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Year : 2019  |  Volume : 30  |  Issue : 2  |  Page : 291-299
Teeth in forensics: A review

Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Deemed University Dental College and Hospital, Pune, Maharashtra, India

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Date of Web Publication29-May-2019


With the ever-increasing crime rate in our society, the field of forensic sciences has become highly evolved. Forensic dentists play a pivotal role in various areas of crime scene investigations and thereby help solve innumerable mysteries. Teeth appear to be vital pieces of evidence in several such investigations. Teeth are preserved in the closed cavities of the mouth and are generally resistant to the threatening environmental conditions that may be associated with the death of an individual, making them very useful in postmortem analysis. Teeth thus obtained may be useful in age estimation of the deceased victim or in determining his blood group. Identification of individuals in mass disasters can also be performed based on the unique morphological characteristics of the human dentition and through dental DNA fingerprinting. Again teeth play an all important role in catching a culprit through the positive correlation of the bite marks left behind at the crime scene and the suspect's own teeth marks. Thus, teeth prove to be an important adjunct in forensics. Its scope is ever-increasing with time, and a great amount of research is being carried out to implement the same. A PubMed, MEDLINE, and Scopus search was conducted of the past 70 years using several search terms like “Forensic odontology,” “history of forensic odontology,” “dental DNA fingerprinting,” “forensic age estimation,” “age estimation from teeth” and “bitemarks.” Other articles and textbook references which were considered to be important were also included in this study. The articles gathered were divided into the following groups: history of forensic odontology, teeth and DNA (dental DNA fingerprinting), teeth and blood grouping, teeth and age estimation, and teeth in bite marks.

Keywords: Age estimation, bite marks, blood grouping, dental DNA fingerprinting, forensic dentistry, teeth

How to cite this article:
Shah P, Velani PR, Lakade L, Dukle S. Teeth in forensics: A review. Indian J Dent Res 2019;30:291-9

How to cite this URL:
Shah P, Velani PR, Lakade L, Dukle S. Teeth in forensics: A review. Indian J Dent Res [serial online] 2019 [cited 2020 Nov 25];30:291-9. Available from:

   Introduction Top

Violence and acts of crime are widely prevalent in today's society. Modern day criminal investigations have reached its peak where involvement of many different disciplines is a must to solve crime.

The term “forensic” is from the Latin, meaning forum or a place where legal matters are discussed.[1] The science of dentistry as related to the law is known as forensic dentistry or forensic odontology.[2] The theory behind forensic dentistry is that “no two mouths are alike.”[3]

Forensic dentistry plays an important role in mass disasters, child/elder/spouse abuse cases, bite mark analysis, criminal and natural deaths and injuries, bioterrorism, etc., It also helps in identification of decomposed and charred bodies like that of drowned persons, burns and victims of motor vehicle accidents. The different methods employed in forensic dentistry include bite mark analysis, tooth prints, rugoscopy, cheiloscopy, dental-DNA analysis, radiographs, and photographic analysis.

Human dentition is often considered as a hard tissue analog to fingerprints. In several situations, teeth and bones are frequently the only sources of DNA available for identification of degraded or fragmented human remains. Recent advances in the field of technology and science have made it possible to identify a person's blood group through his these teeth, thereby narrowing down the suspect pool. In several mass disasters and similar large-scale crime scenes, the identification of the dead bodies and age estimation of the deceased has solely been based on the dentition status of an individual. Bite marks and tooth marks left behind in cases related to child abuse and neglect, murders, or rapes have proved to be substantial evidence leading to the conviction of the culprit. This review, thus, summarizes the various applications of teeth in forensic investigations and need for further research in establishing their potency.

A PubMed, MEDLINE, and Scopus search was conducted of the past 70 years (from 1946 to 2016) and using the search terms: “Forensic odontology,” “forensic dentistry,” “history of forensic odontology,” “dental DNA fingerprinting,” “blood grouping,” “blood grouping from dental pulp,” “blood grouping from dentine,” “forensic age estimation,” “age estimation from teeth,” “bitemarks,” and “bitemarks in forensic odontology.” Apart from these initial articles, other articles and textbook references which were considered to be important and were generated by a manual search and cited as references in other review articles were also included in this study. The articles gathered by the search process were divided into the following groups: history of forensic odontology, teeth and DNA (dental DNA fingerprinting), teeth and blood grouping, teeth and age estimation, and teeth in bite marks.

   History Top

The earliest dental identification began with the Agrippina and the Lollia Paulina case in the year 49 A.D where Lollia's teeth which had certain distinctive features were used to confirm her death. It marks the first use of dental identification of which there is record.[4]

In 1870, Ansil Robinson was charged with the murder of his mistress, Mary Lunsford. Evidence against Robinson included an attempt to match his teeth to the bite marks on the victim's arm.[5]

The fire on board the “Scandinavian Star” was one of the world's worst ferry disasters. Dental identity could be established in 107 cases.[6]

Forensic odontologists successfully identified tsunami victims in South-East Asia in December 2004.[7] According to Elphinstone, M. Raja Jayachandra Rathore of Canouj died on the battlefield in 1191. His body was identified by his false anterior teeth. This was probably the first case of identification using dentition in India.[8]

   Teeth and Dna Top

The tooth often serves as the most valuable source of DNA since it is cast in a sealed box protecting the DNA from extreme environmental conditions. Recently, teeth have been the subject for DNA studies as the dental hard tissue physically encloses the pulp and offers an anatomical configuration of great durability.[9] Moreover, when morphologically evaluated, even a single tooth provides valuable information regarding the individual to whom the tooth belongs.[10],[11],[12]

Schwartz et al. in 1991 isolated high molecular weight (HMW) proteins from teeth under different environmental conditions such as varying pH, humidity, temperature, and storage. It was determined that the environmental conditions examined did not affect the ability to obtain HMW human DNA from dental pulp.[13]

Pötsch et al. in 1992 performed genomic dot blot hybridization for sex determination using the biotinylated repetitive DNA probe pHY 2.1 and sex was correctly classified in all cases using 50–100 ng target DNA from pulp.[14]

Among the several cases described in the literature with DNA isolation from teeth, a very important report was published by Sweet and Sweet. This paper presents a case of human remains identification, by a preserved unerupted third molar which enabled 1.35 μg DNA extraction from the dental pulp.[15]

Currently, there are four types of personal identification circumstances that use teeth, jaw, and orofacial characteristics, which include comparative dental identification, reconstructive postmortem, dental profiling, and DNA profiling.[16]

   How Does Dna Fingerprinting Work? Top

DNA fingerprinting or DNA profile is encrypted sets of numbers that reflect a person's DNA makeup, which can also be used as the person's identifier.[17] Gene is a segment of DNA that codes for a particular protein. This accounts for only 2%–5% of entire cellular DNA. The function of the remaining 95% or more of the DNA is not known and is called as noncoding DNA or junk DNA.[18] Variations in DNA sequence called polymorphisms can be used both to differentiate and to correlate individuals.[19] The pulpal tissue in the radicular and coronal portion of the teeth consists of odontoblasts, fibroblasts, endothelial cells, undifferentiated mesenchymal cells, and nucleated components of blood which are rich sources of DNA. Other less frequently used anatomical locations are the odontoblastic processes that extend into dentinal tubules, soft tissue within accessory canals, cellular cementum, adherent bone, and periodontal ligament fibers.[11]

Different techniques and approaches are available to extract and process DNA from the teeth samples. These are listed in [Figure 1] and [Figure 2].[12],[18],[20]
Figure 1: Approaches to sampling dental source DNA (dental pulp)

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Figure 2: Methods of analyzing different types of DNA polymorphisms

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The horizontal section through the cervical root appears to be the preferred method, as it allows rotary instrumentation of the inner dentin in root canals and independent sampling, while conserving the coronal structure which is very important for morphological identification.

In a study done by Preseeki et al., horizontal section through the cervical root was used to collect material for DNA isolation providing valuable results.[21]

A study done by Corte-Real et al. showed that, despite some adverse forensic condition such as degraded human body remains and exhumed material, the dentin keeps, in the majority of cases, its integrity.[22]

In a study by Adler et al., the mitochondrial DNA content of tooth cementum was found to be 5 times higher than the commonly used dentin, making the cementum-rich root tip the best sample for ancient human material.[23]

In another recent study by Damgaard et al., he demonstrated on 14 ancient teeth that crushed cementum of the roots contains up to 14 times more endogenous DNA than the dentin.[24]

Discovery of the amelogenin gene made sex identification quiet, easy, and reliable. A study was performed by Vemuri et al. to determine the reliability of sex determination by polymerase chain reaction (PCR). Extracted teeth were subjected to various treatment modalities involving varying temperatures and burial in sea water and underground. It was concluded that sex determination by PCR analysis was the most reliable method in markedly decayed or preadolescent bodies.[25]

   Teeth and Blood Grouping Top

A unique blood group is a characteristic of every individual. Besides blood, the blood group antigens are secreted in various body secretions such as semen, sweat, amniotic fluid, and saliva. Moreover, these substances are also present in the teeth. Since tooth pulp contains a lot of blood vessels, blood group antigens are most certainly bound to be present in tooth pulp. The distribution of ABO substances from the pulp cavity wall to the dentin edge and to the enamel gradually decreases because of fewer possibilities of diffusion of antigens from both blood and saliva.[26] Moreover, postmortem changes in pulp are seen very late, and also pulp remains one of the most protected tissues and therefore could be readily available for examination.[27]

Mainly the absorption-elution or the absorption-inhibition methods are used for the ABO blood grouping and rhesus (Rh) typing. A study by Sen et al. was carried out to compare the diagnostic efficacy of absorption-elution method and absorption-inhibition methods in detecting the ABO (H) blood group antigens in secretors. It was found that absorption-elution gave better results than absorption-inhibition.[28]

Ballal and David carried out a study to determine the blood group from dentin and pulp and to correlate the same with blood collected from extraction socket by the absorption-elution method. Pulp showed high positive results, thereby proving promising applicability of blood grouping through pulp. Blood grouping from dentin, however, was not correlating with the control group.[27] The results of this study were found to be in correlation with the studies done by Xingzhi et al. and Smeets et al.[29],[30]

Another study by Aswath et al. was conducted to emphasize the sensitivity and specificity of dental pulp in identifying the ABO blood group and Rh factor. Fifty-seven teeth out of sixty showed positive results, thus highlighting the potential value of dental pulp tissue.[31]

Pai et al. determined the PCR-based blood group on primary teeth pulp obtained from teeth stored under various environmental conditions such as different pH, sea water, and buried in soil for 6 months following extraction. Cent percent results were obtained for samples studied at pH 4 and pH 7 whereas samples stored at pH 10 showed 10% result. Sea water and buried samples showed 80% and 40% results, respectively.[32]

A similar study conducted by Sasmita et al. compared the blood grouping obtained from extracted deciduous teeth of children to that confirmed by the patient's parents. Significant positive results were obtained, further establishing the use of dental pulp for ABO blood grouping.[33] The negative results and mistyping in several pulp samples could be attributed to insufficient quantity of pulp, reduction in fibrosed tissue in the pulp with increasing age and also increased calcification of the canal.[34]

In a study by Kramer, it was thought that negative finding in dentin might be a result of inaccessibility of blood group substances because of high degree of calcification.[35] Karszun also accepted the fact that detection of ABO blood grouping activity in hard dental tissue is unreliable.[36]

Such discoveries in blood typing have contributed immensely in narrowing down the suspect pool and establishing the identity of the dead.

   Teeth and Age Estimation Top

When one comes across a dead body, establishing its identity becomes very important. Age estimation greatly helps in this process of identification. The various methods are physical examinations using anthropometric measurements, skeletal maturation, dental age estimation, a combination of dental development and anthropometric measurements, etc.[37] Dental maturity plays a very important role in estimating the chronological age of individuals because of the low variability of the dental indicators and in living persons who make false age statements.

By the 19th century, determining age using the teeth was needed for admission of children to factory work. Saunders used the dental eruption times in children aged 9–13 years and 5–16 years.[38] In ancient times, age estimations of living adolescents were considered important. According to records in Ancient Rome adolescents were judged to be fit for service, as soon as the second molars had erupted completely.[39]

Commonly, the attainment of specific biological events, such as crown completion of a particular tooth, is used to compare against the person's chronological age to gauge his or her tempo of development. Unfortunately, there are a number of confounding issues such as a person's sex, socioeconomic status, health history, and race. It is unusual that the investigator would know most, let alone all, of these important modifying factors.[40]

Various methods are utilized for the determination of age from dentition. Age assessment methods may be classified as:[41]

  1. According to the state of development of the dentition:

    • Methods applied to the forming dentition
    • Methods for the adult fully formed dentition.

  2. According to the technique of investigation:

    • Clinical or visual
    • Radiographic
    • Histological
    • Physical and chemical analysis.

The twenty teeth of the primary dentition erupt when the infant is between 6 and 30 months of age. Exfoliation of the primary teeth affords another means of estimating a child's age, and Moorrees et al.' landmark publications are still considered the most reliable sets of data in these areas.[42] The stages of root resorption for primary teeth were used by Moorrees initially and are depicted in [Figure 3]. The fourth stage as exfoliation of the tooth was later added.[42]
Figure 3: Stages of root resorption for primary teeth used by Moorrees in determination of a child's age. A representative single-rooted tooth is shown on the left and a multirooted tooth on the right

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Another system of classification was adapted from Moorree's classification based on the development of the tooth [Figure 4].[42] Later, Demirjian et al. gave a system for classification based on schematic diagrams which became accepted worldwide [Figure 5].[43]
Figure 4: Stages adapted from Moorree's classification

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Figure 5: Schematic drawings of the eight ordinal grades used in the Demirjian system of dental age estimation. The dotted circles in stages A through D depict the encapsulating bony crypt. Modified from Demirjian's system.[43]

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Gordon et al. described that, during infancy and childhood, a fairly accurate estimate of age can be made from the study of teeth.[44] Gonzales et al. described that teeth may give reliable information in childhood and youth. Beyond adult life, the changes are too uncertain to be of value.[45] Scot stated that if the third molars are fully erupted, it indicates that the age of an individual is above 17 years, and on X-ray examination if the root formation is not complete, one can definitely conclude than the person was probably <25 years of age.[46]

Factors used for the age determination using dentition include the appearance of tooth germs, earliest detectable trace of mineralization, degree of completion of the unerupted tooth, rate of formation of enamel and formation of the neonatal line, attrition of the crown, and transparency of root dentin.[47]

In dentin, incremental lines of Von Ebner and contour lines of Owen are present [Figure 6]a and [Figure 6]b, which are used to estimate the age of the neonates or fetuses at death. Stack has provided a regression line of weight of growing dental tissues against the age. By weighing the tooth specimen, age of the unknown can be obtained from as early as 5 months in utero until 7 months postnatally.[47]
Figure 6: (a) Von Ebner's incremental lines. (b) Contour lines of Owen

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Size of the pulp chamber indicates the amount of secondary dentin formation. Moore used pulp diameter to crown diameter ratio for calculating age based on the deposition of secondary dentin.[48]

Sema et al. carried out a study to determine the age of fetuses or infants by measuring the tooth development directly from tooth surfaces or from indirect measurements obtained from the tooth structures on the computerized tomography digital images. The results revealed that age could be estimated from various tooth dimensions. The indirect method which was proposed as virtual dental identification could be an option instead of the traditional direct oral autopsy methods.[49]

Camps has described that, after birth and during childhood, it is possible to arrive at a close estimation of age by the presence of the deciduous dentition in various stages of eruption followed by the mixed and permanent dentition periods. He also pointed that state of eruption only gives an indication of age since eruption dates are subject to wide variations.[50]

Helm and Prydsö recorded permanent emergence of mandibular third molar at an early age of 14 years in 235 Danish medieval skulls, 52 of whom were in various stages of mixed dentition. They argued that assessment of age at death could be made fairly accurately for the age group of 5–30 years.[51]

Kaul et al. studied deciduous teeth emergence of 312 children aged 4–31 months. They found earlier tooth emergence in females than their male counterparts. Their study suggests that the number of teeth can be used as a parameter for estimation of age.[52]

Foti et al. studied age determination in living and dead children with the help of linear regression. The equation can be applied based on the number of erupted teeth and tooth germs detected during the clinical examination and on radiograph. This equation helps in age estimation until 20 years of age.[53]

Gustafson in 1950 studied the changes occurring in individual teeth and succeeded in estimating age with some accuracy. He used six dental changes connected with aging, namely, attrition, apical migration of periodontal ligament, deposition of secondary dentin, cemental opposition, root resorption, and transparency of the root dentin.[54] Age was estimated using the following formula:[54]

Age = 11.43 + 4.56x, where x is the total score. It was found that an increase in the total score corresponds to an increase in age.

The extent of racemization of aspartic acid in coronal dentin of normal permanent teeth [Figure 7] can be used to estimate the age of an individual at the time of death. As age advances, L-aspartic acid will change into D-aspartic acid.[55]
Figure 7: Illustration of racemization of aspartic acid

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An interesting method using intensity of fluorescence in dentin and cementum, which shows a strong correlation between age, deepening of color of the tooth, and increase in intensity of fluorescence has been developed. The color changes in the cementum and dentin are caused by infusion of decomposition products from erythrocytes.[56]

A study by Jagannathan et al. assessed the suitability of pulp/tooth volume ratio of mandibular canines for age prediction in an Indian population. It was concluded that the pulp/tooth volume ratio is a useful indicator of age, although correlations may vary in different populations and hence, specific formulae should be applied for the estimates.[57]

The dental system is an integral part of the human body, its growth, and development can be studied in parallel with other physiological maturity indicators such as bone age, menarche, and height.[58] Several authors have shown that dental parameters are more suitable for age estimation in children because the variability is lower since calcification rates of teeth are more controlled by genes than by environmental factors.[43]

Many studies have concluded that tooth formation is a more reliable indicator of dental maturity than gingival emergence or eruption.[59],[60],[61] Thus, teeth can be valuable assets in determination of undetectable age.

   Teeth in Bite Marks Top

MacDonald in 1974 has defined bitemark as “a mark made by the teeth, either alone or in combination with other mouth parts.”[62] Bite marks may be found in food, skin, or in other substances.

   Uniqueness of the Human Dentition Top

The human occlusal profiles of each individual are different from another. There is just a small hypervariation that occurs in the dentition which is unique. This hypervariation can be used to create a database. This has its drawbacks. It is not constant throughout life as compared to DNA which is constant.[63]

The use of bite marks has been reported in both ancient and modern history. William, the conqueror, reported validated royal documents by biting into a wax seal with his characteristic dentition. Debtors coming from Britain or Europe to America to work as servants verified their arrangements by biting the seal on the pact in lieu of a signature and became known as indentured servants.[64]

There are several important steps that a person needs to follow to successfully identify and report a bitemark. These include identifying a bitemark, documenting it, preserving the evidence, dental profiling of the evidence and the suspect, DNA profiling through available salivary swabs, and finally reporting the crucial evidence.

The American Board of Forensic Odontology (ABFO) No. 2 standard reference scale has been recognized by the forensic science community as a geometrical reference scale. A technical document in 1988 detailing the specifications for the ABFO No. 2 scale was published by the American board. It is a photomacrographic ruler designed to optimize the ability to reconstruct a bite mark, skin trauma, a scene, or object from an image [Figure 8]a and [Figure 8]b - adapted from ASCLD/LAB – International Program Overview 2010 Edition].[65]
Figure 8: (a) The American Board of Forensic Odontology No. 2 standard reference scale. (b) Use of length graduations to project a virtual grid, which propagates the length scale to the two-dimensional plane defined by the ruler

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Different methods applied to physically compare the suspect's dentition and the bitemark injury are confocal scanning electron microscope, fingerprint dusting powder, overlays, impressions, and 3D laser scanning of dental casts.[66]

In an article by van der Velden et al., a new method of analyzing bite marks using image perception technology was proposed. With this technology, it is possible to artificially color areas with equal intensity values and depicts a 2D image as a pseudo-3D surface object.[67]

Several newer methods make the use of computer software for virtual identification and recreation [Figure 9].
Figure 9: Virtual recreation of the bite marks

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   Controversies Regarding Bite Mark Evidence Top

There are a number of factors which can alter the bite mark evidence. This can be with respect to its collection, recording, comparison, interpretation, preservation, or reporting. Hence, there has always been a controversy regarding the legal status of bite mark evidence. The ABFO and The British Association of Forensic Odontology have published guidelines which describe that evidence should be collected from both the victim and the suspect and a sound basis for collection should be established. Deviations from these recommendations may be questioned.[68],[69]

Thus, overestimation of bite marks should always be avoided. One should remember that bite marks are not completely like fingerprints and DNA – they cannot tell you a 100% who the culprit is!

   Conclusion Top

Teeth prove to be very helpful adjuncts in forensic dentistry. Owing to their properties and characteristics, they can be readily available and easily processed for several investigations. A great amount of research is in progress which in the coming years would prove extremely beneficial.

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Conflicts of interest

There are no conflicts of interest.

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Correspondence Address:
Dr. Preetam Shah
Department of Pediatric and Preventive Dentistry, Bharati Vidyapeeth Deemed University Dental College and Hospital, Katraj, Pune - 411 046, Maharastra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_9_17

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