| dc.description.abstract | Background:
Forensic age estimation is critical for the Ugandan setting due to the increasing crime rates in
the country among juveniles as reported by the Uganda Annual Police Report of 2017. In
addition, currently Uganda is a host to many refugees from its turbulent neighbors and many
of the children who seek refuge lack legal documentation like birth certificates.
Objectives:
This study aimed at exploring the current practice of age estimation among adolescents and
young adults undergoing criminal proceedings (Sub-study 1) and to develop dental age
estimate tables using third molar eruption (Sub-study II) and development (Sub-study III) for
the Ugandan adolescent and young adult population.
Methods:
Sub-study I This was a qualitative study that enrolled 17 police surgeons and other public and
private health professionals working with the Police, who were directly involved in the age
estimation process within five districts of Uganda. Key informant interviews were used to
collect the data. The data were analysed manually using thematic analysis strategy.
Sub-studies II & III These were cross sectional studies using quantitative methodologies.
One thousand and twenty-five (1025) dental patients aged 10–22 years were recruited for the
study. They were of Ugandan descent attending the Mulago Dental School Clinic at the
Mulago National Referral Hospital between January and December 2017. Patient sociodemographic details, radiographic recordings using the OPG and proof of age using birth
certificates, hospital discharge forms, baptism certificate and national ID were all captured.
Descriptive statistics were used to get means, medians, minimum and maximum age per tooth
eruption (Sub-study II) and development stage (Sub-study III). Student’s t tests were used to
get difference between jaws and sex. Linear regression was used to generate probabilities and
ROC curves were used to determine the performance of the tooth stages (Sub-study III).
Results:
Sub-study I showed that the legally mandated professionals to estimate age are medical
officers, clinical officers and registered midwives. Circumstances requiring age estimation
mainly comprised differentiating between an adult and a child especially in cases of
defilement. Third molar eruption and tooth counting were among the routinely used methods
by many of the health professionals in estimating age. Age estimation methods particularly
third molar eruption were not uniform among the key informants. Generally, the methods
used for age estimation in Uganda do not fully comply with International guidelines.
Sub-study II showed that third molar eruption occurred earlier among females as compared to
males. The overall mean age difference at the complete eruption stage between males and
females ranged between 0.7-1.6 years. The earliest age observed clinically when the third
molar is at complete eruption stage was at 14 years, while the latest age at this stage was 20
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years. Radio graphically, the earliest age at the complete eruption stage was first observed at
13 years and by 18 years close to 50% had the third molar at complete eruption, while by age
20 all the teeth were at full eruption stage. Generally, there was no significant differences
(P>0.05) in mean age at the complete eruption stages using the clinical and radiographic
methods except for teeth 38 & 48 among the females (P<0.05). The mean differences ranged
between 0.1-0.7 years.
The overweight category was significantly associated with age of third molar eruption; β =
−0.95 (95% CI: −1.79, −0.11, P =0.026). The overweight participants had their third molar
erupt about 10 months earlier than their normal-weight counterparts. There was no significant
association between the socioeconomic status and age of eruption of the third molar.
Sub-study III showed that third molar crown completion/ root initiation at stages D
(Demirjian) and Ri (Moorrees) was observed at 12.6 and 13.5 years for females and males
respectively. While apex closure at stages H (Demirjian) and Ac (Moorrees) was observed at
19.8 and 20.1 years for females and males respectively. Females developed root stages earlier
compared to males and the mean age differences ranged between 0.9 to 1.4 years. There were
statistically significant differences in Demirjian root stages E, F and G and MFH/Haavikko
stages Ri, R1/4 and R1/2 between the sexes (P < 0.05).
The probability of identifying an individual as being equal or older than 12, 14, 16 and 18
years using the Demirjian, Solari, Havikko, and Moorrees root development stages was quite
high ranging between 80-100%. The study established that Demirjian and Moorrees root
stages should be considered as good tests for discriminating for ages 16 and 18 and thus
useful for forensic purposes in the Ugandan population.
Conclusions:
The findings of the sub-studies showed that that the current age estimation practice in the
country has challenges and therefore may not be optimal for practice. Hence, a review of the
current guidelines should be undertaken with the aim of adopting more credible and robust
methods. Further-more these findings showed that third molar eruption is not a reliable
method for age estimation in this population. The findings provide a platform for
scientifically generated standards for age estimates for third molar development specific to
the Ugandan adolescents and young adult population for forensic use.
Keywords: Third Molar, Third Molar Eruption, Third Molar Development | en_US |
