Lakota women in the earliest times had a choice of a dress embellished with sewn-down porcupine quills or if they had a successful hunter as a husband, might ornament their dresses with elk teeth. This had a religious meaning since elk were associated with male prowess.

The Lakota said that when an elk dies, in time everything decays, but the ivories of an elk can still be found intact. An elk has two ivories with the male teeth noticeably larger than that of a female.

If there was an ambitious husband, he might hand-carve imitation elk teeth from bone, which was difficult due to its hardness. Because of the effort and time involved, a dress of hand-made teeth was as valuable as those made of real teeth. The girl's blue trade cloth dress has the entire front and back yoke strung with real-looking ivories.

The real elk teeth necklace shown in this picture was formerly worn by a Crow Indian. He undoubtedly was a great hunter, or traded for many of them. Such a person usually was an Elk Dreamer through a vision and this necklace showed his status as one who had power over women.