect (intentionally denying or
withholding care) and passive neglect (unintentionally failing
to provide care) can be equally damaging to the aged person.
The emotional and psychological consequences of all forms of
mistreatment can be life threatening. In some cares, active
neglect can be so damaging that it leads the older person to
long for death.
Physical abuse generally is associated with other forms of
mistreatment such as financial exploitation, verbal or
emotional abuse or active neglect.
Physical abuse is always considered to be criminal behaviour
regardless of extenuating circumstances. 125
Like child abuse, most of the injuries in other forms of
domestic violence are found in the head and neck area, visible
to the dental team.
The signs and symptoms of elder abuse and neglect
sometimes are subtle, but careful observation followed by
sensitive and cautious questioning can optimize accurate
Signs and symptoms of elder abuse / neglect includes
contusions, abrasions lacerations or cuts on the head, face and
neck and exposed areas of arms and legs, lip trauma, fractured
or subluxated teeth, fractured maxilla or mandible, bite marks,
lack of adequate dental care and lack of adequate dental care
and lack of adequate dental care and lack of adequate
A comprehensive and valid history combined with a thorough
head, neck and oral examination is essential in forming a
differential diagnosis regarding the cause of skin and mucosal
Reporting Elder abuse:
If any member of the dental team, especially the dentist,
suspects that the patient is a victim of intentionally inflicted
trauma, specific actions should be taken.The suspected victim
of abuse should be interviewed in a supportive, non
accusatory manner.The examiner or recorder should
document all patients statements regarding the history of
abuse in patients own words.
In elder abuse cases, documentation of the injury patterns is
important. Photographs and a diagram if possible should be
Radiographs are essential in the diagnosis and appropriate
treatment of maxillofacial trauma. Evidence of features at
various stages of healing and missing teeth in the absence of
periodontal disease can be evidence of repeated assaults.
The word malpractice means wrong doing / neglect of duty.
Malpractice is, dishonest use of a position of trust for personal
TYPES OF MALPRACTICE CASES:
This list is given in order of frequency
1. Paresthesia or Anesthesia
There are usually associated with the removal of lower
third molars and bicuspids as well as occur following
endodontic treatment. Poor techniques and / or inadequate
radiographs are often encountered.
2. Failure to diagnose:
Failure to take a complete medical and dental history, to
complete a thorough oral examination, take quality
radiographs, study models, written records of diagnosis,
treatment plans. Pulp vitality testing is often omitted for teeth
involved in major reconstruction cases. 3. Improper
These cases often imply the dentist has not taken
advantage of continuing education courses available. He still
relies on the education obtained in dental school and is not
keeping abreast with up to date knowledge concerning the
4. Failure to refer:
Many dentists frequently attempt to do services for
patients that are beyond their limits of skill, training
experience and expertise.
5. Failure to inform:
The patient must be adequately informed as to what his
dental problems are, what results and limitations of proposed
treatment can be expected and what financial investments he
will incur for these services. Alternative methods of treatment
and the consequences of no treatment must be explained. It
behooves every dentist to thoroughly inform his patients
when there is a broken instrument, fractured root tip or
endodontic instrument, foreign bodies in sinuses, air
emphysema or severance of nerves and vessels.This must be
documented by radiographs as well as written records.
6. Removal of wrong tooth:
This problem is often a result of poor communication
between the referring dentist and the oral surgeon.
7. Denture problems:
Frequently this is really a communication problem
between the patient and the dentist. Often the dentist does
what is technically correct but does not understand the
patient’s desires.The patient often has unrealistic
8. Negligent deaths:
There is little or no excuse for not taking and recording a
complete health history. Proper management of the medically
compromised or high risk patient first requires that the patient
be identified by health history, drug history, physical
examination and / or medical consultation. Full
documentation in the dental record, appropriate
modifications in treatment procedures an advance emergency
planning are required, including emergency drugs and training
of personnel in CPR.
DEFENCE INTHE MALPRACTICE SUIT:
It would be beneficial for the dental profession to take
more preventive attitude.
1)Try to provide above average dental care, be fully aware of
the probable increase in the legal standard of care.
2) Keep accurate, legible written records.
3) Complete the written record in the presence of patient.
4) Never add to or alter records.
5) Keep abreast of changes within the profession through
publications and continuing education courses.
6) Be ware of your legal responsibilities to patients. Determine
their dental expectations and obtain adequate consent before
delivery of treatment.
7) Utilize radiographs both pre operatively and post operatively.
They not only serve as a diagnostic tool, but function as an
outstanding record as well.
8) Keep professional confidence of patients strictly privileged.
9) Make appropriate financial arrangements and never guarantee
10) Be aware of oral changes suggestive of disease.
11) Advise patients of any absence from practice. Recommend a
competent, available substitute dentist.
12) Establish and maintain rapport with your patient.
13)Take thorough medical histories.
14) Keep all promised appointments.
15)Avoid diagnosis and prescribing by phone.
16) Refrain from utilizing unapproved or experimental
procedures. Avoid fields where you are not properly qualified.
17) Select, train and properly utilize dental auxillaries within the
parameters of your state laws.
18) Be familiar with manufacturers warnings of possible adverse
19) Have an attorney review your liability insurance policy to
determine whether or not the company can arbitrarily settle
your case out of court.
VI. LIP PRINTS
Tsuchihashi named the wrinkles and grooves visible on the lips
as ‘sulci labiorum rubrorum’.The imprint produced by these
grooves is termed ‘lip print’, the examination of which is
referred to as ‘cheiloscopy’. These grooves are heritable and
are supposed to be individualistic. Lip prints therefore, can
constitute material evidence left at a crime scene, similar to
LIP PRINTS WERE FIRST CLASSIFIED BY SANTOS AS:
1) Simple wrinkles:
Sine shaped curve
2) Compound wrinkles:
Type – I : Clear cut vertical grooves that run
across the entire lip
Type – II : Similar to type I, but do not cover the
Type – III : Branched grooves
Type – IV : Reticular grooves
Type –V : Grooves that cannot be morphologically
TYPE – IV :RETICULAR
Type – III : Branched
Type – V :
DISADVANTAGES OF LIP PRINT INVESTIGATIONS ARE:
1) Uncertainty about the persistence of lip patterns.Trauma,
pathosis, surgery can affect the size and shape of the lip.
2) Anatomic position of lip roves on the zone of transition
close to the vermilion border is extremely mobile.
Consequently, the prints produced may differ in appearance
depending upon the pressure applied and its direction.
VII. THE PALATAL RUGAE IN
Identifying individuals from their teeth, either by comparison
with antemortem dental records or DNA samples is
impractical in identifying edentulous individuals. A method
developed of identifying such individuals is by examining the
palatal rugae pattern.
The rugae pattern on the deceased’s maxilla or maxillary
denture is compared to old dentures that may be recovered
from the decedent’s residence, or plaster models that may be
available with the treating dentist.
Palatal rugae are ridges on the anterior part of palatal mucosa
on each side of the mid palatine raphae, behind the incisive
papilla. Palatal rugae are well protected by the lips, cheek,
tongue, buccal pad of fat and teeth in incidents of fire and
high impact trauma. 142
Rugae pattern in unique to an individual.They do not change
shape with age and reappear after trauma or surgical
CLASSIFICATION OF PALATAL RUGAE:
Lysell, measured rugae in a straight line, from their origin on
the medial side to terminus at the lateral and categorized
1) Primary rugae (> 5 mm)
2) Secondary rugae (3-5 mm)
3) Fragmentary rugae (2-3 mm)
(Rugae < 2 mm is not taken into consideration).
Thomas and Kotze gave details of various patterns of primary
rugae.These include branched, unified, cross linked, annular,
ANALYSIS OF RUGAE PATTERNS:
Thomas andVan Wyk have manually traced rugae patterns on
to clear acetate and then super imposed these tearings on
photographs of plaster models.
On digitized images of the palate, characteristic points are
plotted on the medial and lateral extremities of all the rugae.
The plotted points are processed by the software and in
information sequentially stored corresponding to pixel
position.This is compared with ante mortem records.
VIII. CLASSIFICATION FROM
The conventional method of dental identification requires
adequate / complete dental records that may not always be
Polymerase chain reaction (PCR) allows amplification of even
highly degraded DNA.
This facilitates comparison with a known biological ante
mortem sample of the decedent, such as hair from a hair
brush, epithelial cells from a tooth brush or a biopsy specimen.
A major advantage of DNA analysis over conventional dental
identification is that if a decedent’s ante mortem sample is
unavailable, the DNA pattern may be compared to a parent or
to a sibling thus allowing identification.
EXTRACTION OF DENTAL DNA
Owning to its neuro vascular nature, pulpal tissue is
considered to be the best source of dental DNA. Sweet &
Hidebrand have advocated a method known as cryogenic
grinding for extracting DNA.
This involves cooling the whole tooth to extremely low
temperatures using liquid nitrogen and then mechanically
grinding it to fine powder.
Using standard protocols, sufficient amount of DNA can be
obtained from intact, carious, as well as root filled teeth.
Extraction of DNA can be done from pup and hard tissues such
as dentin and cementum.
The major drawback of cryogenic grinding is that the tooth
needs to be completely crushed.
Trivedi and coworkers have suggested a less destructive
method for DNA isolation.
These method involves drilling of the root canals, scraping the
up area with a notched medical needle and subsequent
flushing of the tissue debris.This method will save the
morphology of tooth
TYPES OF DNA:
Pretty and Sweet have pointed out the use of two types of
The first is called genomic or nuclear DNA.This is located in
the nucleus of the cells and is commonly used in forensic
The second, known as mitochondrial DNA (mt DNA), is
present in the mitochondria of cells.
A major advantage of mt DNA is that each cell has a high copy
number of mt DNA, Eg: Epithelial cells contain 5000 mt DNA
Hence, mt DNA can substitute in cases where nuclear DNA is
Also, mt DNA is exclusively inherited from the mother i.e.,
there is no contribution whatever from the father.
Thus, an identical mt DNA pattern is observed among
siblings, their mother and many maternal relatives.
Moreover, due to their exclusive maternal inheritance.They
can be used to establish identity in cases where there is a gap
of several generations.
Because of the high percentage of physical abuse that occurs
to the head, face and neck regions in all age groups, it is
important for members of the dental profession to recognize
the signs and symptoms of abuse, to understand the
obligation to report, and to know the mechanism for
reporting.The recognition and reporting of neglect is equally
important. Many individuals can be spared pain, suffering and
death by timely intervention after observations made in a