CHRISMED Journal of Health and Research

: 2019  |  Volume : 6  |  Issue : 3  |  Page : 131--134

Oral and paraoral structures; An aid for person identification: A review on forensic stomatology

Vidya Kadashetti1, KM Shivakumar2, Rajendra Baad1, Nupura Vibhute1, Uzma Belgaumi1, B Sushma1, K Wasim1,  
1 Department of Oral Pathology and Microbiology, Forensic Odontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Malkapur, Karad, Maharashtra, India
2 Department of Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Malkapur, Karad, Maharashtra, India

Correspondence Address:
Vidya Kadashetti
Department of Oral Pathology and Microbiology, Forensic Odontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Satara, Malkapur, Karad - 415 110, Maharashtra


The identification of oral tissues, including bone and teeth remains, is of primary importance when the deceased person is skeletonized, decomposed, burned, or dismembered. Primary role in the identification of remains when postmortem changes, traumatic tissue injury or lack of a fingerprint record invalidate the use of visual or fingerprint methods in Forensic Odontology. Forensic medicine and odontology has become an integral part for investigations and identification over the past decades. Forensic odontology utilizes oral and paraoral findings to serve the judicial system to investigate the truth head-and-neck findings can be used for identification as using them is cost-effective, reliable, and fast. Forensic odontology is a branch of dentistry that analyzes dental evidence to overlap the dental and legal profession. The tooth has been used as an evidence in the identification of the biter, age estimation, and gender determination of the accused. The study of forensic stomatology helps in criminal, noncriminal, and research purposes.

How to cite this article:
Kadashetti V, Shivakumar K M, Baad R, Vibhute N, Belgaumi U, Sushma B, Wasim K. Oral and paraoral structures; An aid for person identification: A review on forensic stomatology.CHRISMED J Health Res 2019;6:131-134

How to cite this URL:
Kadashetti V, Shivakumar K M, Baad R, Vibhute N, Belgaumi U, Sushma B, Wasim K. Oral and paraoral structures; An aid for person identification: A review on forensic stomatology. CHRISMED J Health Res [serial online] 2019 [cited 2019 Aug 20 ];6:131-134
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Identity of person is the main backbone of civilization, and the identification of unknown dead individuals always has been of paramount importance to the society. The identification of a missing individual can aid tremendously in the process of grief resolution of family and friends. Not only it is important to identify the deceased person to ensure or identify but also in cases of criminal investigations, insurance cases, and military proceedings that can be resolved only with positive identification of individual. Overall, in worldwide scenario, forensic dentists are playing an important role in human identification, age estimation and gender determination in dead individuals which cannot be identified by appearance or on complete loss of soft tissues, bite mark analysis in physical abuse or in an animal attack, maxillofacial trauma, and malpractices.[1] In 1970, Keiser-Nielson defined the forensic odontology or forensic dentistry as “that branch of forensic medicine which in the interest of justice deals with the proper handling and examination of dental evidence and with the proper evaluation and presentation of the dental findings.” Forensic medicine refers to areas of endeavor that can be used in a judicial setting and accepted by the court and the general scientific committee to separate truth from untruth.[2],[3]

The least invasive and cost-effective procedures practiced in forensic odontology and forensic dentists are playing an important role in human identification, bite mark analysis, maxillofacial trauma, and malpractices.[1],[4],[5]

Utilization of forensic odontology has major role in areas such as diagnostic examination, and evaluation of hard tissue and soft tissue in oral and Paraoral structures for assessment of age estimation, gender identification, in person identifications and criminal cases too.[7] In cases of mass disasters, identification of individuals and also in casualties in criminal investigations.[6] Identification, examination, and evaluation of bite marks which occur with some frequency in sexual assaults, child abuse cases, and in personal defense situations. This article reviews the evolving trends in different methods and the advanced concepts used in forensic odontology.

 Tooth Evidences in Forensic Sciences

Bite mark evidence

The science of evidence for bite mark identification can be used to link a suspect to a crime. A bite mark has been defined as “a pattern produced by human or animal dentitions and associated structures in any substance capable of being marked by these means”.[8] Bite mark analysis can elucidate the kind of violence and the elapsed time between its production and examination. It can show if the bite mark was produced intravitam or postmortem and in case of several bite marks, identify the sequence of them. It can be extremely useful in establishing a link between the bitten person and the biter or excluding the innocent. Bite mark analysis is currently contentious. It is a vital area within the highly specialized field of forensic science and constitutes the most common form of dental evidence presented in criminal court.[9]

Bite marks on inanimate objects

In the view of criminal investigations, it is important for both investigative professionals and odontologists to know about that bite marks in inanimate objects. The same principle of bite mark assessment applies, i.e., the bite must hold a high level of forensic significance before it can be considered for comparison to a suspect for identification.[10] Bite marks are found in a variety of nonhuman substrates and more commonly in food stuffs such as apple, cheese, sandwiches, chocolates, chewing gums, etc., pencils, and also in pacifiers, envelopes, bank books, wooden cabinets, pipe stems, and mouth pieces of musical instruments.[11]

Since the bite marks in food substances may produce exact mesiodistal (MD) dimension of teeth, records should be made as soon as possible. Saliva swabbing can be taken from the bite marks for blood group analysis or DNA analysis. With recent advances in research, more objective methods of bite mark analysis like salivary DNA recovery and bacterial genotyping have become the main stay of investigation in such crimes.[12],[13]

 Palatal Rugae in Determination of Gender

Determination of species usually presents no difficulties unless only patchy evidence is found at the scene of the crime. Palatal rugae are unique to every individual and can be used as an indicator in forensic odontology. Palatoscopy/rugoscopy is the study of palatal rugae that helps in sex determination. Palatal design and structure are not altered during growth. Identification of palatal rugae pattern is based on classification by Thomas and Kotze. This classification includes number, length, shape, and identification pattern of rugae. By determining the length of all rugae, three categories are identified.[14] The patterns of rugae architecture are highly specific for the female and male populations. The average number of rugae in females was slightly higher than that in males, and the diverging pattern was found more common in females than males. The rugae morphological pattern may be useful in forensic science in case of mutilation when compared to other parts of the body. Palatal rugae form an intrinsic and integral pattern for every single individual and can also help in sex determination. The ease of reproducibility and lower level of variation make palatal rugae a potential tool in forensic odontology.[15]

 Tooth in Determination of Gender

Odontometric method involves Mesio Distal (MD) dimensions and buccolingual (BL) dimension of teeth and mean canine index. Sexual dimorphism exists in the shape and size of the tooth. Tooth size can be measured best during early permanent dentition because it is the stage when the tooth is subject to less external and internal stimuli. MD dimensions and BL dimension of tooth dimension is the most simple and reliable method to analyze sexual dimorphism. Many studies report that the MD dimensions of teeth in males are more than that of females. Greater thickness of enamel in males is due to the long period of amelogenesis compared to females and also because of Y chromosomes producing slower male maturation.[16],[17]

The orthometric method involves morphology of skull and mandible with a constellation of six traits and frontal sinus dimensions. Williams and Rogers found that sex could be predicted correctly in 96% of cases using different features of skull and mandible.[18]


The word Chelios comes from the Greek word meaning lip. The study of lip prints is called Cheiloscopy. Lip prints can be identified even at the 6th week of intrauterine life. These prints do not change after that. Therefore, lip prints are unique patterns on the lip, which help in identification of a person.[19],[20] Lip prints bring added evidence to a crime scene that can be valuable, especially in cases lacking other evidence, like fingerprints. Lip prints can be a factor in many different kinds of crimes, such as tape when a person has been bound or gagged, prints on a glass that a person drank from, prints on a cigarette butt, and prints on a glass/window if they were pressed up against it. All of these are potential places where lip prints may be found and used in the investigation of a crime. However, the use of lip prints in criminal cases is limited because the credibility of lip prints has not been firmly established in the court system.[21]

 Molecular Analysis

Since morphological patterns vary with time and external factors, the best-suited method in the identification of gender is by molecular analysis of DNA. The extracted DNA from the teeth of an unidentified person can be compared with the antemortem DNA samples. DNA stored in blood, hairbrush, clothes, cervical smear, or biopsy sample can provide a good source of antemortem DNA. The different types of DNA are nuclear DNA and mitochondrial DNA. Extraction of DNA can be done by cryogenic grinding which involves cooling the whole tooth to extreme low temperature using liquid nitrogen and grinding the tooth to extract the DNA. The lesser destructive method for DNA isolation involves opening of root canals and scrapping the pulp area with notched medical needles. The extracted DNA can be analyzed using various methods such as restriction fragment length polymorphism, polymerase chain reaction (PCR), and microarrays.

Barr bodies termed the deeply stained chromatin material in nuclei of cells in female as Barr bodies. These structures play an important role in the determination of sex of an individual. The chromatin materials represent inactivation of one of the X chromosome in each somatic cell in females occurring during early embryonic development.

Barr bodies are basophilic structures. They exhibit various shapes such as spherical, rectangular, plano-convex, biconvex, and triangular. In electron microscopy, they resemble various alphabetical letters such as V, W, S, or X.

As Barr bodies are seen with the nucleus, they can be visualized by various special staining procedures like papanicolaou stain. Negative results can be attained under certain pathological conditions as they can be associated with variations in the size and shape of Barr bodies.[22]

Amelogenin is the protein involved in amelogenesis. Developing human enamel has about 30% protein, 90% of which are amelogenins. AMEL gene is involved in the formation of amelogenin. AMEL X gene is present in 106 bps and AMEL Y is present in 112 bps of the DNA. Therefore, the female has two identical AMEL genes or alleles, whereas the male has two different AMEL genes. This can be used to determine the sex of the remains with very small samples of DNA.[23],[24]

 Determination of Age

The need for age estimation has increased in recent years because there is increase in numbers of unidentified cadavers and human remains especially in metropolitan cities and age estimation for living individuals who do not have valid proof of date of birth with them. Age estimation is important in forensic medicine and odontology for identification of deceased victims and also for crimes and accidents. Dental maturity has played an important role in estimating the chronological age of individuals because of the low variability of dental indicators. Various methods have been constructed and tested to estimate the age of young individuals, among them are the physical examinations using anthropometric measurements, skeletal maturation, dental age estimation, and combination of dental development and anthropometric measurements.

Age assessment from the incremental lines

Microscopic examination of the incremental markings is found in longitudinal ground sections of the teeth and relies on the identification of the neonatal line in teeth forming at birth. Starting from the neonatal line, the numbers of small incremental lines that cross the enamel prisms are counted up to the edge of the forming enamel front. Making the assumption that each increment represents one day's addition of enamel, the number of increments is taken to represent the number of days of age.[25] Size of the pulp chamber indicates the amount of secondary dentin formation. Cementum is continuously deposited at the root end and seen as incremental lines. Many researchers have used cemental annulations to determine the age of adults.[26],[27]

 Dental Record for Legal Documentation

Dental records consist of documents related to the history of present illness, clinical examination, diagnosis, treatment done, and the prognosis. A thorough knowledge of dental records is essential for the practicing dentist, as it not only has a forensic application but also a legal implication with respect to insurance and consumerism. In addition, records of laboratory tests, study casts, clinical photographs, and radiographs become important components of the record and should be kept for 7–10 years. Computer-aided dental records are becoming more common, and obvious advantage of these electronic records is that they can be easily networked and transferred for routine professional consultation or forensic cases requiring dental records for identification. Dental records are preserved in written form or on a computer database, and following the principles of record management ensures that all dental information that may be required to resolve a forensic problem is properly maintained and retrievable. Another way the dental record may be used is to help provide information to appropriate legal authorities that will aid in the identification of a dead or missing person. The most common element of forensic dentistry that a general practitioner is likely to encounter is to supply antemortem (before death) records to a forensic odontologist.[28],[29]


The role of forensic dentistry plays a major role in the identification of those individuals who cannot be identified visually or other means. Forensic odontology is not a recent branch of dentistry. DNA recovery from dental pulp and other structures of tooth has become easy with advancements in PCR techniques; hence, genetically correct identification of persons has become easy. Gender and age estimation using biochemical markers are some of the recent advances in this field that gives scope for future research and standardization. It is of forensic science. The use of teeth, dentures, and other aids has revolutionized forensic science. The teeth and facial bones are resistant to fire, burns, and highly concentrated acids and can be still recovered from disaster sites for use. Forensic odontology can, therefore, be regarded as one of the most important areas of forensic science as far as “individual identification” is concerned. Despite breakthrough in science and technology, natural calamities and crimes continue to persist in human life. Identification of human remains is essential for various reasons, including legal, criminal, humanitarian, and social grounds. The production, retention, and release of clear and accurate patient records are an essential part of the dentist's professional responsibility. Success in this task will assist the dentist should a medico-legal claim be made and can assist the police and coroners in the correct identification of individuals. This article reviews how dental and paradental structures help in the field of forensic odontology as well as forensic investigations while highlighting the role of the dentist too.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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