Decayed, filled and missing teeth as a forensic-odontologic aid for determining the age above 18 years: A radiographic study of orthopantomograms from a group of teenagers and young adults

The human teeth are a valuable source of information concerning identification and age calculation in forensic sciences. Dental treatment often causes permanent alteration of the teeth, which is visible on radiographs. The correlation of decayed, missing or filled teeth and chronological age has not yet been used for determining the accomplished 18th year of life in teenagers and young adults, e. g. for legal and anthropological purposes. The aim of this study was to determine whether the evaluation of these findings on radiographs correlates with the chronological age in teenagers and young adults. MATERIAL AND METHODS: The dental X-rays (orthopantomograms, OPG) of 1053 outpatients (age: 14 to 24 years) were evaluated. The values "decayed", "missing", or "filled" were recorded for each tooth present. The data were then calculated using statistical tools. RESULTS: The correlation between the number of missing teeth and the chronological age is low. However, the positive predictive value of determining the age of 18 years for certain types of teeth proved to be very high, even up to 100 %. Further, high numbers of filled teeth gave reasonable positive predictive values for an age of 18 years. The number of decayed teeth did not correlate with age. DISCUSSION: This study provides for the first time predictive values for the estimation whether a person is 18 years of age, based on the evaluation of decayed, missing or filled teeth on OPGs only. Whereas the number of patients with such findings is generally low in this age group, some of the positive findings can be used for age estimation as an adjunct to other sources of age calculation. The sole application of these items is not recommended, as sanitary conditions of the teeth depend on both social and individual circumstances. Therefore, the calculated values also reflect the culture of the sample studied. Finally, they are time-dependent and have to be compared to data from other populations. These results have some bearing on the field of forensic odontology.     

中国汉族女性青少年法医学活体骨龄推断数学模型的建立

目的建立推断中国汉族女性青少年活体骨龄的数学模型。方法摄取华中、华南及华东等地区的838名年龄介于11～20周岁正常女性青少年双侧锁骨胸骨端以及左侧肩、肘、腕、髋、膝、踝关节的X线片。依据青少年骨发育分级标准对24项骨骼发育指标进行阅片、分级,结合考虑身高、体质量及地区等影响因素．应用SAS8．1及SPSS11．0软件进行统计学处理,探索各指标与年龄的相关性。结果建立了我国汉族女性青少年利用锁骨胸骨端及6大关节骨骺闭合程度联合推断活体年龄的多元回归数学模型．推导出判定我国汉族女性青少年是否已满14、16和18周岁的Fisher’S两类判别分析方程。结论本研究所建立的判定活体年龄的数学模型丰富了活体年龄的法医学鉴定方法,有利于提高活体骨龄鉴定方法的科学性和结论的准确性。     

The use of quantitative light-induced fluorescence (QLF) to identify composite restorations in forensic examinations

There has been a large increase in the number of tooth colored restorations "white fillings" placed in recent years. An increased demand from the public for more aesthetic dental restorations causes a potential problem for forensic dentists who may find the fillings difficult to identify and hence include in postmortem odontograms. This has implications for the accuracy of dental identifications, particularly in situations where limited time is available for postmortem identification, e.g., mass casualty incidents. A new method for the detection of composite restorations is presented. Quantitative Light-induced Fluorescence (QLF) is a technique currently employed to detect small changes in enamel mineral content. An experiment was conducted to determine if the technique would afford a greater degree of contrast between composite and enamel and thus enable the accuracy of composite identification in enamel. Twenty-four previously extracted human premolars were gently cleaned with pumice and wet-and-dry paper. Twelve were subsequently randomly selected and restored on their buccal surfaces with Spectrum (a composite) following manufacturer's instructions. No attempt was made to color match the teeth and all were filled with shade B3. Twelve teeth were left unrestored. QLF and normal white light images were taken of both restored and non-restored surfaces with teeth wet and then dried. Ten forensic dentists were asked on two separate occasions (one month between each attempt) to indicate whether or not they thought the surface was: a) restored or b) unrestored. Results indicate that forensic dentists detected a significantly higher proportion (p<0.005) of filled surfaces with QLF.     

Variations in pulp/tooth area ratio as an indicator of age: a preliminary study

This paper details a method for age determination of adults from single rooted teeth. The sample consisted of 100 Italian white Caucasian patients (46 men, 54 women) aged between 18 and 72 years. The single rooted maxillary right canine was utilized in this preliminary study. Pulp/root ration, tooth length, pulp/tooth length ratio, pulp/tooth area and pulp/root width ratios at three different levels were computed. Pearson's correlation coefficients between age and these variables showed that the ratio between pulp and tooth area correlated best with age (r2 = 0.85). Stepwise multiple regression models yielded a linear relationship between pulp/root width at mid-root level and chronological age and a linear relationship when pulp/tooth area was compared to age. Statistical analysis indicated that these two variables explain 84.9% of variations in estimated chronological age. The median of the absolute value of residual errors between actual and estimated ages was less than four years.     

四川省阿坝地区藏族青少年膝关节骨发育趋势

目的探讨四川省藏族青少年膝关节骨发育趋势,更新利用膝关节骨龄推断我国藏族青少年活体年龄的数据资料。方法在我国四川省阿坝地区调查483例14~19周岁藏族男、女性青少年膝关节X线片,选取股骨远端、胫骨近端及腓骨近端骨骺作为骨骼发育指标,观察骨骺发育情况,并运用SPSS 16.0统计学软件计算出青少年膝关节骨骺闭合年龄的描述性数据。结果膝关节中,闭合最早的骨骺是股骨远端骨骺,闭合最晚的是腓骨近端骨骺,其中女性青少年膝关节骨骺发育较男性提前约1岁左右。结论应用于法医学活体骨龄鉴定的藏族青少年相关数据资料应定期更新。本研究结果可为法医学、人类学及临床医学等相关学科在进行骨龄评价时提供参考。     

Radiographic survey of third molar development in relation to chronological age among Japanese juveniles

The aim of the present study was to establish Japanese reference material on the third molar development of Japanese juveniles for forensic application. Observations were performed on the orthopantomograms of 1282 Japanese patients between the ages of 14.0 and 24.0 years. Demirjian formation stages of the maxillary and mandibular third molars were recorded for chronological evaluation of wisdom teeth and applied for further statistical analysis. Statistically significant differences were noted between the upper and lower jaws and genders. Accordingly, males achieved root developmental grades earlier than females. We assessed the mean ages for all formation grades and predicted the probability that a Japanese juvenile would be older than the relevant ages of 14, 16, and 20 as defined by Japanese Juvenile Law. We determined the likelihood that a Japanese youth is older than the relevant age of 18 as defined by legislation in the United States.     

中国汉族6-18周岁男性牙齿生长发育的年龄研究

目的研究牙齿钙化程度与年龄的关系,建立利用牙齿钙化程度推断中国汉族6～18周岁男性年龄的办程。方法通过对6568名6～18周岁汉族男性全口曲面断层影像上牙齿的钙化程度进行评分;将分级值及其对应年龄输入SPSS软件进行分析,建立推断年龄的方程模型;从研究样本外随机抽取已知年龄的样本160例进行卣测,,结果同名牙齿钙化评分值侧别间秩合检验结果P〉0．05;下颌左侧恒牙钙化评分值与年龄相关分析结果r值均存0．7以上,下颌同名牙间相关系数r均在0．9以上;所建回归模型拟合优度R^2=0．828,估计值标准误为1．23岁;阿测平均洪差为0．423±0．269岁。结论本研究所建立的方法准确可靠,可用于中国汉族6～18周岁男性人群的年龄推断。     

Epidemiology, etiology, and prevention of multiple sclerosis. Hypothesis and fact

Slow, retrograde seepage of ionic mercury from root canal or Class V amalgam fillings inserted many years previously, recurrent caries and corrosion around filling edges, and the oxidizing effect of the purulent response may lead to multiple sclerosis in middle age. Epidemiologic studies of MS consistently reveal more neurological disease in the north, inferentially because there may be less caries and therefore fewer fillings done in the south. Clinical and epidemiologic data also suggest that a second heavy metal, lead, may operate almost interchangeably with mercury. Possibly, cases of unilateral MS derive from mercury-amalgam fillings in ipsolateral teeth, whereas the generalized disease may result from ingestion or inhalation of volatile mercury or exhaust fumes of lead additives to gasoline. The forensic and preventive-medical challenge is to identify, monitor, and resolve questions of hidden heavy metal hazards in a high technology society, especially those of lead and mercury. Further clinical-epidemiologic and basic science studies of heavy metal assays in whole blood, CNS tissues, packed cells, and serum are warranted. Prevention awaits further testing of the hypothesis and experience with substitute filling materials.     

The value of examination aids in victim identification: a retrospective study of an airplane crash in Nepal in 2002

After the crash of an airplane in Nepal in the year 2002, the dental status of the 14 European victims was examined at autopsy as well as after additional removal of the soft tissue and compared with antemortem findings which were available in 11 cases. Re-examination of all jaws showed that nine composite fillings and seven root fillings as well as one parapulpal pin could not be detected during autopsy. Because tooth-coloured restorations may be overseen even by an experienced expert, the findings underline the necessity of performing a full resection of both jaws and removal of the soft tissue. Furthermore, X-ray analysis of the jaws and the use of phosphoric acid or ultra violet radiation for recognizing tooth-coloured restorations are recommended.     

Age estimation in children by measurement of open apices in tooth roots: Study of a Mexican sample

The aim of this cross-sectional study was to test the accuracy of Cameriere's European formula for age assessment in a large sample of Mexican children. The accuracy of dental age estimation was defined as how closely real age, measured as the difference between chronological age (CA) and dental age (DA), could be predicted. Digitalized orthopantomographs of 502 Mexican children (254 girls and 248 boys), aged between 5 and 15 years, were analyzed. The seven left permanent mandibular teeth were evaluated using Cameriere's method. Intra- and inter-observer variability for this technique was tested on a small random sample. Dental age was estimated for each individual and compared with known chronological age. Accuracy was measured as the difference between known chronological age and dental age and tested for significance with the mean prediction error (ME). The standard deviation and 95% confidence interval of the mean difference were also calculated. ME was 0.63 years for girls and 0.52 years for boys. ME was found to be slightly overestimated by 0.10 years for girls, but was correctly estimated for boys with an accuracy of 0.00. In conclusion, this method is very useful and may be recommended for practical application both in clinical dentistry and forensic procedures on the Mexican population.     

Comparative study of Greulich and Pyle Atlas and Maturos 4.0 program for age estimation in a Portuguese sample

Age estimation of living individuals has become one of the big issues of forensic anthropology. The increase of children and adolescents with no valid proof of their chronological age is a legal concern to many countries, especially in situations of illegal immigration, sub adult delinquency and juvenile work. For this purpose, the use of radiological methods for evaluation of skeletal maturation is particularly useful. In this study we compare the two of the most common methods applied in age estimation by hand/wrist radiographs: the Radiographic Atlas of Skeletal Development of the Hand and Wrist made by Greulich and Pyle (GP), 1959,and the Sempé method developed for computer--Maturos 4.0 (MT) program. These methods were applied to a sample of 230 radiographs of the hand and wrist from Portuguese children and adolescents of known sex age and age, aged between 12 and 20 years, who performed medical examination at the University of Coimbra Hospitals during 2005. The methods achieved different performances, depending on the age group. Between 12 and 15 years the bone age with the MT program is closer to the chronological age, whereas in older ages the GP Atlas method is more trustworthy. At the ages with legal consequences in Portugal (16 and 18 years) the GP Atlas method is most accurate, namely to decide whether an individual is younger or older than 18 years. Around 16 years old, although there are doubts in relation to the accuracy of both methods, GP Atlas seems to perform better.     

RUS-CHN图谱骨龄评价法用于推侧青少年年龄

目的探讨RUS-CHN(RC)图谱评价法用于13~18岁青少年年龄推侧的应用价值。方法4 424名(男2 272,女2 152)13~18岁正常城市汉族青少年,以简化RUS-CHN法建立手腕骨发育等级图谱。另以1 048名(男530,女518)13~18岁青少年为检验样本,比较不同方法骨龄与生活年龄的差异。结果RUS-CHN图谱法可仅评价桡骨、尺骨远端和第III指的4块掌指骨骺。检验样本中男14~17岁、女13~16岁年龄组,RC图谱法骨龄与生活年龄之间的差异均无统计学显著性(W ilcoxon符号秩和检验,P>0.05),对男18岁、女17岁组出现显著性差异的可能原因进行了讨论。结论RUS-CHN图谱法骨龄适用于男13~18岁、女13~17岁青少年的年龄推测。     

Age of attainment of mineralization stages of the permanent dentition.

The ages at which the maxillary and mandibular teeth of 121 boys and 111 girls reached 14 mineralization stages were determined from serial cephalograms at the Burlington Growth Centre. The present data are more comprehensive than any previously available and can be applied to chronological age determinations in juveniles of indefinite age, and of specimens in anthropological and forensic investigations. The sexes differed in the age at which they attained the stages of mineralization, with the canines demonstrating the greatest difference. In each sex, the ages at identical stages were similar for the corresponding teeth in the maxilla and mandible. Variability in age was greater among the males, especially for the first premolars, and increased with age, except for the third molars. Variability in age of third molar mineralization was greater in females and diminished among both sexes at late stages of root formation.     

Measuring the distance of the wisdom teeth from the occlusal plane as forensic-odontological method for chronological age determination

As part of an epidemiological study on tooth eruption it was attempted to define easily accessible criteria for age estimation in living human beings based on the distance of the wisdom teeth from the occlusal plane. 253 cast models of 149 female and 104 male patients were used for evaluation. Due to the great variability observed in the eruption of the wisdom teeth, only a small fraction of the total number of 10,924 cast models was suitable for investigation. Only teeth with the axis being perpendicular to the plane of occlusion during eruption according to radiological and clinical findings were included. After defining these inclusion criteria, the distance of the wisdom teeth from the plane of occlusion was determined and correlated to the age of the subjects. The results confirmed the known large variability concerning wisdom tooth eruption and did not show any reliable relation between age and distance values. Nevertheless, a remarkable finding that may be relevant for forensic odontostomatology was seen in one case where the lower wisdom teeth were taller than the occlusal plane, although the female patient was younger than 14 years. The upper molars were retained and root development was incomplete.     

Usefulness of combining clinical and radiological dental findings for a more accurate noninvasive age estimation

The aim of this study was to establish correlations of clinical and radiological dental findings, alone or in combination, with chronological age in adults. Dental findings and orthopantomograms of 984 patients (aged 20-60 years; 524 females/460 males) were analyzed. DMF-T index and distance (alveolar bone level, ABL) between cemento-enamel junction and alveolar bone margin were recorded. Additionally, clinical and radiological findings at each tooth crown and root were collected according to the actual status of destruction and restoration, and a total score for each dentition (TSD) was calculated. After univariate correlation analysis, correlation coefficients for ABL and TSD were improved by using square root (sqrt). However, the determination accuracy was still not satisfactory; 90% of the residuals were in the range of about +/-10. The present study showed that clinical and radiological dental findings could not be used, not even in combination, for accurate age estimation as a single method, but that they could support other methods.     

Forensic medical diagnostics of chronic alcoholic intoxication based on the measurement of bone mineral density in the postcranial skeleton and periodontal complex

The objective of this work was to develop forensic medical criteria for the diagnostics of chronic alcoholic intoxication based on the measurement of bone mineral density in the postcranial skeleton and periodontal complex. The stomatological status of 380 subjects was evaluated. Two hundred patients regularly consumed alcohol (group 1) and 180 ones practically did not use it (group 2). The stomatological status was evaluated based on the simplified oral hygiene index (OHI-s), the decayed, missing and filled teeth (DMF) index, periodontal index (P1) and the papilla bleeding index (PBI). Bone mineral density was measured by X-ray two-photon absorptiometry. The study demonstrated the relationship between variations of the stomatological status and alcohol abuse. Chronic alcoholic intoxication was associated with marked changes of the stomatological status and the loss of bone mineral density that correlated with the results of the orthopantomographic study. It is concluded that the above observations should be taken into consideration in the practical work of forensic medical experts as additional diagnostic criteria of chronic alcoholic intoxication and alcohol-related death.     

中国汉族6～18周岁女性人群牙齿生长发育的年龄研究

目的研究牙齿钙化程度与年龄的关系,建立利用牙齿推断中国汉族女性人群年龄的方程。方法通过对6923名6～18周岁汉族女性儿童及青少年全口曲面断层影像下颌恒牙的钙化程度进行评分;将分级值及其对应的年龄输入SPSS软件进行分析,最终建立推断年龄的方程模型;从研究样本外随机抽取已知年龄的样本181例进行肓测。结果牙齿钙化评分值与年龄相关分析结果相关系数r均大于0．6,同名牙评分值侧别间统计分析结果P〉0．05且相关系数r均大于0．93,方程拟合优度检验R^2=0．789,估计值标准误为1．28岁,盲测结果与真实年龄的平均误差为0．421±0．272岁。结论本研究所建立的方法在推断中国汉族女性6～18周岁群体年龄方面有良好的应用前景。