Timing of dental development in Saudi cleft lip and palate patients.

Bindayel et al1 addressed in their interesting study comparing with their chronological age, Saudi patients with non-syndromic cleft lip and palate (CLP) have delayed dental development as defined by dental age using Demirjian’s method. Actually, a lot of concerns do present worldwide, considering the accuracy of Demirjian’s method in assessing the timing of dental development. A recent meta-analysis was conducted on 26 studies with a total of 11,499 children (5,301 boys and 6,198 girls) aged 3.5 to 16.9 years. Overall, the Demirjian’s method was found to overestimate dental age by 0.35 years in males (4.2 months), and 0.39 years in females (4.68 months). A subgroup analysis by age revealed that boys and girls between the ages of 5-14 years were given a dental age estimate that was significantly more advanced than their chronological age. Differences between the underestimated dental ages and actual chronological ages were lower for male and female 15and 16-year-old subgroups, although a significant difference was found in the 16-yearold subgroup. Accordingly, Demirjian’s method’s overestimation of actual chronological tooth age has triggered the need for population-specific standards to better estimate the rate of human dental maturation.2 In the Kingdom of Saudi Arabia, considerable concerns between the true and estimated dental age based on the Demirjian’s curves have been also triggered. This is based on the following 2 points: 1. comparing the accuracy of dental age of different population-specific curves, using the Demirjian method, to the chronological age of Saudi children aged between 4 and 14 years, has suggested that although population-specific curves are more accurate in the prediction of age, a considerable variation within each population still exists. The Demirjian’s method offers a great scope in fields that require the study of the pattern of growth rather than the accuracy of age estimation;3 and 2. the role of ethnicity-specific dental maturation curves in dental age estimation of Saudi children has been recently assessed among a cohort of healthy Saudi children aged 4-14 years based on the original French-Canadian Demirjian’s curves, and several modified Demirjian curves specified for certain ethnic groups: Saudi, Kuwaiti, Polish, Dutch, Pakistani, and Belgian. The curves designed for Dutch, Polish, Saudi, and Belgian (5th percentile) populations had a significantly lower error in estimating age than the original French-Canadian and Belgian (50th percentile) curves. The optimal curve for males was the Saudi one, with a mean absolute difference between estimated age and chronological age of 8.6 months. For females, the optimal curve was the Polish one, with a mean absolute difference of 7.4 months. The study concluded that ethnicity might play a role in age determination, but not a principal one.4 Recently, new age prediction models and maturation scores for Saudi population are developed based on the Demirjian’s method using multinomial functions. They have a significantly lower error than the tables designed for French-Canadian and Belgian populations.5 I presume that employment of these new maturation scores and tables designed specifically for Saudi population might alter 8.4 months delay in dental development for CLP patients reported by Bindayel et al.1