Sargaiyan V et al. Forensic Odontology.

Review Article
Forensic Odontology: A Review
Vinod Sargaiyan1, Aprinderpal Singh Dhaliwal2, Prutha Soni3, Dishani M Shah4, Anshul
Shah3 , Rakesh Vadher5
1

Department of Oral Pathology and Microbiology, Maharana Pratap College of Dentistry and
Research Centre, Gwalior, Madhya Pradesh, 2Adesh Institute of Dental Sciences and
Research, Bathinda, Punjab, 3Ahmedabad Dental College and Hospital, Gandhinagar, Gujarat,
4
A.M.C. Dental College and Hospital, Ahmedabad, Gujarat,
Department of Conservative
Dentistry and Endodontics, Government Dental College and Hospital, Ahmedabad, Gujarat.
Abstract:
Forensic odontology is a specialized field of dentistry which analysis dental evidence in the
interest of justice. Forensic odontology embraces all dental specialties and it is almost
impossible to segregate this branch from other dental specialties. This review aims to
discuss the utility of various dental specialties with forensic odontology.
Key words: Dental specialties, Relationship, Forensic odontology.

Corresponding Author: Dr. Vinod Sargaiyan, Department of Oral Pathology and

Microbiology, Maharana Pratap College of Dentistry and Research Centre, Gwalior, Madhya
Pradesh, India.
This article may be cited as: Sargaiyan V, Dhaliwal AS, Soni P, Shah DM, Shah A. Forensic
Odontology: A Review. J Adv Med Dent Scie Res 2014;2(4):45-52.

NTRODUCTION
Forensic odontology is that branch of
dentistry which deals with the proper
handling and examination of dental
evidence and with the proper evaluation and
presentation of dental findings in the
interest of justice.1 This branch has been
utilized for many years for the identification
of victims and suspects in mass disasters,
abuse and organized crimes.2 Forensic
odontology embraces all dental specialties
and forensic dental field work requires an
interdisciplinary knowledge of all dental
specialties.
The
widely
accepted
classification of forensic odontology is
based on the major fields of activity i.e.
civil, criminal and research by Avon.3 More
recently the author has published a new
working
classification
for
forensic

odontology based on the relationship of

various dental specialties with forensic
odontology.4
The present review investigates in-depth
about each specialty and its relationship
with forensic odontology. The dental
specialties considered in the review are oral
pathology and microbiology, oral medicine
and radiology, oral and maxillofacial
surgery,
paedodontics,
periodontics,
conservative dentistry and endodontics,
prosthodontics, orthodontics and finally
community dentistry.
Oral Pathology and Microbiology: Oral
pathology and microbiology is the specialty
of dentistry that deals with the diseases
affecting the oral and maxillofacial regions.
This specialty is utilized for age estimation

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Sargaiyan V et al. Forensic Odontology.

studies using ground sections of teeth.

Ground sections are the sections prepared
without using any chemical and thus
maintaining
normal
anatomy
and
constituents. The histological technique is
more appropriate for postmortem situations
and also significant in estimation. The
techniques used to estimate age by means
of teeth include Gustafson's technique,
incremental lines of Retzius, perikymata,
prenatal and postnatal line formation,
racemization of collagen in dentin,
cemental incremental lines and translucency
of dentin.4
Gustafson 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.2 Incremental lines of
Retzius are caused by /variation in the
rhythmic mineralization of enamel prisms.6
These rhythmic patterns may be altered by
various external factors such as metabolic
disturbances so that the lines may appear
closer or the rest periods may be prolonged.
The number and spacing of incremental
markings at the enamel surface, known as
perikymata, are considered important
indicators of dental growth patterns, as they
provide information on crown formation
times and the underlying developmental
processes.7
The prenatal and postnatal line formation is
considered as an indicator of birth.8 These
lines are present in both enamel and dentin
of deciduous teeth and permanent first
molars which indicate the development
during the transitional period between intra
uterine and extra uterine environments. So
it can be used to assess the amount of
prenatal and postnatal enamel formation. In
the dentin incremental lines of Von Ebner
and contour lines of Owen are present.
These lines are used to estimate age of the
neonates or foetus at death. The extent of

racemization of aspartic acid in coronal

dentin of normal permanent teeth can be
used to estimate the age of an individual at
the time of death.9 As age advances Laspartic acid will change into D-aspartic
acid. The incremental lines of cementum
will help to determine the age of adults.10 A
major disadvantage of this method is the
necessity to extract or section the tooth. It is
not practical among living individuals.
Dentinal translucency is one of the morphohistologic parameters considered best for
dental age estimation, not only in terms of
accuracy, but also simplicity.11
Root dentin starts to become translucent
due to the increased intratubular
calcification. Dentin translucency will
increase with age. Disadvantages of this
method include underestimation of age in
older age groups due to slowing down of
dentin sclerosis and irregular junction at
translucent and non-translucent zones will
make difficulties in measuring the length.
When conventional dental identification
methods fail, DNA (deoxyribonucleic acid)
material from teeth can provide the
necessary link to prove identity. Teeth
represent an excellent source of DNA
material and DNA is found within distinct
locations of the tooth. DNA preserved in
and extracted from the teeth of an
unidentified individual can be compared to
a known antemortem sample or to a parent
or sibling.12 The principal laboratory
techniques used to compare and evaluate
fragments of DNA material from a suspect
or victim are restriction fragment length
polymorphism (RFLP) and polymerase
chain reaction (PCR) analyses. The method
currently preferred to extract as much high
quality DNA as possible is a method called
cryogenic grinding. This technique involves
cooling the whole tooth to extremely low
temperatures using liquid nitrogen and then
mechanically grinding to fine powder. The
major disadvantage of this method is that

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Sargaiyan V et al. Forensic Odontology.

the tooth needs to be completely crushed.

This specialty is also utilized for
identification of individuals through
developmental disturbances of teeth,
regressive alterations of teeth and tumours
and cysts of oral cavity.4
Oral Medicine and Radiology: Oral
medicine and radiology is the specialty of
dentistry that deals with the nature,
identification and management of diseases
affecting the oral and maxillofacial regions.
This specialty is utilized for age estimation
studies using radiographic method. The
parameters used to estimate age by
radiographic method include secondary
dentin formation, changes in the orientation
of mental foramen and inferior alveolar
canal, eruption and formation of mandibular
third molar, trabecular pattern in jaws,
pulp/tooth area ratio of teeth and pattern of
lamina dura.4
Deposition of secondary dentin can be
assessed using periapical radiograph to
estimate age. Measurements such as pulp
diameter to crown diameter ratio and
pulp/tooth area ratio are calibrated to assess
secondary dentin formation.13,14 Further, the
examination of the mandible will help in
assessing the age of the individual
approximately (i.e. by the orientation of
mental foramen and inferior alveolar canal
in the mandible). Third molars are the most
variable teeth in the dentition and they
remain the most reliable biologic indicator
available for estimation of age during the
middle teens and early twenties.15 Age
estimation is also assessed from root
development of mandibular third molars in
comparison with skeletal age of wrist
joint.16 Trabecular pattern in jaws is
considered useful in age estimation.
Trabecular pattern can be assessed in
mandible using periapical and panoramic
radiographs.17,18 Pattern of lamina dura is
also considered useful in age estimation.

Dental tissue is often preserved indefinitely

after death. Dental identification assumes a
primary role in the identification of remains
when postmortem changes, traumatic tissue
injury or lack of a fingerprint record
invalidates the use of visual or fingerprint.3
A complete charting of dentition using
Federation Dentaire Internationale (FDI)
system or any other nomenclature should be
done.1 The type of dentition (either
permanent or deciduous) and surfaces of
teeth involved should be evaluated. Teeth,
periodontal tissues and normal anatomical
features are assessed in comparative dental
identification. Periapical and bitewing
radiographs are routinely used for
identification purposes. Moreover, the
stages of healing and chronology after tooth
extraction and/or post-traumatic loss will be
valuable for referencing the duration of
alleged injury.
Comparison of antemortem and postmortem
radiographs are the most accurate and
reliable
method
of
identification.
Odontograms
(symbolic
pictorial
description of dentition) form a basic
outline to compare dental characteristics at
the simplest level.1 The fundamental
principles of dental identification are those
of comparison and of exclusion.
Unfortunately in the present scenario,
dentists often maintain poor dental records,
resulting in confusion that makes dental
identification impossible. A mixed case
retrieval method is proposed for the
knowledge reuse of dental records based on
case-based reasoning.19 It is demonstrated
that this method is very effective in terms of
reducing the time of writing medical
records and improving the efficiency and
quality. This method is also proven to be an
effective aid for diagnoses and provides a
new idea for the management of medical
records and its applications. Cheiloscopy is
the study of lip prints. Lip prints are
probably unique to the individuals and are

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Sargaiyan V et al. Forensic Odontology.

recorded using lipstick.20 The recording of

human lip prints is problematic because of
their highly deformable nature. Another
factor to be considered is the existence of
some pathological conditions such as
congenital lip pits, lymphangioma and
cheilitis which can invalidate the lip print
study.
Oral and Maxillofacial Surgery: Oral and
maxillofacial surgery is the specialty of
dentistry concerned with the surgical and
adjunctive treatment of diseases, injuries
and deformities of the oral and
maxillofacial region. This specialty is
utilized for identification of individuals
through
maxillomandibular
and
dentoalveolar fractures, surgical repairs and
implants and craniofacial superimposition.4
Usually the assessment of accidental or
deliberate damage to the teeth and jaws
comes within the scope of the oral surgeon.
However, in many instances where this
damage may be relevant to a criminal
activity; the oral surgeon has to appear
before the court for medicolegal
investigation. Craniofacial superimposition
is established as a method of identification
complimentary
to
fingerprinting.
Photographs may be compared with images
of skull and radiographs may be compared
with skull to reconstruct face.21 The
reliability of the technique is largely
depending upon the experience and
subjective judgment of the expert making
the superimposition. Current research is
exploiting recent developments in computer
technology to refine this technique.22,23 In
oral autopsy, LeFort I osteotomy procedure
is done to get full access to teeth and
intraoral structures.24
Pedodontics: Pedodontics is the specialty
of dentistry concerned with the treatment of
dental disease in children. This specialty is
utilized for age estimation studies which
include eruption sequence, Schour and

Massler chart, Demirjian's method using

dental maturation chart and Nolla's stages
of calcification.4 Tooth eruption and tooth
calcification are the two events that can be
used to measure dental age in children and
adolescents.5 Radiographical evidence of
formation of crown and root completion has
been utilized for this age group. Small
variations in tooth formation and eruption
among persons has made dental estimation
of chronological age the primary method of
age determination for younger persons.25
Schour and Massler's chart is to estimate
dental age in developing dentition. This
chart permits direct comparisons with
radiographs. Demirjian's method based on
seven teeth is used for determining dental
maturity scores, establishing gender
specific tables of maturity scores and
development graphs.26 Nolla's stages of
calcification are based on the radiographic
identification of morphologically distinct
stages of calcification.27 As mandated
reporters, dentists play an important role in
recognizing child abuse. Majority of the
dentists lack the adequate knowledge about
recognition and reporting issues of
suspected cases of child abuse.28 The dental
office should maintain complete and legible
records on file for the potential forensic
identification of a child.
Periodontics: Periodontics is the specialty
of dentistry dealing with diseases of the
gums and other structures around the teeth.
This specialty is utilized for age estimation
studies which include periodontosis (gum
recession), root transparency and root
length.29,30 This specialty is also utilized for
identification of individuals through
gingival morphology and pathology,
periodontal ligament morphology and
pathology and status of alveolar bone.4
Conservative Dentistry and Endodontics:
Conservative dentistry and endodontics is
the specialty of dentistry concerned with the

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Sargaiyan V et al. Forensic Odontology.

etiology, prevention, diagnosis, and

treatment of conditions that affect the tooth
pulp, root, and periapical tissues. This
specialty is utilized for identification of
individuals through restorations and root
canal fillings.4 Presumably, individuals with
numerous and complex restorations are
often easier to identify than those
individuals with little or no restoration.3
Restorations play a significant role to aid in
the identification process, as various
restorative
materials
have
varying
resistance to high temperatures.31
Prosthodontics: Prosthodontics is the
specialty of dentistry that deals with the
replacement of missing teeth and related
mouth or jaw structures by artificial
devices. This specialty is utilized for
identification of individuals through
dentures and prostheses, denture marking,
bite mark analysis and palatal rugoscopy.4
Dental impressions such as vinyl siloxane
and polyether are commonly recommended
for recording bite mark evidence.32 It is
recommended that the casts should be
prepared using type II dental stone and
additional casts should be made by
duplicating the master casts.33 Palatal
rugoscopy is the study of palatal rugae and
their uniqueness to individuals, can provide
reliable source of identification.34 Palatal
dimensions are appreciably larger in males
than females.
It is accurate to say that any items that
records information about the suspect's
teeth can serve as a basis for comparison in
the identification. These have included
study models, old dentures, custom bleach
trays and custom splints.3 The author has
reported a case of identification of a suspect
using artificial denture.35 It was the first
case identified with the help of forensic
odontology in the Kerala State in India.
There are different methods suggested for
marking dentures in the identification.
These have included engraving methods,

inclusion methods, metal inserts and microchips.36 The author has proposed a simple
method in denture identification using lead
foil in the intraoral periapical radiograph as
an inclusion agent.37 The introduction of
uniform system of naming and coding the
dentures by dentists will be of immense
help in identification.35
Orthodontics: Orthodontics is the specialty
of dentistry that deals with the prevention
or correction of irregularities of the teeth.
This specialty is utilized for identification
of individuals through tooth rotation and
malposition, orthodontic appliances and
orthodontic reconstruction.4 Orthodontic
reconstruction can be done in a murder
victim using electronic superimposition
technique. Race identification is very useful
in disasters where different races may be
involved. Cephalic index helps to identify
the race.4
Gender dimorphism can be studied using
mandibular canine index and mandibular
first molar index. The mandibular canines
are considered to demonstrate the greatest
percentage of gender dimorphism amongst
all teeth in their mesiodistal width.38
Mandibular canines can be considered as
the key teeth for identification since they
are the last teeth to be extracted with
respect to age. Apart from canines, the first
molar would be the tooth most likely to
exhibit the greatest univariate sexual
dimorphism.39 This specialty is utilized for
age
estimation
studies
through
cephalometrics.4 Cephalometric parameters
will vary with age and it has also role in
racial differentiation studies.40 In the
estimation of pubertal state, dental status is
assessed by orthopantomograph (OPG) Xray and the skeletal status is determined by
hand wrist X-ray.4
Community
Dentistry:
Community
dentistry is the specialty of dentistry that
deals with the community and its aggregate

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dental or oral health rather than that of the

individual patient. This specialty is utilized
for identification of individuals through
endemic fluorosis.4 Endemic fluorosis is a
geographic factor; for example it is more
prevalent in Kanyakumari district, Tamil
Nadu and Nalgonda district, Andhra
Pradesh in India.41,42 The presence of
fluorosis of teeth in an unidentified person
gives a clue that the person is from an
endemic area and this will help in
identification. The prevalent groups of
dental caries, periodontal disease and oral
cancer in a population, the type of
restorative material used and the design of
the restoration may give some important
information concerning socioeconomic
grouping.4 Mass disasters can be classified
into natural calamities, accident and
criminal attacks (terrorist bombings). The
identification of large numbers of casualties
in mass disasters is complex and the
identification process is fundamentally the
same as that in routine comparative dental
identification.43 Human identification in
mass disasters will continue to benefit from
advances in technology.
Malpractice is a broader term referring to
the failure to exercise skill, knowledge or
care with resultant injury to the patient.25
Dentist is considered negligent when he
does not provide the duties to the patient.
Charging for materials or procedures that
were not used or performed are examples of
fraud. In cases of dental fraud and
malpractice, the dentist may serve as expert
witness to make inferences about physical
facts based on ordinary experience.44
Dentists may be called upon to examine and
give opinion regarding suspected elderly
abuse cases.45 Dentists may serve as expert
witness to give opinion regarding tooth loss
in homicide cases, since the loss of tooth is
designated as grievous hurt under section
320 of the Indian Penal Code (I.P.C).
Relevant variations of this grievous hurt as

organ loss or function loss are applicable in

other penal systems.
CONCLUSION
To sum-up, experienced dental specialists
should link together and provide guidance
for the research studies in forensic
odontology. Perhaps this review might help
the dental specialist to understand the
forensic implications of his specialty and to
do research in the parent specialty.
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Source of support: Nil

Conflict of interest: None declared

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