Dental age estimation using radiographs: Towards the best method for Sri Lankan children.

Research supports the need for regionally and ethnically specific validated data as the reference base for age estimation techniques. This retrospective study evaluated the accuracy of three dental age estimation methods; Demirjian et al. (1973), Willems et al. (2001), and Blenkin and Evans (2010), for use in Sri Lanka for medico-legal purposes. Panoramic radiographs of 688 Sri Lankan children ranging in age from 8.00 to 16.99 years were used to determine their appropriateness to a Sri Lankan population. The mean age and standard deviations (±SD) were calculated separately for males and females of each age group. Paired t-test and mean absolute errors (MAE) were calculated to compare the calculated dental age (DA) with the chronological age (CA) across the nine age groups. The results revealed the mean CA of the entire sample was 12.38 ± 2.68 years, while the mean DA calculated using the Blenkin and Evans method was 11.83 ± 2.20 years, using the Demirjian et al. method was 12.57 ± 2.53 years, and using the Willems et al. method was 11.99 ± 2.43 years. The Demirjian et al. method consistently overestimated the age of males except in the 2 groups aged over 15 years, whereas the Blenkin and Evans method consistently underestimated the age except for the 11.00-12.99 age range. The method of Willems et al. produced DA quite close to CA up until 12.99 years of age, and then underestimated the age for all higher age groups. In females, the Demirjian et al. method consistently overestimated the age up until 13.99 years and then underestimated the higher age groups, while the Willems et al. method underestimated the age in all age groups except 10.00-10.99 years. The Blenkin and Evans method also consistently underestimated the age except in the 10.00-10.99 and 12.00-12.99-year age groups. The percentages of either overestimation or underestimation calculated for ±0.5 years of the true age were 41.0% for the Blenkin and Evans method, 42.8% for the Demirjian et al. method and 49.1% for the Willems et al. method. In conclusion, while all three methods could be applicable in the estimation of dental age for medico-legal purposes, the Willems et al. method appears to be more appropriate in overall measures for the Sri Lankan reference sample, up to the age of 12.99 years.

Challenges in implementing best practice DVI guidelines in low resource settings: lessons learnt from the Meethotamulla garbage dump mass disaster.

The management of mass fatalities following disasters is a complex process which requires the involvement of multiple stakeholders and resources. A garbage dump at Meethotamulla in Sri Lanka suddenly collapsed, resulting in the death of 32 individuals. Efforts to implement best practice guidelines in Disaster Victim Identification (DVI) during this disaster revealed several important aspects that need to be considered by the forensic community. Delays in initiating the legal processes to investigate and manage the incident resulted in public dissatisfaction towards the post-disaster management process. Body recovery by Police and military personnel without the involvement of medical teams had numerous shortcomings including the lack of proper tagging and photography, commingling of body parts, and non-preservation of personal items. Public expectation and demand for early release of the bodies conflicted with the necessity to undergo a stringent DVI process according to best practice guidelines. Many adaptations and alternate strategies were necessary to ensure that DVI could be done scientifically. The use of primary identification markers including odontology and DNA had many limitations including non-availability of antemortem data, resource availability and cost. Identification was established using a combination of secondary identification markers including clothing, jewelry, scars, tattoos, morphological descriptions and circumstantial evidence. In two cases, odontological features further supported positive identification. Samples for DNA were obtained and preserved but were not utilized in establishing the identities. This paper highlights the need for better public awareness and multidisciplinary commitment in managing mass fatalities and also reflects on the challenges of implementing best practice DVI guidelines in low-resource settings with different legal and socio-cultural expectations.