Dental Age

Estimation
Introduction

• age estimation as a scientifically researched component

of the forensic sciences is relatively new.
• 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.
• 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”
• Dr. Edwin Saunders, a dentist, produced a pamphlet
evaluating over 1000 children and providing tables that he
said could be utilized by “relatively untrained people” to
assess children’s age for the purpose of enforcement of
the Factory Act
Purpose & 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.
• 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.
• to aid authorities in determining eligibility for
social benefits, the age of license and age of
legal majority.
• In the United States and many countries
throughout the world, immigration authorities use
the age of 18 for the legal age of majority.
Scientific Rationale

• The evaluation of dental tissue has long been regarded as a

good tool for the assessment of age
• The rationale for scientific evaluation of dental tissues for age
estimation can be divided into three criteria:
1. Tooth Formation & 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.
2. Post-formation Changes
-can be subdivided into:
a. Anatomical 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.
b. Histological Changes
-include secondary dentin apposition, cementum
apposition, and dentin transparency.
Scientific Rationale

3. Biochemical 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 Factors

Other Factors:

• Gender
• Ancestry
• Environmental Factors
Climate
Nutritional Health
Disease/ (Lack of)
Habits
Addictions
Occupation
Place of residence
Dental & Skeletal Abnormalities
Age Estimation Tools

1. calipers, rulers, tooth sectioning wheels and disks, loops, and

microscopes for magnification.

2. Digital Microscopes

3. Computer
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.

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 4 μm/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 Age Estimation

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. 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.
Child Dental Age Estimation

• dental age estimation techniques involving tooth maturation

have long been established as the most accurate indicators of
chronologic age in sub-adults.
• 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.
• “the canine tooth shows the greatest sex differences and
should be avoided if possible when estimating age.”
Four stages of tooth resorption were described: ¼ resorption,
½ resorption, ¾ resorption, and exfoliation.
Adolescent Age Estimation

• By age 14, the only remaining tooth undergoing growth

and formation is the third molar.
• The third molar is the most developmentally variable
tooth and age estimation is based on average
morphologic development.
• Regardless, the third molar is arguably the most reliable
biological indicator during adolescence and in to early
adulthood (Harris et al., 2010, 288) and can easily and
noninvasively be evaluated with dental radiographs.
Certain other factors need to be understood when utilizing third
molar age estimation techniques (Lewis and Senn, 2010):

1. Third molar development is a variable nonlinear process.

2. A number of studies have concluded that ancestral variation
becomes less significant as age 18 is approached.
3. Sexual dimorphism necessitates gender-specific data and
because third molar development occurs during and
postpuberty, some populations demonstrate a role reversal with
males developing earlier than females.
4. Environmental factors play a role in human development.
UT-Age, a computer application, has been developed by
Lewis, Senn, and Silvaggi to simplify and expedite the
process of performing third molar age estimations (Lewis et
al., 2001, 2008). It is particularly useful in assisting in age
estimation for immigration cases in North America. The
application records and archives case information data;
calculates average estimated age, age interval to 95%
confidence and probability of attaining age 18 based upon
the ancestry and gender of the individual and the Demirjian
staging of the third molars; then generates an editable
template report.
Post-formation Techniques
• The problem with adult forensic age assessment, whether
performed with dental or anthropologic methodology, is
that the investigator is attempting to assess chronological
age on the basis of physiological age.
• Aging is an extremely individual process and is affected by
the manner in which we live our lives.
• Alcohol and drug abuse, nutrition, intensive physical labor,
disease, treatments, and accidents are all factors in the
aging process.
• All adult age assessment methods are limited in some
manner.
A historical and often referenced dental adult age estimation
technique was published by Gustafson in 1950.

Attrition is the gradual wearing away of the tooth surface as a

result of mastication. Although attrition itself is associated with
aging when the tooth is in normal occlusion, it has issues as a
marker in age assessment. Erosion and pathological
abrasion, such as bruxism, clenching, tooth brush abrasion,
or any other mechanical causes including dental treatment,
result in an over estimation of age. Cultural habits, diets, and
other population specific factors will affect the attrition rate.
Periodontosis is the term originally used by Gustafson
(1950) and is considered antiquated today. The
contemporary term, periodontal recession, refers to the
alveolar and gingival shrinkage around the tooth as a
result of the inflammatory response due to bacterial
infection. This process results in the root surface being
exposed, allowing it to become stained and pitted. The
measurement in loss of periodontal attachment is the
maximum distance (in millimeters) between the
cementoenamel junction and the line indicating soft tissue
attachment on the labial surface of the tooth.
Secondary dentin has two forms—physiological and
reparative. Physiological secondary dentin forms at a slow
steady rate by the healthy pulpal tissue following
completion of root formation and is associated with the
normal aging process. Reparative secondary dentin, also
known as tertiary dentin, is formed as the result of trauma
to the tooth.
Cementum apposition occurs throughout life on healthy
mammalian teeth. The deposit can increase in thickness
threefold between the ages of 11 and 70 and is thicker in
the apical third than it is near the cementoenamel junction.

A study by Solheim (1990) showed that the strongest

correlation between human cementum thickness and age
occurs at one-third the root length from the apex. He also
observed that the cementum apposition rate decreases in
the elderly and is deposited slower in women than in men.
Root resorption has been described as the least
dependable post-formation change associated with age
by Gustafson (Johanson, 1971; Maples, 1978). External
root resorption is more closely associated with traumatic
injuries, resulting in a prolonged localized inflammatory
response causing osteoclasts to resorb the root dentin.
Common causes include orthodontic treatment and
periapical disease.
Root transparency is the phenomenon that results from the
deposition of hydroxyapatite crystals within the dentin
tubules over time and it does not appear before the age of
20. Root transparency begins at the apex and progresses in
a coronal direction. Bang and Ramm (1970) reported “no sex
differences or differences between teeth from living and dead
persons in the degree of root transparency.” This post-
formation dental change is also the variable that is least
influenced by external factors. Therefore, root transparency
is a very useful tool in adult age assessment when the
gender of the individual is unknown and the volume of
skeletal remains is small.
 “A Smile is the best
accessory you can wear.”
THANK YOU!

Prepared by:
Aaron Paul Bernas, DMD