|Year : 2015 | Volume
| Issue : 1 | Page : 29-34
Gender determination using dentition
Jayapal Dinakaran, Thayalan Dineshkumar, Gunasekaran Nandhini, Natraj Priyadharshini, Krishnan Rajkumar
Department of Oral Pathology, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
|Date of Web Publication||19-Jan-2015|
Department of Oral Pathology, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
Forensic odontology analyzes dental evidence for human identification. Teeth form an excellent material for anthropological, genetic, odontologic and forensic investigations, as their characteristics remain unchanged even after long periods of stay in extreme environments. Determining the sex is one of the most important steps in the process of human identification. Dental remains help in establishing the sex of victims with bodies mutilated beyond recognition. This article reviews the importance of the role of dentition in sex determination using clinical methods like differentiating sex by measuring the mesiodistal and buccolingual dimensions of the teeth, permanent canine teeth and their intercanine distance in sex identification through dimorphism, morphological features of the tooth crown or root which create a difference between men and women and microscopic method like determining sex by the study of X and Y chromosomes in the cells which are not undergoing active division and usefulness of advanced technique like polymerase chain reaction in sex determination has also been discussed.
Keywords: Amelogenin, forensic odontology, sex determination, canine dimorphism, polymerase chain reaction
|How to cite this article:|
Dinakaran J, Dineshkumar T, Nandhini G, Priyadharshini N, Rajkumar K. Gender determination using dentition. SRM J Res Dent Sci 2015;6:29-34
|How to cite this URL:|
Dinakaran J, Dineshkumar T, Nandhini G, Priyadharshini N, Rajkumar K. Gender determination using dentition. SRM J Res Dent Sci [serial online] 2015 [cited 2021 Sep 18];6:29-34. Available from: https://www.srmjrds.in/text.asp?2015/6/1/29/149587
| Introduction|| |
Forensic odontology or forensic dentistry is one of the most unexplored and intriguing branches of forensic sciences. It primarily deals with the identification, based on the recognition of unique features present in an individual's dental structures. Forensic dentistry plays a significant role in the identification in manmade or natural disasters and many other events that result in multiple fatalities that may not be able identifiable through conventional methods such as fingerprints. 
The theory behind forensic dentistry is "no two mouths are alike." Forensic dentistry or forensic odontology involves dentists' participation in assisting legal and criminal issues and in the identification of human. It refers to the proper handling, examination and evaluation of dental evidence, which will be then presented in the interest of justice. 
Forensic identification by its nature is a multidisciplinary team effort relying on positive identification methodologies as well as the presumption or exclusionary methodologies. In general, this effort involves the cooperation and coordination of law enforcement officials, forensic pathologists, forensic odontologists, forensic anthropologists, serologists, criminalistics, and other specialists as deemed necessary. 
The major area of activity of forensic odontology is the identification of human beings, either dead or alive. This is more so in case of mass disaster, where the corpse is usually badly mutilated. Other areas of application include criminalistics, in cases involving abuse of children and elderly.
The scope of forensic dentistry is broad and ever-challenging. Each case is different and even the seemingly routine case may test the dentist's ingenuity in applying his dental knowledge.
Skeletal tissues have a very ancient ancestry in the evolutionary record. The basic chemistry of the calcified tissues like bone and tooth is fundamentally the same, although they differ in their mode of growth and microstructure. Tooth (pl. teeth), Dentes in Latin, is present in the oral cavity and it is the hardest calcified tissue in the human body. Tooth enamel is rather specialized and differs from the other calcified tissues in that it is more crystalline and has a negligible organic content. Healthy enamel has zero porosity, apart from occasional growth defects. Although there has been little or no investigation of the porosity of tooth dentine, it is clear that its porosity is low compared with that of bone. Because of the absence of a vascular network in tooth dentine, its relatively low porosity, and the hard shell of impervious enamel that covers the exposed crown, it is generally accepted that teeth are less susceptible to diagenesis (changes undergone by skeletal tissues in burial environment) than bones and therefore, they represent a more reliable source of ancient DNA. The only method that can give a totally accurate result for gender determination is the DNA technique, but in many cases it cannot be used. ,,, Recent evidence supports the view that the potential for postmortem and postexcavation contamination of teeth is much lower than for bones. 
Teeth are good material in living and nonliving population for anthropological, genetic, odontologic, and forensic investigations. This is due to the hardness and high resistance of dental tissues to degradation and putrefaction which enable the teeth to survive for longer periods than other human tissues. 
Teeth are the hardest tissue in the human body and therefore they are the tissue that is most resistant to trauma, decomposition, water immersion, chemicals and fire making them an invaluable evidential source. To match these natural requirements, the foreign materials subsequently placed in the mouth by the dental practitioner such as fillings, dentures, crowns, bridges and implants must be equally resistant to the intense mechanical demands placed upon them and therefore their survivability.
Moreover, teeth were found to have greater resistance to high temperatures more than other parts of the skeleton that makes them of great value for forensic identification of burned bodies. 
Sexual dimorphism represents a group of morphologic characteristics that differentiate a male from a female. Among these dimorphic traits, tooth has been evaluated in various populations for its applicability in anthropologic and forensic investigations. The morphological differences of the teeth between males and females have been reported and can be applied to identify the gender from dental remains. 
| Gender determination|| |
First step in human identification is gender determination. Determination of sex using skeletal remains presents a great problem to forensic experts especially when only fragments of the body are recovered. Forensic dentistry can help to determine the sex of the remains by using teeth and skull. Various features of teeth, like morphology, crown size, root lengths etc., are characteristic for male and female sexes. There are also differences in the skull patterns. These will help a forensic odontologist to identify the sex. New developments like PCR amplification etc., will assist in accurately determining the sex of the remains. Forensic odontology plays an important role in establishing the sex of victims with bodies mutilated beyond recognition due to major mass disasters.
| Gender determination methods|| |
Size of tooth
Teeth may be used for differentiating sex by measuring their mesiodistal and buccolingual dimensions.  This is of special importance in young individuals where skeletal secondary sexual characters have not yet developed. Studies show significant differences between male and female permanent and deciduous tooth crown dimension. One is reminded that tooth size or odontometrics, is under considerable influence of the environment. Such measurements are, therefore, population specific, and do not apply to the world at large.
Amongst teeth, mandibular canines show greatest dimensional difference with larger teeth in males than in females. Premolars, first and second molars, as well as maxillary incisors, are also show differences.  In a study on the mesio-distal crown diameter of permanent teeth of aborigines (Australian race of people), sex differences in tooth sizes were observed, and the mandibular canines showed the most marked difference.  Doris et al., reported that the early permanent dentitions provide the best sample for tooth size measurements because early adulthood dentition has less mutilation and less attrition in most individuals.  Richardson and Malhotra found that teeth of males tend to be larger than those of females for each type of tooth in both the arches.  Lund et al., investigated the accuracy of gender prediction using odontometric analysis and found maxillary canine usefulness in gender determination. 
Permanent canine teeth and their intercanine distance contribute to sex identification through the dimorphism. The dimensions of canine teeth have been studied by several methods, including Fourier analysis (Minzuno, 1990), Moire topography (Suzuki et al., 1984) and the measurement of linear dimensions such as mesiodistal width, Buccolingual width and inciso-cervical height.
Various theories have been given to explain canine dimorphism. First theory states that according to Moss, there is a greater thickness of enamel in males due to long period of amelogenesis and slower rate of maturation of teeth than in females, whereas according to second theory Y chromosomes cause a slower maturation of enamel in males. 
In the study of Saudi Arabian sample of 503 school children by Al-Rifaiy et al. showed that the mean values for left and right maxillary and mandibular canines, the mesiodistal width was less for females than for males, with no statistically significant differences.  Abdullah et al. in his study on Saudi Arabian population observed the mean mesiodistal width of maxillary canines were greater in males than females but not statistically significant. 
A study by Anderson and Thompson  showed that mandibular canine width and inter-canine distance was greater in males than in females and permitted accurate differentiation between the sexes in 74% of cases. Garn et al.  studied sexual dimorphism by measuring the Mesiodistal width of canine teeth in different ethnic groups. Furthermore, the mandibular canine showed a greater degree of sexual dimorphism than the maxillary canine. Rao et al.  reported that the mesiodistal width of mandibular canines was significantly greater in males than in females. Parikh et al. reported that the most sensitive predictors for gender determination were the mandibular inter-canine distance and canine index. Mandibular canine teeth showed significant and consistent results of sexual dimorphism and hence can be used as an adjunct along with other procedures for sex determination. 
Root length and crown diameter
Morphological features of the tooth crown or root, which create a difference between men and women may appear due to different thicknesses of the enamel. However, these features are neither permanent nor always reliable, and can be population-specific. 
Using optical scanner and radiogrammetric measurements on mandibular permanent teeth sex determination can be done with 80% accuracy by measuring root length and crown diameters. 
In addition to absolute tooth size, tooth proportions have been suggested for differentiating the sexes.
Aitchison presented the "incisor index" (Ii), which is calculated by the formula:
Ii = [MDI2/MDI1] Χ100,
where MDI2 is the maximum mesiodistal diameter of the maxillary lateral incisor and MDI1 is the maximum mesiodistal diameter of the central incisor. This index is higher in males, confirming the suggestion of Schrantz and Bartha that the lateral incisor is distinctly smaller than the central incisor in females.
Another index, the "mandibular canine index" proposed by Rao et al. associates have given an accurate indication of sex in the Indian population. Using the mesiodistal (m-d) dimension of the mandibular canines, these researchers obtained the formula:
[(Mean m-d canine dimension + (Mean m-d canine dimension in female + standard deviation [SD]) in males − SD)]/2.
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. The success rate of determining sex using the above formula was close to 89%. However, relative to the near 100% accuracy using pelvis and skull, sexing by odontometrics is relatively poor
The odontometric difference between males and females is generally explained as a result of greater genetic expression in males. 
Lakhanpal et al., reported that males have larger teeth than females and dimension is a good gender predictor than buccolingual dimension. Due to the difficulty in measuring the mesiodistal dimensions due to close proximal contacts, there may be a discrepancy in its measurement. So including both the dimensions for gender determination would be better and more reliable. 
Hemani et al. who used tooth dimensions for gender prediction reported that among the maxillary and mandibular teeth, mesiodistal dimension of mandibular canine showed more significance in gender determination. 
Acharya and Mainali observed that mesiodistal dimensions had recognizably greater accuracy in gender identification than buccolingual measurements in Nepalese population. However, higher accuracy levels have been obtained when both types of dimensions were used concurrently. 
Ruengdit et al. observed that buccolingual dimension of upper left second molar exhibited the highest degree of sexual dimorphism, and the canines were in the second level. In our study, we found that upper first premolar exhibited higher degree of sexual dimorphism. Canine stands second in both the studies. 
Tooth morphology and sexing
The most common morphological characteristic of the tooth which differentiates men from women is the so-called deflecting wrinkle which represents a variation of the medial ridge on the mesio-lingual cusp of the first lower molar, wherein the ridge deflects towards the disto-lingual cusp. The existence of this wrinkle is a feature that only appears in men. Among the acquired morphological characteristics, which differentiate men from women, tooth abrasion is the most important. Due to stronger masticatory muscles and greater masticatory forces, men experience more tooth wear than women, which may lead to a lowered tooth crown height.  Distal accessory ridge, a nonmetric feature on the canine is the most sexually dimorphic crown trait in the human dentition, with males showing significantly higher frequencies and more pronounced expression than females. 
Clinical method is a simple and rapid method for gender determination. The visual or clinical method provides only minor details in gender prediction, and they can act only as adjuncts to other methods of gender prediction using teeth and are not highly reliable. Reliability of visual method is compromised due to factors like regressive alterations of teeth, aging, defect in enamel and dentin formation due to syndrome association, nutritional and environmental causes and so on. Clinical method is useful when other methods of gender prediction cannot be performed.
Sex can also be determined by the study of X and Y chromosomes in the cells that are not undergoing active division. Presence or absence of X chromosome can be studied from buccal smears, skin biopsy, blood, cartilage, hair root sheath, and tooth pulp. After death, it persists for variable periods depending upon the humidity and temperature in which tissue has remained. X chromatin and intra-nuclear structure is also known as Barr body as it was first discovered by Barr et al. It is present as a mass usually lying against the nuclear membrane in the females.  In a study carried out by Das et al.  it has been shown that up to a period of 4 weeks after death we can determine the sex accurately from the study of X and Y chromosomes keeping in view the variation of temperature and humidity.
Whittaker et al. determined sex from necrotic pulp tissue stained by quinacrine mustard using fluorescent Y chromosome test for maleness and claimed that up to 5 weeks sex determination can be done with high degree of accuracy. It was found that in cases after fires, high impact crashes and explosions fragmentation and thermal trauma renders other methods impossible to determine the sex of the remains except the above said method from pulp. Pulp tissue cells become embedded firmly into the dried fibrosis matrix. Duffy et al.  have shown that Barr bodies and F bodies of Y chromosomes are preserved in dehydrated pulp tissues up to 1-year and pulp tissues retain sex diagnostic characteristics when heated up to 100C for 1 h.
Polymerase chain reaction
Polymerase chain reaction (PCR) is a method of amplifying small quantities of relatively short target sequences of DNA using sequence-specific oligonucleotide primers and thermostableTaq DNA polymerase.  The teeth can withstand high temperature and are used for personal identification in forensic medicine. In the case of few teeth or missing dental records, there is not enough information to identify the person. The dental pulp enclosed by the hard tissue is not influenced by temperature, unlike the buccal mucous membrane, saliva, and calculus.
A procedure utilizing Chelex 100, chelating resin, was adapted to extract DNA from dental pulp. The procedure was simple and rapid, involved no organic solvents, and did not require multiple tube transfers. The extraction of DNA from dental pulp using this method was as efficient, or more so, than using proteinase K and phenol-chloroform extraction. In a study by Tsuchimochi et al., they used Chelex method to extract DNA from the dental pulp and amplified it with PCR and typing at Y-chromosomal loci to determine the effects of temperature on the sex determination of the teeth. Das et al., studied that the sex can be determined from pulpal tissue in living as well as dead. By studying 100 case, 50 males and 50 females subjecting the teeth to different temperatures. A join search for the presence or absence of Barr bodies and F-bodies was also made to establish the sex from the human tooth pulp tissue.  Hanaoka and Minaguchi  conducted a study to determine sex from blood and teeth by PCR amplification of the alphoid satellite family using amplification of X (131 bp) and Y (172 bp) specific sequences in males and Y specific sequences in females. It was showed to be a useful method in determining the sex of an individual. Sivagami et al. prepared DNA from teeth by ultra-sonication, and subsequent PCR amplification, they obtained 100% success in determining the sex of the individual. Malaver and Yunis.  reported that pulp produced strongest PCR amplification signals while dentin and cementum signals were very similar to each other. In which 20 teeth were obtained from unidentified bodies buried in 1995 and exhumed in 2000, providing 45 DNA samples (5 from pulp, 20 from dentin and 20 from cementum).
| Amelogenin|| |
Amelogenin or AMEL is a major matrix proteins found in the human enamel. Amelogenin is a low-molecular-weight protein found in developing tooth enamel, and it belongs to a family of extracellular matrix proteins. Developing enamel contains about 30% protein, and 90% of this is comprised of amelogenins. In the early stages of tooth development, internal enamel epithelial cells differentiate into ameloblasts, which synthesize and secrete specific proteins as enamel matrix. Protein concentrations are as high as 25-30% can be found in newly-secreted enamel. The matrix proteins then decrease during the maturation of the enamel and are replaced by apatite crystals. These proteins are thought to play important roles in the process of enamel mineralization.
There are two classes of proteins in the early enamel, amelogenin and enamelin. Amelogenin, which was termed by Eastoe is a discrete and major constituent unique to the developing enamel.  This protein contains high concentrations of proline, glutamine, leukine and histidine. Amelogenin is now well-characterized from amino acid sequencing data and the gene structure. Another protein, enamelin, termed by Termine et al. is a minor protein component present in a form associated with the mineral phase in the developing enamel. 
It has a different signature (or size and pattern of the nucleotide sequence) in male and female enamel. The AMEL gene that encodes for female amelogenin is located on the X chromosome and AMEL gene that encodes for male amelogenin is located on the Y chromosome. 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. 
Both microscopic method and advanced method are highly reliable in gender determination using the dentition. The use of microscopic and advanced method in gender prediction is expensive, time-consuming, laborious technique of DNA isolation when compared with clinical methods of gender determination. In addition, there are common problems with DNA analysis from human remains due to decomposition and exposure to environmental factors such as high temperatures, humidity, and many organic compounds may result in DNA degradation. Thus, the need for experts in DNA identification highlights the need for clinical method. Hence, the role of clinical, microscopic and advanced method is equally important in gender prediction when anyone of the method is not applicable due to inevitable circumstances.
| Conclusion|| |
Dentition guides in determination of gender where skeletal remains present a great problem to forensic experts, especially when only fragments of the body are recovered. Thus, dentition plays a major role in identifying the gender of an individual.
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