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Review Article DOI: 10.17354/cr/2016/210 Relationship between the Dental Characteristics and General Profiling of the Decedent: A Review Tanu Tewari1, Sulabh Jain2, Praveen Samant3, Charu Tandon4, Anika Bhasin5 Assistant Professor, Department of Conservative Dentistry & Endodontics, Babu Banarasi Das College of Dental Sciences and Research Centre, Lucknow, Uttar Pradesh, India, 2Post-graduate Student, Department of Oral Medicine and Radiology, KD Dental College, Mathura, Uttar Pradesh, India, 3 Professor and Head, Department of Conservative Dentistry & Endodontics, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India, 4 Assistant Professor, Department of Periodontics, Babu Banarasi Das College of Dental Sciences and Research Centre, Lucknow, Uttar Pradesh, India, 5 Post-graduate Student, Department of Conservative Dentistry & Endodontics, Babu Banarasi Das College of Dental Sciences and Research Centre, Lucknow, Uttar Pradesh, India 1 In the field of forensics, the use of dentition for identification has been well established. The dental analysis has been employed mainly for the positive personal identification of the person. Therefore, the purpose of this review is to show the possibility of using the dental characteristics, for example, caries and dental restorations for the general profiling of the decedent. It was found that many significant relationships existed between the dental characteristics and the sex, race, age, and socioeconomic status of the person identified. The socioeconomic status is having the least number of correlations while the age and race were seen to have the most. Keywords: Antemortem, Anthropology, Odontology, Perimortem, Postmortem INTRODUCTION When the human remains are found, the priority of the investigators is to identify who the individual was. To a ain this goal, investigators and researchers use methods from various fields of science. In cases where the remains are completely or mostly skeletonized or in which the soft tissues have been completely decomposed, deformed or have become such that the possibility to perform an autopsy or collect fingerprints, have become negligible. In those cases, the identification is determined by utilizing physical anthropology and odontology. Anthropologists, especially those trained in forensic science, first analyze whether the skeletal remains are complete or incomplete. Many different techniques are used to gain different types of information. These techniques vary depending on the part of the skeleton being examined. For example, age can be estimated from dentition, suture, or epiphyseal closure, changes in the pubic symphysis, auricular surface of the ilium, and sternal end of ribs (These techniques involve the jaws, cranium, long bones, pelvis, Access this article online Month of Submission Month of Peer Review Month of Acceptance Month of Publishing : : : : 01-2016 02-2016 03-2016 03-2016 www.ijsscr.com and ribs). Using these methods, along with each other helps the anthropologist to reach a more accurate estimation of age, but the completeness of the skeleton may limit the techniques that can be utilized (anthropological analysis provides an estimation of age, race, and sex. Analysis can also include conclusions about antemortem, perimortem, and postmortem trauma). Most dentists, or odontologists, have the basic knowledge and skill to perform dental analysis for forensic purpose. The analysis of dentition generally includes an examination of position and shape of fillings, presence or absence of teeth, and shape of molar roots. Usually, this information is gained through the use of radiographs. Forensic odontologists also perform a comparative analysis between postmortem information of an unknown individual and antemortem information of an individual who has been missing. By comparing these data, it is often possible to identify an unknown individual. Presently, there are three types of dental identification procedures that are considered:1 Comparative dental identification: A empts are made for a conclusive identification by comparing the dead individual’s teeth with presumed dental records of that individual. Reconstructive postmortem dental identification or dental profiling: A empts are made to find out the race, gender, Corresponding Author: Dr. Tanu Tewari, 205, Chandralok Colony, Aliganj, Lucknow - 226 024, Uttar Pradesh, India. Phone: +91-9838399926. E-mail: [email protected] IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 10 45 Tewari, et al.: A Brief on Forensic Odontology age, and occupation of the dead individual. This is done when there is no clue leading to the identity of the deceased. Dental profiling to oral tissues: This method is undertaken when the dental records are not available for comparison. The technique uses modern forensic DNA profiling methods of oral tissues to establish the identity. In this review, the possible use of dentition for determining the general profile information has been done. Only the dental features that have been utilized previously for positive identification, such as filling shape, have been incorporated in this article for correlations to sex, race, age, and socioeconomic status. The importance of forensic dentistry was officially recognized, in 1969, along with the establishment of the American Society of Forensic Odontology, and in 1970, when the Odontology Section within the American Academy of Forensic Sciences was formed.2 After fingerprints, teeth are the most useful tool in determining positive identification of human remains. Teeth are the most durable portion of the body and have the ability to resist erosion, deterioration, and fire long after death. Teeth must be exposed to a temperature of over 500°C (932°F) to be reduced to ash. Teeth demonstrate a variety of form and varied conditions of wear, trauma, disease, and professional manipulation. Approximate age and useful indications of probable sex, race, occupation, personal habits, medical history, and environment can often be revealed by analysis of only teeth.3-5 DISEASE, RESTORATION, AND ATTRITION The mouth houses a wide variety of microscopic organisms: Bacteria, viruses, yeasts, and protozoa. Many different habitats for these invaders can be found in the mouth: Pits and fissures, cuspal surface, proximal surface of the crown, area between teeth, and gingival crevice or sulcus around the neck of the tooth. Caries, periodontal disease, periapical osteitis, antemortem tooth loss, and malocclusion are the disease processes of the jaws and mouth. A structure is termed as diseased only when it can no longer operate efficiently. The site at which an abnormality is observed is known as a lesion. Damage to the structure may be limited to soft tissues; it may or may not involve the hard tissue destruction and repair.6 The common causes of tooth loss are dental caries in the younger population and periodontal disease in the older population. Dental caries is the name used for tooth decay. It represents the irreversible and progressive destruction of tooth structure due to the bacterial acid formation. A carious 46 lesion is characterized by the demineralization of enamel, dentine, and/or cementum by microorganisms that are present within the plaque on crown surfaces. Caries is found to begin at the enamel surface of the crown or exposed parts of the neck of the tooth, proceeding through the dentine into the pulp cavity. It may also start from the roots exposed by periodontal disease. The crown may be completely destroyed and other periodontal difficulties, such as the formation of a granuloma or an abscess, may arise. If left untreated, the affected tooth may loosen and fall out, and the alveolus will heal in time. Although, the inflammation can spread into the surrounding bone.7 A carious process on the crown surface is visible first as a microscopic opaque spot in the enamel. This spot may be white or brownish in color. With time, the spot becomes larger, the enamel surface becomes rough and, eventually, a small cavity appears. Hillson6 noted the variation in the results of different observers when opaque spots were included in a study. Due to this reason, these spots were not included in this research, only the visible cavities have been included. These cavities continuously grow until they are treated. If the cavity reaches the pulp chamber, the soft tissues become exposed to infection thus leading to inflammation, bone destruction, and tooth loss. Severe a rition or a traumatic fracture of the crown may also cause a similar result. Local inflammation occurs leading to pus collection in that area. Pus is often restricted by a wall of fibrous tissue, forming an abscess or cyst. The pulp chamber does contain the inflammation for some time, but eventually the pulp is completely necrosed by the progressing lesion. When this death of the pulp occurs, the infection might proceed down the root canal into the bone and connective tissue. Due to its location at the apex of the root, it is known as periapical inflammation. Chronic periapical inflammation results in bone resorption. Pus accumulates in the lesion to form an abscess. The pus has to be removed in for the lesion to heal. Eventually, the bone and soft tissues get resorbed, thereby forming a channel to the surface called a sinus or fistula that usually penetrates the gum on the buccal side of the alveolar process.6 One of the main purposes of the regular dental check-up is the early detection and arrest of dental caries. Once caries is detected, the carious lesion is removed while restoring the structure and function of the tooth. Most of the cavitated lesions caused by caries have to be restored after the affected tissue has been removed. Restorations or fillings can be comprised a variety of materials. The preferred materials change with time, geographical region, personal preference, and affordability. Probably, the most common are amalgam fillings. This type is used mostly on posterior teeth because of esthetic reasons, though it is used in about 80% of all restorations.2 Resin and ceramic fillings are more esthetic IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 10 Tewari, et al.: A Brief on Forensic Odontology and natural in appearance. If a carious lesion infects the pulpal tissue, the only treatment of choice is either root canal treatment or extraction. A crown is required on teeth that have been extremely damaged by a carious lesion or have been treated with a root canal treatment. Crowns replace the entire natural crown of a tooth. They can be metal, acrylic resin, or porcelain. The resin or porcelain, again, provides a more a ractive or natural look to the restored tooth. The host’s resistance and dietary factors affect the extent of dental caries. Morphological crown complexity, tooth size, trace elements in food and water, developmental defects, dental wear, and immunologic characteristics of saliva are all factors of host resistance.8 Dietary factors that cause caries progression include the types of foods eaten, methods of food preparation, eating habits, and duration and degree of mastication.8 Between 1945 and 1951, a series of experiments were done that demonstrated a correlation between annual sugar consumption and the frequency of carious lesions.6 For the anthropologists, caries has become the most important dental disease because of its association with the evolution of food production. Numerous studies have revealed many important facts about caries such as it has been observed that the parents and their off springs tend to, have similar caries experiences. Women have been found to be more affected by the disease than men, also in one individual, left and right sides are usually equally affected.6 The first molar is generally thought to be the most commonly affected tooth. Although, this opinion has not been supported by any extensive data. It has also been found that the upper molars are usually less affected than their lower counterparts, and posterior teeth are more affected than anterior teeth.7 The occlusal a rition, or occlusal wear, has been studied widely to find any correlating factors of sex, age, tooth position, and dental caries. The sex of the individual was found to play a major role in tooth wear and have a higher degree of a rition which in females. The older individuals had the most heavily worn teeth, but this relationship was not constant since a few differences were seen. Tooth position was also an important variable in determining the degree of destruction due to tooth grinding, mastication, and occupational use.9 SEX, AGE, SOCIOECONOMIC STATUS, AND RACE According to past studies, a few differences have been found to exist consistently and for obvious reasons between the teeth of male and female individuals such as size and rate of dental growth. Tooth eruption was found to be more IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 10 affected by hormonal disturbances and dietary deficiencies than by racial differences.10 Hence, the teeth provide a lot of information in various ways such as the age of an individual at the time of death. Teeth are also the most reliable indicator of age if an individual is 14-year-old or younger, due to the consistent rate with which teeth erupt. Although naked-eye observation of emergence and a ritional changes can be adequate for an estimation of age. Radiographic methods or histological techniques may also be used to supplement these observations and reveal tooth deterioration more accurately. Dental restorations often indicate the economic, regional, and racial background of an individual. The amount of expensive restorations found in an individual may suggest their social status.11 The wear pa ern and staining of teeth can also suggest the occupation or personal habits of an individual such as smoking. Main Body Researchers and investigators agree that dentition aids in positive identification and may prove just as valuable for general identification. Dental conditions also help to conclude the sex, race, and age when many standard methods cannot be performed satisfactorily. In this review, it has been discussed that many significant relationships have been found to exist between the dental conditions and their identifier’s sex, race, age, and socioeconomic status. The canines and incisors are the most commonly and severely worn teeth. Usually, the lower right lateral incisor is involved. This conclusion was drawn and concluded to be obvious because, as the first stage of the digestion process, these teeth encounter foods in their most tough form. Anterior teeth are also commonly used for holding nails or pins and tearing or opening objects other than the masticatory function. The teeth of males are worn more than those of females. This result was not consistent with the study done by Molnar, in 1971,12 or with the idea that the teeth of females may be more worn earlier due to earlier eruption than the teeth of the males. Perhaps this can be explained by the fact that men tend to have more manual labor jobs than women and, thus, more likely use their teeth as a tool. Furthermore, the fact that women are not usually pipe or cigar smokers and would also contribute to this fact. The correlation between socioeconomic status and tooth wear is not as it is expected to be. It would be reasonable to think that individuals of a lower status exhibit more tooth wear because of more manual labor jobs. However, in a study, the teeth of individuals of middle socioeconomic status were found to be more worn out. This correlation 47 Tewari, et al.: A Brief on Forensic Odontology might be thought of being present due to dietary differences or the choice of the method of smoking, for example, smoking a pipe instead of a cigare e. The upper incisors are the most common teeth to be crowned, because these are the most visible teeth in the mouth, and a crown is certainly more a ractive than a filling or diseased tooth. Because it is easier for the people of middle socioeconomic status to be able to afford a more expensive and more esthetic porcelain crown, but for the people of lower socioeconomic status it is very difficult. This might be the reason for the account of association of crown type and socioeconomic status. The difference in the amount of tooth wear in individuals according to their age is predictable because the older a person gets, the more wear his or her teeth will get. The caries rate is affected by tooth type, race, and age but not by socioeconomic status or sex. In a study,7 it has been suggested that the first molars are the most affected by caries. In the same study, the second molars were found to be more affected, although an insignificant difference was present between the first and second molars. It has also been stated that mandibular teeth are more affected than the maxillary teeth. As stated by Hillson in his study,6 carious lesions of teeth are found to be more in females as compared to males and the occlusal surface of the crown is usually more affected because it is the chewing surface also the posterior teeth have pits and fissures that hinder proper cleaning. It was also found that the males preferred to get their teeth restored with silver amalgam while the females preferred to opt for more esthetic restorations. least amount of effect on the dental characteristics. The age and race have been found to have the most number of connections with the characteristics studied. Though the fact remains that more studies must be conducted for more accurate assessment of the possibilities of this topic. REFERENCES 1. 2. 3. Sweet D. Forensic odontology. Dent Clin North Am 2001;15:237-51. Sopher IM. Forensic Dentistry. Springfield: Thomas Books; 1976. Rogers SL. The Personal Identification of Living Individuals. Springfield: Thomas Books; 1986. 4. Rogers SL. Personal Identification from Human Remains. Springfield: Thomas Books; 1987. 5. Rogers SL. The Testimony of Teeth: Forensic Aspects of Human Dentition. Springfield: Thomas Books; 1988. 6. Hillson S. Teeth. New York: Camvridge University Press; 1986. 7. Caselitz P. Caries: Ancient plague of humankind. In: Alt K, Rösing FW, Teschler-Nicola M, editors. Dental Anthropology: Fundamentals, Limits, and Prospects. New York: Springer-Verlag/ Wien; 1998. p. 203-25. 8. Turner CG IInd, Nichol CR, Sco GR. Scoring procedures for key morphological traits of the permanent dentition: The Arizona State University dental anthropology system. Advances in Dental Anthropology. New York: Wiley-Liss; 1991. p. 13-31. 9. Molnar S. Sex, age, and tooth position as factors in the production of tooth wear. Am Antiq 1971;36:182-7. 10. Miles AE. The dentition in the assessment of individual age in skeletal material. In: Brothwell DR, editor. Dental Anthropology. New York: The Macmillan Company; 1963. p. 191. 11. Keiser-Nielsen S. Person Identification by Means of the Teeth: A Practical Guide. Bristol: John Wright & Sons Ltd.; 1980. 12. Johansson A, Kiliaridis S, Haraldson T, Omar R, Carlsson GE. Covariation of some factors associated with occlusal tooth wear in a selected high-wear sample. Eur J Oral Sci 1993;101:398-406. CONCLUSION The goal of presenting this review was to determine if the dental conditions could be used to establish or help support the sex, race, age, and socioeconomic status of unknown skeletal remains. According to various studies, it can be concluded that the socioeconomic status has the 48 How to cite this article: Tewari T, Jain S, Samant P, Tandon C, Bhasin A. Relationship between the Dental Characteristics and General Profiling of the Decedent: A Review. IJSS Case Reports & Reviews 2016;2(10):45-48. Source of Support: Nil, Conflict of Interest: None declared. IJSS Case Reports & Reviews | March 2016 | Vol 2 | Issue 10