Research Article

Shekhar Grover1,
Dental Age Estimation of 6-15 Year Old
Tanu Anand2 Indian Children Using Demirjian Method
1
Department of Public
Health Dentistry,
2
Abstract
Department of
Community Medicine, Objective: Assessment of tooth development to estimate the age of living subjects is
Maulana Azad Medical required in various disciplines including pediatric dentistry, orthodontics, and forensic
College, New Delhi
dentistry. The most widely used method is the one given by Demirjian et al. in 1973.
Correspondence to: This method has been tested only a few times in North Indian children, thus the need
Dr. Shekhar Grover, for present study.
Department of Public
Health Dentistry, Maulana Methodology: Seven left mandibular teeth were assessed from 215
Azad Institute of Dental orthopantomograms (OPGs) belonging to healthy children aged 6–15 years randomly
Sciences, B.S. Zafar Marg, selected and were staged according to Demirjian method. Univariate quantitative
New Delhi-110002.
analysis was performed.
E-mail Id: shekhargrover
[email protected] Results: A general over-estimation of 0.61 years was observed (0.66 years – males and
0.56 years – females) (p <0.05). The gender differences were not statistically significant
(p >0.05). Also, younger age groups had a higher amount of overestimation.

Conclusion: The present results support the need for refinement of the population-
specific standards in Demirjian method, for its further application.

Keywords: Age estimation, Chronological age, Dental age, Demirjian method.

Introduction
Dental age determination is required in various clinical and scientific disciplines.1,2 In
certain communities, the chronological age of living people bears significant importance
regarding social benefits, employment and marriage.3 Assessment of tooth
development to estimate the age of living subjects has a long history.4 Individuals may
not have accurate information about their date of birth, or they may choose to
suppress such information. In such circumstances, age determination technique, i.e.,
estimation of chronological age, may be required.5 The main criteria for forensic age
determination in the relevant age group based on odontological examination are tooth
eruption and tooth mineralization, both developmental biological features.

For evaluation of tooth mineralization, various stages classifications have been put
forward.6-8 The most widely used method for comparison between different
populations was first described in 1973 by Demirjian et al.6

The use of Demirjian’s scale has demonstrated differences between several worldwide
How to cite this article: groups,9-11 as well as between geographical areas or cities within the same country.12,13
Grover S, Anand T. Dental This method has been tested scarcely in North Indian children, so little is known about
Age Estimation of 6–15 its applicability in the region.14 For this reason, the aim of this study was to evaluate the
Year Old Indian Children applicability of Demirjian’s method for dental age estimation in North Indian children.
Using Demirjian Method.
Epidem Int 2016; 1(3): 10-
13. Methodology
A cross-sectional study was carried out by estimating the development of teeth in the
ISSN: 2455-7048
mandibular left permanent teeth (central incisor to second molar) in panoramic
radiographs of children aged 6–15 years (with North Indian descent and having parents

© ADR Journals 2016. All Rights Reserved.

Epidem. Int. 2016; 1(3) Grover S et al.

of same ethnicity). The study involved 215 radiographs. panoramic radiographs available in the Department of
The radiographs were estimated by tracing them by a Pedodontics and Department of Orthodontics in a North
pencil (by a single examiner) on a translucent paper Indian dental institution.
against a light source and were assessed using Demirjian
method and compared with the chronological age of the The data was analyzed using SPSS software (SPSS v17).
child. Chronological age and estimated dental age were
analyzed demographically and using univariate
Children showing congenital developmental quantitative analysis. The level of significance was set to
abnormalities, physically/mentally challenged children, be at 0.05 (*p <0.05).
children having systemic diseases or having a gross
malocclusion were not included in the study. For any Results
subject with an absent left permanent mandibular
tooth, the equivalent tooth on the subject’s right was The subjects were divided into 10 age groups of 1 year
used. Tooth formation is divided into eight stages and each, from 6 years to 15 years (Fig. 1). Demirjian
criteria for these stages are given for each tooth method produced a significant mean over-estimation of
separately. Each stage of the seven teeth is given score. 0.61 years in study sample (0.66 years in males and 0.56
The sum of scores for seven teeth is referred to as a years in females) (Table 1). Pearson’s Correlation
table giving the dental age. Analysis signified a gradual decrease in overestimation
(dental age minus chronological age) as the age
A pilot study on 10 random radiographs was performed advances in both genders (Figs. 2 and 3). Table 2 shows
initially, giving the final sample size as 190. A random the gender comparison of overestimation by Demirjian
sampling method was performed to select the method; no significant difference was seen.

Figure 1.Distribution of Study Samples according to Age Categories

Table 1.Chronological Age and the Dental Age by Demirjian’s method (*p <0.05)
Group Chronological Age Dental Age Mean Diff. SD Diff. p-Value
Mean SD Mean SD
Males 10.27 2.80 10.93 2.68 0.66 0.38 0.02*
Females 10.81 2.94 11.37 2.90 0.56 0.36 0.04*
Overall 10.56 2.88 11.16 2.80 0.61 0.37 0.03*

Table 2.Gender Comparison of Overestimation by Demirjian Method (*p <0.05)

Gender n Mean SD t-value p-Value
Chronological Age Minus Males 102 0.66 0.38 1.96 0.05 (NS)
Dental Age Females 113 0.56 0.36

11 ISSN: 2455-7048
Grover S et al. Epidem. Int. 2016; 1(3)

1.75

1.50

Dental age (D) minus chronological age (yrs)

1.25

1.00

0.75

0.50

0.25

0.00
4.0 6.0 8.0 10.0 12.0 14.0 16.0
-0.25

-0.50

-0.75
Chronological age

Figure 2.Scatter Diagram of Overestimation of Dental Age among Boys

1.75

1.50
Dental age (D) minus chronological age (yrs)

1.25

1.00

0.75

0.50

0.25

0.00
4.00 6.00 8.00 10.00 12.00 14.00 16.00
-0.25

-0.50

-0.75
Chronological age

Figure 3.Scatter Diagram of Overestimation of Dental Age among Girls

Discussion the past, implying its inapplicability in various

populations.1,6,9,10,14 The findings can be inferred to the
There are often seen large differences in growth and fact that the Demirjian method was framed almost 40
development rates among children of same years ago, and there may have been a difference in the
chronological age.15 Teeth are one of the key systems in present-day comparisons due to positive secular trends.
the body, and their degree of development is used as
one of the indices of biological age. The study of Gender comparison did not reveal any significant
morphological parameters of teeth on dental X-ray of difference, implying that there is no disparity in the
children is more reliable than most other methods for accuracy of age estimation among boys and girls.
age estimation and is most commonly used to According to the present results, we cannot judge the
determine age in living humans. OPGs are considered as favorable accuracy of dental age estimation towards any
the best tool for age estimation in children because gender as is with other studies.7,15
intraoral radiography is difficult to obtain in children
without image distortion.16 A total of 215 OPGs were When scatter plots were created between estimated
investigated (aged 6–15 years) in the present study-102 age and chronological age, there were linear lines
males (48%) and 113 females (52%). Ethnic uniformity showing a strong negative correlation (Figs. 2 and 3).
of the study sample was a prerequisite as development This implied that the younger age groups had a greater
of teeth may vary among populations.17 overestimation than the older age groups. This may be
explained by the fact that acceleration of growth
The observed difference in estimation of age by reduces as the age advances and body development
Demirjian method is reported in numerous studies in becomes gradually stabilized, as the growth reaches

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Epidem. Int. 2016; 1(3) Grover S et al.

maturity. This finding is comparable to results of Leurs 8. Kullman L, Johanson G, Akesson L. Root
et al.19 where a significant difference was seen in the 5– development of the lower third molar and its
10 years age groups. Some other studies predict a relation to chronological age. Swed Dent J 1992; 16:
variable result, showing more overestimation in higher 161-67.
age groups20 or in different age categories.11,18 This 9. Tunc ES, Koyuturk AE. Dental age assessment using
varying degree of overestimation indicates that dental Demirjian’s method on northern Turkish children.
growth is not a steady and uniform process, but is Forensic Sci Int 2008; 175: 23-26.
possibly associated with para-pubertal speed 10. Maber M, Liversidge HM, Hector MP. Accuracy of
fluctuations. age estimation of radiographic methods using
developing teeth. Forensic Sci Int 2006; 159S: S68-
Assessing OPGs was favorable as it is a non-invasive S73.
approach and hence readily acceptable. Also, teeth 11. Koshy S, Tandon S. Dental age assessment: The
were assessed for development and not for eruption, applicability of Demirjian’s method in South Indian
which accounts for low variability due to local and children. Forensic Sci Int 1998; 94: 73-85.
environmental factors. 12. Chertkow S. Tooth mineralization as an indicator of
pubertal growth spurt. Am J Orthod 1980; 77: 79-
Conclusion 91.
13. Nystrom M, Ranta R, Kataja M et al. Comparisons of
The Demirjian method produced a significant
dental maturity between the rural community of
overestimation similar to other population studies.
Kuhmo in north-eastern Finland and the city of
Gender comparisons achieved satisfactory results and
Helsinki. Community Dent Oral Epidemiol 1988; 16:
younger age groups were presumed to have more
215-17.
irregular growth pattern as compared to their
14. Rai B, Kaur J, Anand SC et al. Accuracy of the
adolescent counterparts. The overall study supports the
Demirjian method for the Haryana population. The
need for refinement of the population-specific
Internet Journal of Dental Science 2008; 6(1).
standards in Demirjian method for further application in
15. Jamroz GMB, Kuijpers-Jagtman AM, Hof MA et al.
forensic sciences.
Dental maturation in short and long facial types: Is
Conflict of Interest: None there a difference? Angle Ortho 2006; 76(5): 768-
72.
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