Action

Ann Wenzel / RAD awenzel at ODONT.AU.DK
Mon Feb 19 09:06:02 PST 2001


Thanks to Leif for mentioning my old papers, they were part of my
ph.d.thesis.
I will participate in the discussion with a few arguments for the way we do
things in Denmark.

I still do skeletal and dental maturity assessments for various
organisations in Denmark, such as committees for refuges and immigrants, but
also for private families (through their physician) who wish to have the age
of their adopted child tried. These assessments never stand alone, and if a
given birth date is to be changed, several other indicators or criteria
should point in the same direction. For example psycho-motor skills and a
number of psychological parameters count as much or more than the skeletal
and dental parameters.
As we all know, there is a wide variation in normal growth, and genes, race
and environmental factors do of course influence growth and maturity in the
individual. Lennart is right that there are very few estimates from
populations in e.g. developing countries. Therefore these assessments should
not stand alone. I use the criteria described by Tanner and Whitehouse
(London) for my estimates.

I think I am the one in Denmark who do most of these assessments, and nobody
ever questioned whether a dentist should do this. I also give courses to
postgraduates in orthodontics who use bone maturity indicators in a simpler
form for some of their treatment planning procedures (not routine, though).
I also teach them to predict individual adult height from bone maturity
assessment and present height, and I am doing this for children and parents
(through the dentist/orthodontist, usually) who are worried that their child
does not grow normally. In Denmark, the dentist is often the only medical
person who sees a child regularly, since the physician only sees a child
once in its shool time period (over at least 9 years). I have quite good
statistics on my height predictions, the major deviation from what I
estimated being 2 cm, when I do the assessment around the age of eleven (I
have not tried with earlier ages than that). There should of course be an
indication to do this, but parents' worries seems to me to be indication
enough. We take the hand x-ray with the hand in a leaded box, with very
little radiation exposure as the result.

Growth and maturity should act together, if the latter is advanced, the
child will be a short adult and vice versa. In the majority of cases of
course, a child is merely a late maturer and its state of growth relates to
its maturity, then parents are obviously happy after I have done a height
prediction which is within the normal acceptable adult height in Denmark.
Through all the years, I have seen 3 children who were very small for their
age, but with an advanced bone maturity. The dentist may send  such cases
(through the family physician) to a pedodontist clinic for check of growth
hormone level, etc. I have seen one case where a girl was assessed to become
2 meters tall, her father was a pedodontist!, she had maturity hormone
treament and ended up being 1,84 meters. She looks very good, she is now an
orthodontist!.

Maybe this is helpful in the debate of indications for hand x-rays.

Ann



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