Dental development in UK subjects of diverse ancestry
Research type
Research Study
Full title
An evaluation of dental development in UK subjects of diverse ancestry
IRAS ID
239922
Contact name
Fraser McDonald
Contact email
Sponsor organisation
Guy's and St Thomas' NHS Trust/King's College London
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Research Summary
Asylum seekers of unknown age currently present a challenge to the immigration system, particularly at the 18-year-old threshold. Immigrants claiming to be children, i.e. under 18 years old, without documentation or with suspect documentation relating to their age may be unfairly assessed as being adult by their physical appearance alone. The asylum process is made particularly daunting and distressing when unaccompanied children are disbelieved and may be unlawfully detained or denied the support of social services which would otherwise be provided in the absence of a family unit.
In cases of age dispute, Dental Age Estimation (DAE) may be used to help determine whether an individual has reached the age of 18 because the third molar, or wisdom tooth, is regarded as the most useful marker of growth at this age. This is usually determined by the degree of development of the third molar compared with data compiled from dental x-rays which provide data of individuals of known age. Despite claims of the appropriateness of “multi-ethnic” dental age databases, ethnic differences in third molar development have been suggested and population-specific data may improve accuracy and fairness in DAE.
The aims of this research will be to increase understanding of dental development between diverse ethnic groups and to find out if ethnic differences affect third molar development in British subjects of White and Black ethnicity in the UK. This will be investigated by examining a large sample of existing dental x-rays held at the King's Dental Institute and determining the degree of dental development compared to chronological age while noting the ethnic group to which the individuals have assigned themselves. The fundamental aim is to increase accuracy and fairness in age estimation of individuals of unknown age.Summary of Results
Population differences in dental development between Black and White ethnic groups have been debated but not previously studied in the UK. Using inappropriate data for dental age estimation (DAE) could lead to erroneous results and injustice.Data were collected from dental panoramic radiographs (dental X-rays to review the whole teeth of a patient) of 5590 subjects aged 6–24 years in a teaching hospital archive. The radiographs had been taken for dental assessments and not for the study.
Demirjian stages (stages identified to establish the way in which a tooth develops) were determined for left-sided teeth and third molars and data collected regarding hypodontia and third molar agenesis. Third molar (wisdom tooth) development in self-assigned Black British, including other self-assigned Black ethnicity, was compared with that of self-assigned White British subjects.
Data were compared for males and females in the two ethnic groups using T-tests for Demirjian Stages A–G of third molar development and Mann-Whitney tests for Stage H once a cut-off age at the maximum age for Stage G had been imposed. Third molar development occurred earlier in subjects of Black ancestry compared to those of White ancestry. While both ethnic groups showed large age ranges for every third molar stage, in female subjects these generally occurred at least 1.5 years earlier, and in males at least one year earlier. Hypodontia (missing teeth which have not formed as opposed to those which have been extracted) and third molar agenesis (tooth absence) were more prevalent in White British, but the ethnic difference in third molar development persisted in subjects with complete dentitions (sets of teeth).
This is a large study that confirms ethnic differences in a London population, emphasises the difficulties of establishing the 18-year-old threshold using DAE, and confirms the risk of overestimating the age of individuals of Black ethnicity using White ethnic reference data.
REC name
West Midlands - Edgbaston Research Ethics Committee
REC reference
18/WM/0215
Date of REC Opinion
24 Aug 2018
REC opinion
Further Information Favourable Opinion