Dental Age Estimation

Introduction:

The romans are believed dental age estimation to determine

if an individual had reached the age for military

conscription through the evaluation of the eruption of the

second permanent molars (Müller, 1990).

However, age estimation as a scientifically researched

component of the forensic sciences is relatively new.

 introduction

The British penal code and child labor laws of the early 1800s

began legal interest in estimating the chronologic age of children.

 During this period of time, the penal code presumed that an

individual below age 7 did not have the capacity to commit a crime;
but, individuals over the age of 7 that were convicted of even minor

crimes were often severely punished by the state (Miles, 1963a).

Because birth certificates were not issued and birth registration was

not required, there was often difficulty in providing evidence of true

chronologic age.
 Introduction

In 1836, a medicolegal expert by the name of Thomson began suggesting

that the dentition could be useful in the assessment of age in children.

 He stated that if the first permanent molar “hath not protruded, there can

be no hesitation in affirming that the culprit has not passed his seventh
year” (Thomson, 1836).
Need for age assessment continued as a result of the factory acts.

 The Factory Act of 1833 forced the textile industry to conform to a

uniformly established workday for individuals under the age of 18

defined as beginning at 5:30 AM and ending at 8:30 PM.
 Purpose and value

In today’s society, the purpose and value of forensic dental age estimation has

expanded to meet a variety of medicolegal needs such as providing an estimated age

at death.

 With over 40,000 unidentified bodies and 100,000 missing individuals at any given

time in the United States alone, age estimation significantly narrows the search

possibilities for law enforcement.

 In mass disaster and cluster victim situations, age segregation aids in the process of

identification.

Then there is forensic application to aid authorities in determining eligibility for

social benefits, the age of license and age of legal majority.

 Scientific Rationale

The evaluation of dental tissue has long been regarded as a good

tool for the assessment of age, and therefore, age estimation

techniques involving these tissues have been widely used by
forensic odontologists and anthropologists.
The rationale for scientific evaluation of dental tissues for age

estimation can be divided into three criteria:

 tooth formation and growth changes,

postformation changes, and

biochemical changes
 Scientific Rationale
Tooth formation and growth changes:

Tooth formation and growth changes involve the progressive

morphological development of the crown, root and apex of any

given tooth and/or its timed emergence and eruption sequence.

An advantage of tooth formation and growth techniques is that they

are noninvasive with age assessment easily accomplished through

visual and radiographic examination.

 Scientific Rationale

Tooth formation and growth changes:.

 Additionally, tooth development techniques are classically

“thought to be the most accurate and reliable way of correlating

growth and development” to age (Taylor and Blenkin, 2010,).
 Through the development of tooth maturation stages, or

intervals, and correlating those stages to chronologic age,

researchers have developed dental age estimation techniques.
 Scientific Rationale

There are multiple staging systems that have been proposed and

it is imperative that the forensic scientist always be mindful to

utilize the appropriate staging system that is associated with a
given study’s data set.
Because tooth development is a maturation process, techniques

that utilize this rationale are reserved for cases involving fetuses,
infants, children, and adolescents.
 Naturally as an adolescent individual approaches adulthood,

they also approach the end of dental and skeletal development.

 Scientific Rationale

Tooth formation and growth changes:

Once dental and skeletal growth has ceased, forensic dental

investigators must use a technique that involves either

biochemical tooth changes or dental postformation changes to
assess age.
There are two biochemical dental age estimation techniques:

aspartic acid racemization and carbon-14 dating.

They are both lab techniques that involve the sacrifice of tooth

structure and are expensive and time consuming.

 Scientific Rationale

Postformation changes:
 Are adult dental considerations and can be subdivided into gross

anatomical and histological changes.

 The gross anatomical changes include but are not limited to

attrition, periodontal condition, apical root resorption, pulpal size

to tooth size ratios (two dimensional and volumetric), root
smoothness, and dentin coloration.
 The histological changes include secondary dentin apposition,

cementum apposition, and dentin transparency.

 Age Estimation Tools

 Classically, the tools for dental age estimation included calipers, rulers,
tooth sectioning wheels and disks, loops, and microscopes for
magnification.
They are still useful today, but technology has provided us a number of

extraordinary tools.
Digital microscopes are becoming inexpensive and not only enhance

one’s ability to discern minute detail but can photograph an object with
visual and alternate light sources.
These images can be imported into computer imaging software

substantially improving acuity.

 Age Estimation Tools

 To utilize these tools, the forensic odontologist must become familiar and
proficient with their own imaging software.

 Useful photographic enhancement functions include image enlargement,

adjusting image levels, brightness, contrast, and saturation.

 Sometimes, using the invert function to view the image as a negative will also

reveal detail previously unnoticed.

 But there are more benefits provided by imaging software in addition to image

enhancement.

 Images can be rotated into a desired structural orientation and software

measurement tools are more accurate than handheld calipers.

 Fetal Dental Age Estimation

Because embryonic tooth development begins early in fetal development

and the degree of morphologic enamel mineralization is easily viewed

radiographically,
 the dentition is an excellent indicator of age soon after conception.

 for the primary and permanent human dentition (Nelson and Ash, 2010,

23, 36–37).
In this chart, the times indicated for initial primary tooth mineralization

are expressed in terms of weeks in utero while primary crown and root
completion times and all permanent tooth development times are
expressed in months and years from birth.
 Fetal Dental Age Estimation

Developmental histological changes in teeth are also useful in fetal age

assessment.
Enamel formation results from ameloblast cell secretion of enamel

proteins that later mineralize and form enamel rods.

 During the mineralization phase, the ameloblasts produce the enamel

matrix at a rate of approximately 4μm/day;

 however, there is a rhythmic variation in the calcification process every 4

days.
 As a result, incremental growth lines known as the striae of Retzius

appear microscopically within the enamel.

 Fetal Dental Age Estimation

In cross-section, these lines resemble concentric bands parallel to

the dentoenamel junction (Copenhaver et al., 1978, 461–465).

 Whenever a systemic disturbance occurs the enamel

mineralization process is interrupted and the currently developing

striae will appear darker.
The darkest and largest incremental growth line seen in the

deciduous teeth is called the neonatal line and is caused by the

stress and physiologic changes at birth (Bath- Balogh and
Fehrenbach, 2006, 186).
 Fetal Dental Age Estimation

 When present, the neonatal line can be used to distinguish

whether a child died before or after birth.

Furthermore, counting the incremental growth lines that form

subsequent to the neonatal line may approximate how long a

child lived after birth.
 Because, the neonatal line does not form immediately at birth

but rather takes a few days to a week to form, caution should be

exercised in making absolute statements of death prior to birth.
 Child Dental Age Estimation

Although all techniques available should be considered,

dental age estimation techniques involving tooth

maturation have long been established as the most
accurate indicators of chronologic age in subadults.
 Early in life, genetic factors predominate and

environmental factors tend to have minimal effects on

tooth maturation.
This is especially true between birth and age 10.
 Child Dental Age Estimations

Dental age estimation techniques in children can be

subdivided into two categories:

 atlas style—a diagrammatic representation of the developing

tooth structures with their associated eruption pattern;

 and, techniques that require some form of incremental

staging of the developing teeth.

 All techniques in both categories rely on high-quality

radiographic imaging to access dental development.

 Child Dental Age Estimation

All atlas style techniques have some inherent problems. They are not sex

differentiated,
 resulting in a high degree of variability particularly from midchildhood

through adolescence.
 With DNA testing now available and affordable, sex differentiation of

skeletal remains is possible.

 Additionally, there are not enough ancestral and population specific studies.

The most concerning problem is that atlas style techniques tend to have a

relatively higher degree of interobserver disagreement and a larger error rate

than other tooth formation and development techniques
 Child Dental Age Estimation

The incremental staging techniques utilize noninvasive radiographic

analysis to measure dental development or deciduous tooth resorption

according to technique-
specific systems that contain diagrammatic and written descriptors of an

individual tooth’s morphology.

The classic deciduous tooth exfoliation technique study (Moorrees et al.,

1963a) evaluated the primary tooth resorption of the mandibular cuspids,

 first molars, and second molars from a group of healthy, white Ohio

children from an average socioeconomic background.

 Child Dental Age Estimation

Four stages of tooth resorption were described:

 ¼ resorption,

½ resorption,

 ¾ resorption,

 and exfoliation.

 Average age estimation data with standard deviation is provided by

the individual tooth’s stage in a tabular form for males and females.
 This data provides useful information between the 5 and 12 years

of age.
 Child Dental Age Estimation

arches, and for both sexes.

• An important finding of this study was the order of variability

in specific tooth development for males and females.

• According to Anderson, variability decreases as follows:

• Males: First Bicuspid and Third Molars > Second Bicuspid

and Second Molars > Cuspid > Incisors > First Molar.
• Females: Third Molars > Second Molars > Cuspid and

Bicuspids > Incisors > First Molar.

 Child Dental Age Estimation

It should be noted that the first molar consistently provides

the most accurate results.

Because the data from the Anderson study begins later in

life than the age assessment data in the Moorrees et al.

 study, it is considered an alternative study to Moorrees et al.

 and should be considered in later childhood and early

adolescence.
 Child Dental Age Estimation

Demirjian (Demirjian et al., 1973;

 Demirjian and Goldstein, 1976) produced a more simplified

staging system.
The chart consists of eight stages, A through H, that define

morphological tooth development beginning at the first

radiographic appearance of mineralization to complete closure of
the root apex.
This technique requires the evaluation and staging of the entire

mandibular left quadrant excluding the third molar.

 Child Dental Age Estimation
Demirjian stages
Child Dental Age Estimation
 Child Dental Age Estimation

The mandibular arch was selected because of the better clarity of radiographic

images in comparison to maxillary imagery as a result of superimposing dental

and cranial anatomy.
 It is permissible to utilize a portion or all of the dentition on the mandibular

right when the contra-lateral teeth are missing, malformed, rotated, or difficult
to stage for any reason.
Once all teeth have been staged, each tooth is assigned a “self-weighted score”

based its staging designation and gender of the individual.

 The seven self-weighted scores from each tooth are then summed to give a

“maturity score.”
 Child Dental Age Estimation

The maturity score is cross-referenced in a gender-specific

table converting the score to corresponding age.

The study also provides graphical data that allow for the

maturity score to express the age interval at the 10th and

90th percentiles.
 Statistical data from this study was derived from the

panoramic dental radiographs of 1446 boys and 1482 girls

of French Canadian ancestry.
 Child Dental Age Estimation

This system of age estimation has been applied to a numerous other

populations worldwide including but not limited to South Indian

(Koshy and Tandon, 1998),

 Norwegian (Nykänen et al., 1998), Finnish (Nyström et al., 1986;

Chaillet et al., 2004),

 Belgian (Willems et al., 2001), Dutch (Leurs et al., 2005),

 and Australian (Blenkin and Evans, 2010).

 Child Dental Age Estimation

Both the Moorrees and Demirjian methods provide acceptable age estimations of children

and should be utilized, and results reported where applicable.

Although the Demirjian technique does have more population specific studies available,

the technique can be problematic particularly in cases that involve fragmented remains or

where a tooth is bilaterally missing or malformed.

 Furthermore, the Demirjian technique inherently assigns equal weight to each tooth in the

age estimation process in contrast to Moorrees et al.

 where the data is tooth specific. Moorrees also provides a full range of age estimation

data beginning at birth where most Demirjian population studies begin to assess age

between 2 and 3 years.