American Dental Association

Technical Report No. 1077

Human Age Assessment 

by Dental Analysis

2020

ADA Technical Report No. 1077

SCDI approval: July 23, 2020

NOT LICENSED FOR COMMERCIAL USE

By resolution of the ADA Council on Dental Practice, this 

technical report is made available free of charge and license-free to 

non-commercial entities and others provided it is not used for commercial purposes
Copyright © 2020 American Dental Association. All rights reserved. Any form of reproduction is strictly prohibited without prior written permission.
ADA Technical Report No. 1077 – 2020

AMERICAN DENTAL ASSOCIATION TECHNICAL REPORT NO. 1077 FOR HUMAN AGE ASSESSMENT 

BY DENTAL ANALYSIS

The ADA Standards Committee on Dental Informatics (SCDI) has approved ADA Technical Report No. 1077 

for Human Age Assessment by Dental Analysis. Working Groups of the ADA Standards Committee on 

Dental Informatics (SCDI) formulate this and other standards and technical reports for the application of 

information technology and other electronic technologies to dentistry’s clinical and administrative operations. 

The ADA SCDI has representation from appropriate interests in the United States in the standardization of 

information technology and other electronic technologies used in dental practice. The ADA SCDI confirmed 

approval of ADA Technical Report No. 1077 on July 23, 2020. 

This ADA technical report was prepared by the Organization of Scientific Area Committees (OSAC) for 

Forensic Science Forensic Odontology Subcommittee’s Age Assessment Task Force. It was developed in 

cooperation with the ADA SCDI Subcommittee on Forensic Odontology Informatics Working Group 14.3 on 

Human Age Assessment by Dental Analysis.

The ADA Standards Committee on Dental Informatics thanks the members of the Organization of Scientific 

Area Committees (OSAC) for Forensic Science Forensic Odontology Subcommittee’s Age Assessment 

Task Force and the organizations with which they were affiliated at the time the Technical Report was 

developed, shown with the professional organization or interest group they represent: 

Kenneth W. Aschheim (Chairperson 2018-Publication), Office of the Chief Medical Examiner, New York City, 

NYU College of Dentistry, NY;

Robert Barsley (Chairperson 2013-2018), Louisiana State University, New Orleans;

David Banks, Duke University, Durham, NC;

Paula Brumit, Individual representative, Nocona, TX; 

Mary Cimrmancic, Marquette University, Milwaukee, WI;

Franklin Damann. Defense POW/MIA Accounting Agency Laboratory, Offutt AFB, NE; 

Lawrence Dobrin, Office of the Chief Medical Examiner, New York City, NY;

Derek Draft, Western Michigan University Homer Stryker M.D. School of Medicine, Grandville, MI; 

Carla Evans, Boston University, Goldman School of Dental Medicine, MA;

James Lewis, Individual representative, Knoxville, TN;

Peter Loomis, New Mexico Office of the Medical Examiner; Los Ranchos, NM;

James McGivney, Individual representative, Saint Louis, MO;

Roger Metcalf; Tarrant County Medical Examiner’s District, Fort Worth, TX;

Haskell Pitluck, Retired Circuit Court Judge, State of Illinois, Chicago;

Graham Roberts, King’s College London Dental Institute, England;

David R. Senn, University of Texas Health, San Antonio, School of Dentistry, San Antonio, TX; 

Sharon Stanford, American Dental Association, Chicago, IL; and

Warren Tewes, Office of the Chief Medical Examiner, State of Maryland, Baltimore.
2 ADA Technical Report No. 1077 – 2020

The ADA Standards Committee on Dental Informatics thanks the members of Subcommittee 14 Forensic 

Odontology Informatics and the organizations with which they were affiliated at the time the Technical Report

was developed, shown with the professional organization or interest group they represent:

ADA Liaison and Chair SC 14 Forensic Odontology Informatics:

Kenneth W. Aschheim, Office of the Chief Medical Examiner, New York, NY, NYU College of Dentistry, NY.

Working Group 14.3 Human Age Assessment by Dental Analysis Drafting Committee Chair:

Kathleen A. Kasper, Collin County Medical Examiner, McKinney, Texas.

Drafting Committee Members: 

Joe Adserias-Garriga, Mercyhurst University (Member), Catalonia, Spain;

Sakher AlQahtani, King Saud University (Observer), Glen Head, NY;

 Paula Brumit, University of Texas Health Science Center at San Antonio,

 University of Tennessee Health Science Center-Graduate School of Medicine (Member), Nocona, TX;;

Mary Cimrmancic, Marquette University School of Dentistry (Member), Milwaukee, WI;

 Franklin E. Damann, Defense POW/MIA Accounting Agency Laboratory (Member), Offutt AFB, NE;

Derek Draft, Western Michigan University Homer Stryker M.D. School of Medicine (Member), Grandville, MI; 

Carla Evans, Boston University, Goldman School of Dental Medicine (Member); MA;

James P. Fancher, University of Texas Health, San Antonio, School of Dentistry (Member),TX;

Phyllis Ho, Individual representative, (Member), New York, NY;

James M. Lewis, Director of Forensic Dentistry Fellowship, University of Tennessee, Graduate School of 

Medicine (Member), Knoxville;

Victoria Lucas, King’s College London Dental Institute (Observer), England;

Graham Roberts, King’s College London Dental Institute (Observer), England; and

David R. Senn, University of Texas Health, San Antonio, School of Dentistry (Member), TX.. 

Working Group 14.3: Human Age Assessment by Dental Analysis

Kathleen Kasper, Collin County Medical Examiner Office (Chairperson), McKinney, Texas;

Bradley Adams, New York City Office of Chief Medical Examiner (Observer), NY;

Joe Adserias-Garriga, Mercyhurst University (Member), Calalonia, Spain;

Sakher AlQahtani, King Saud University (Observer), Glen Head, NY;

Corinne D Anjou, Laboratoire de Sciences Judiciaires et Médecine Légale (Observer), La Prairie, QC, 

Canada;

Robert Barsley, Louisiana State University (Observer), New Orleans, LA;

Vibha Babbar, Individual Representative (Observer), Mundelein, IL; and

 Paula Brumit, University of Texas Health Science Center at San Antonio

 University of Tennessee Health Science Center-Graduate School of Medicine (Member), Nocona, TX;
ADA Technical Report No. 1077 – 2020 3

Mary Cimrmancic, Marquette University School of Dentistry (Member), Milwaukee, WI;

Glinda Cooper, Innocence Project (Observer), New York, NY;

Derek Draft, Western Michigan University Homer Stryker M.D. School of Medicine (Member), Grandville, MI;

Carla Evans, Boston University, Goldman School of Dental Medicine (Member), MA;

James P. Fancher, University of Texas Health, San Antonio, School of Dentistry (Member), Martindale, TX;

Phyllis Ho, Individual representative (Member), New York, NY; 

Sigrid I. Kvaal, Faculty of Dentistry, University of Oslo (Observer), Norway;

James M. Lewis, Director of Forensic Dentistry Fellowship, University of Tennessee, Graduate School of 

Medicine (Member), Knoxville, TN;

Victoria Lucas, King’s College London Dental Institute (Observer), England;

Murray K. Marks, University of Tennessee Health Science Center, Department of General Dentistry 

(Observer), Knoxville, TN;

Raymond G. Miller, State University of New York at Buffalo, School of Dental Medicine (Observer), 

Lancaster, NY;

Cristiana Palmela Pereira, Dental Medicine University of Lisbon (Observer), Portugal;

Graham Roberts, King’s College London Dental Institute (Observer), England;

David R. Senn, University of Texas Health, San Antonio, School of Dentistry (Member), TX;

Kirt Simmons, Individual Representative (Observer), Little Rock, AR;

David Williams, Hagerstown Community College (Observer), Hagerstown, MD; and 

David A. Wold, Individual representative (Observer), Bensenville, IL.

 

 

 

 
4 ADA Technical Report No. 1077 – 2020

AMERICAN DENTAL ASSOCIATION TECHNICAL REPORT NO. 1077 FOR HUMAN AGE ASSESSMENT BY DENTAL 

ANALYSIS

FOREWORD

(This Foreword does not form a part of ADA Technical Report No. 1077 for Human Age Assessment by Dental Analysis).

In 1992, there was interest in the standardization of clinical information systems related to electronic technology in the dental 

environment. After evaluating current informatics activities, a Task Group of the ANSI Accredited Standards Committee MD156 

(ASC MD156) was created by the ADA to initiate the development of technical reports, guidelines, and standards on electronic 

technologies used in dental practice. In 1999, the ADA established the ADA Standards Committee on Dental Informatics (SCDI). 

The ADA SCDI is currently the group that reviews and approves proposed American National Standards (ANSI approved) and 

technical reports developed by the standards committee's working groups. The ADA became an ANSI accredited standards 

development (ASD) organization in 2000.

The scope of the ADA SCDI is

The ADA SCDI shall develop informatics standards, technical reports and guidelines and interact with other entities involved 

in the development of health informatics standards aimed at implementation across the dental profession. 
ADA Technical Report No. 1077 – 2020 5

AMERICAN DENTAL ASSOCIATION TECHNICAL REPORT NO. 1077 FOR HUMAN AGE HUMAN AGE ASSESSMENT BY 

DENTAL ANALYSIS

PREFACE 

The assessment of chronologic age for living or deceased individuals requires careful documentation. Procedures to assess 

human chronologic age have been recommended by numerous forensic organizations, including the American Board of Forensic 

Odontology (ABFO), American Society of Forensic Odontology (ASFO), and the International Organization for Forensic OdontoStomatology (IOFOS) as well as others.

The goal of this technical report is to provide the best available current information and guidance for estimating age from the 

human dentition. It includes guidelines on how to obtain forensic dental data and the selection of recommended methodologies 

to establish accurate assessments of human chronologic age. It is intended for practitioners performing dental age assessments

and for individuals, groups, or agencies utilizing the age assessment information.

Dental age assessment is highly technical and requires skill, training, education, and experience to execute correctly. 

This document provides a guideline to generate an estimated dental age and age interval utilizing databases and scientifically 

reviewed algorithms. However, dental age assessment is based on large identifiable human group populations and has an

associated level of uncertainty. It is beyond the scope of this document to determine the appropriate use of this assessment by 

any entity in determining appropriate actions based on the estimated age interval as it relates to the chronological age of any 

specific individual. It is beyond the scope of this document to recommend the application of the assessment by any user in 

determining appropriate actions as it relates to chronological age.

BACKGROUND

Forensic dental age assessment is the estimation of an individual’s chronologic age through scientific evaluation of the dentition 

and maxillofacial structures. Medico-legal applications in the deceased include estimation of the age at death and assist in the 

identification of missing and unidentified individuals by narrowing search parameters. In the living, it will assist the legal system 

in answering questions regarding immigration, legal age of majority, and legal age of license. In the US, only the courts or 

designated agencies determine legal disposition of the individual. The forensic dental age assessment practitioner reports the 

facts as best as they are understood and does not get involved with policymaking. 

The complexity of the age estimation process requires forensic dental age assessment practitioners to follow these guidelines to 

the fullest extent applicable, practical, and appropriate to ensure scientific integrity. In addition, the consequences of 

inappropriate assessment of age can have emotional and legal ramifications. Age assessment methods vary in their advantages 

and disadvantages and are dependent upon the availability of suitable population-specific reference data. In addition, whenever 

possible, multiple independent dental and non-dental methodologies should be performed by qualified practitioners.

1 RATIONALE

Forensic dental age assessment produces an estimate of chronologic age through dental analysis. The intent of this technical 

report is to describe current best practices for the process of human dental age assessment; however, it is not intended to 

supersede local, state, or federal regulations. As a resource, this document could assist in the development of regulations for 

those agencies.

2 SCOPE

This document describes the methodologies and best practices for estimating the chronologic age of a living or deceased 

individual by analysis of the human dentition and associated maxillofacial structures.

Note 1: This document is not an implementation guide; therefore, the practitioner needs to evaluate the proper techniques and applicability for 

each method.

Note 2: This is not a legal document and is not intended for that purpose. 
6 ADA Technical Report No. 1077 – 2020

3 TERMS AND DEFINITIONS 

3.1

Age assessment Database

Information that can be processed to generate normal distribution data or percentile data and assembled to create a reference 

data set.

3.2

Adolescent Dental Age Interval 

The interval in human dental development that begins after all primary teeth are normally shed, and the permanent teeth are 

developing or developed. The adolescent interval ends when all permanent teeth present are fully developed. 

Note: During the adolescent and adult dental age intervals, primary teeth may be atypically retained for various reasons, including congenital 

absence or ectopic eruption of the permanent teeth that would typically replace them.

3.3

Adult Dental Age Interval

The interval begins when human dental development ends and all permanent teeth have completely formed crowns and roots

and continues throughout life.

Note: During the adolescent and adult dental age intervals, primary teeth may be atypically retained for various reasons, including congenital 

absence or ectopic eruption of the permanent teeth that would typically replace them.

3.4

Age at Assessment (AaA)

The estimated age and estimated age interval derived from the dental developmental stage or stages present at the time an 

individual’s estimated age is calculated by the forensic dental age assessment practitioner. (For example, the mean age for a 

subject with observed dental characteristics similar to the individual being evaluated is estimated to be 10.34 years with a 

minimum and maximum age distribution of 8.67 to 14.33 years on the day of assessment).

3.5

Bias

The variance of measured results as influenced by human perceptions or systemic factors.

Note: It is beyond the scope of this document to outline the numerous types of biases.

3.6

Biologic Age

The age corresponding with the developmental, degenerative, biochemical or isotopic status of an individual.

Note: The rate at which organ systems age may differ from the individual's chronologic age.

3.7

Blinding

The process of withholding information that may bias the forensic dental age assessment practitioner. 

3.8

Chronologic Age

The difference between the individual’s date of birth and a specific later date.

Note: Chronologic age may be expressed in varying degrees of precision and can be derived from computer programs that report age values 

using multiple significant digits. To correctly interpret and report results, consultation with a statistician may be necessary.
ADA Technical Report No. 1077 – 2020 7

3.9

Dental age assessment

The processes used to produce an estimation of an individual’s biologic age using dental data and subsequently correlate 

biologic age to chronologic age.

3.10

Dental Emergence (Eruption)

The process of tooth migration from its initial position in its bony crypt through the gingival tissue and into the occlusal plane.

3.11

Dental Age Estimation

The estimated mean age and the corresponding distribution of ages that result from dental age assessment.

3.12

Dental Age Estimation Technique

A method used for age assessment.

3.13

Dental Data

Dental age assessment involves analysis of available dental data of an individual in her/his current state. The term ‘prior data’ 

refers to data collected when that individual was in a previously known and documented circumstance and does not mean a 

specific point in time. The term ‘current data’ refers to the available data for the individual or remains in her/his current state. For 

a deceased individual requiring age assessment, the current data is referred to as postmortem data. For a living individual 

requiring age assessment, the data is simply referred to as prior dental data and current dental data.

3.14

Developmental Stages of Dental Growth

Intervals in the morphologic appearance of teeth as the crown or root mature. 

3.15

Estimated Age Interval

The estimated age interval expresses the mathematically determined minimum and maximum associated age range at a 

particular level of uncertainty. 

3.16

Expression of Uncertainty (EoU): The parameter, associated with the assessment method used, that characterizes the 

dispersion of the values that could reasonably be attributed to the measurand.

3.17

Forensic Dental age Assessment Practitioner

An individual who provides an assessment of an individual’s dental age based upon accepted methodology.

Note: The term “practitioner” will be used instead of “Forensic Dental age assessment Practitioner” throughout this document as an abbreviated 

way to describe an individual who provides an assessment of an individual’s dental age based upon accepted methodology.

3.18

Gingival Dental Emergence
8 ADA Technical Report No. 1077 – 2020

The interval in the migration process from a tooth’s initial appearance through the gingival soft tissue to the point of final eruption. 

3.19

Identifiable Human Group

A population of individuals based on ancestry or population specificity that reflects a similar genetic, geographic, and 

environmental background.

3.20

Independent Verification

The process of obtaining a second analysis from a forensic dental age assessment practitioner, blinded to the results of the first 

practitioner’s assessment.

3.21

Infant/Child Dental Age Interval

The interval in human dental development that begins at birth, includes the presence of the developing, developed and resorbing 

primary dentition as well as the initial development of the permanent dentition. This interval includes the early period of mixed 

primary and permanent dentitions and ends when the last primary tooth is exfoliated normally.

Note 1 to entry: During the adolescent age and adult dental age intervals, primary teeth may be atypically retained for various reasons,

including congenital absence or ectopic eruption of the permanent teeth that would typically replace them.

3.22

Level of Uncertainty (LoU)

This characterizes the dispersion of values used for measuring dental age assessment based on the variation within the data.

3.23

Measurand

A physical quantity or property which is measured. 

3.24

Prenatal Dental Age Interval 

The interval in human development that occurs prior to birth. 

3.25

Reference Data Set (RDS)

The assembly of data related to a specific identifiable human group comprising all the relevant information to enable dental age 

assessment. 

3.26

Reference Study 

A detailed investigation and analysis of a specific population to relate chronologic age to dental development and maturation.

4 SCIENTIFIC METHODS OF DENTAL AGE ASSESSMENT

The scientific evaluation of dental and maxillofacial structures for assessment of age can be divided into four criteria:

1. Gross formation and developmental growth changes: The progressive morphologic development of the 

crown, root, and apex of any given tooth or its timed emergence/eruption sequence. In addition, emergence occurs 
ADA Technical Report No. 1077 – 2020 9

through alveolar bone or gingival tissue. These changes are discernible radiographically showing progressive 

mineralization of the crown and roots of each tooth in the human dentition.

2. Maturation and post-formation changes: These are changes following complete morphologic 

development of the tooth crown and root.

3. Histologic changes: Microscopic changes that include but are not limited to secondary dentin apposition, 

cementum apposition, root transparency, periodontal attachment, root resorption, and attrition.

4. Biochemical changes: Changes over time in the biochemical nature of teeth that can be measured by 

laboratory techniques, including but not limited to amino acid racemization, carbon-14 dating, and rare isotope 

analysis.

The specific circumstances of each individual case will determine the dental age assessment method(s) to be 

employed. Forensic dental age assessment methods for estimating age are dependent upon the specified 

developmental growth interval of the individual and the availability of specific teeth for the precise technique. 

4.1 Data utilization: Data utilized in dental age assessment is based on reference data sets from sex and populationspecific studies. Other factors that may or may not affect dental development, post-formational dental changes, histologic, and 

biochemical changes are typically not included. The relative contributions of genetic, environmental, and other factors, when 

examining variability within and between populations has not been established. 

The practitioner provides the best and most accurate assessment of an age interval and is responsible for being familiar with and 

utilizing current age assessment scientific methodology. Thoughtful consideration should be given to sex, identifiable human 

group, geographic population specificity, and environmental factors.

4.2 Limits to Scientific Dental Age Assessment Methods: The precise rates at which the processes of 

developmental, maturational, and post-developmental dental changes occur are unique to each individual. Consequently, age 

assessment procedures estimate biological age intervals of an individual, from which a chronologic age interval is derived. 

Biologic age does not necessarily correspond with chronologic age. These procedures generally involve comparison of the 

individual being evaluated with one or more reference data sets that are described statistically in terms of an average, minimum,

and maximum age at which developmental or post-developmental changes occur. The individual being evaluated may or may 

not progress through these changes at a rate comparable to the subjects in the reference study, thereby giving an over or 

underestimation of chronologic age. A point estimate of age alone is not an accurate way to describe a dental age estimation. It 

is unacceptable because it may lead an investigator to misinformed conclusions about the value of the estimation.

It is advised that reference population studies be utilized, when available, for dental age assessment of an individual to address 

these limitations. This will increase the probability that the individual is compared to a human reference sample representative of 

genetic and environmental factors associated with their developmental, maturational, and post-developmental dental changes. In 

cases where there is not a reference population study comparable to the individual being assessed for age, then the reference

population study that most closely aligns with the individual being assessed should be utilized, and direction of possible error 

reported. The basis for the choice of the reference population should be fully described.

4.3 Ancestry: Analogous to a genetic description of the individual, ancestry refers to a genetic line of descent of an 

individual, an association with an identifiable human group. Reference population studies used in dental age assessment

techniques should recognize identifiable human groups and their respective phenotypic characteristics that may affect age 

estimation. Comparison of an individual within the same identifiable human group is a comparison of an individual that would 

more likely possess similar dental formation and developmental growth changes, maturational and post-formation changes, 

histologic changes, or biochemical changes. 

Scientifically, both maternal and paternal sides of descent are considered. Practitioners should maintain awareness that selfreported identifiable human groups may be a sensitive, multidimensional concept influencing the reporting of one line of descent 
10 ADA Technical Report No. 1077 – 2020

over others that may or may not represent the outcome of genetic testing.

4.4 Geographic Population Specificity: This is the specific location in the world that a population resides, and the 

ethnic, cultural, environmental, and socioeconomic conditions experienced by that population. Variation in dental development, 

maturation, and post-developmental change have been observed among populations within the same country or region. 

4.5 Sex: Some differences in tooth development and maturational and post-developmental changes between sexes 

have been documented. In cases where the definitive assignment of sex cannot be determined, a method that does not require a 

designation of sex should be used, or the assessment using both sexes should be reported.

4.6 Nutritional Health: Consistency of diet may account for gross anatomical changes to teeth such as attrition and 

secondary dentin formation. These processes will affect the final dental age assessment in some techniques. The rate and 

extent of development of somatic and non-dental skeletal structures are more readily affected by nutritional status than the 

dentition in children and adolescents. However, extreme environmental factors may affect the developing teeth. It is prudent that 

the practitioner is aware of this limitation when assessing the age of an individual who is exposed to such conditions.

4.7 Current and Prior Systemic Diseases: The rate and extent of tooth and skeletal formation can be affected by 

systemic conditions such as endocrine disorders, especially in the developing individual. Moreover, cancer treatments such as

chemotherapy, or radiation therapy applied to developing anatomic regions, may interrupt tooth formation, affecting tooth 

morphology. In adults who have completed dental formation, the effects of systemic diseases may also influence maturational 

and post-formation dental changes.

4.8 Socioeconomic Status: This represents external factors where an individual may or may not have the financial 

ability or access to adequate health care, dental care, and good nutrition. An individual who is deficient in any of these areas can 

have delayed development or accelerated deterioration of their teeth and skeleton, which may affect dental age assessment.

4.9 Habits and Addictions that may Affect Health or the Maxillofacial Structures: The following may have 

unintended consequences to the dentition because of the habits or addictions of the individual: staining, extensive caries, 

extensive restorations, bruxism, wear, traumatic occlusion, periodontitis, pulpal and periapical disease, tooth loss, and tooth 

fracture. Specifically, alcohol and drug addictions, drinking dark-colored liquids, tobacco usage and betel nut chewing, poor oral 

hygiene, and excessive carbohydrate intake are several habits that may adversely alter the teeth and affect dental age 

assessment. The significance of each condition may vary with the age assessment methodology.

4.10 Additional environmental factors that may affect developmental or post-formation dental and skeletal development 

include growth hormone therapy, endocrine or immunosuppressive therapies, traumatic injuries, conditions that affect physical 

development, and postmortem changes.

5 TOOTH DEVELOPMENT AND DENTAL AGE ASSESSMENT

Humans who survive to adulthood normally develop two distinctive sets of teeth: Twenty (20) deciduous teeth with four incisors, 

two canines, and four molars in both the upper (maxillary) and lower (mandibular) jaws; and thirty-two (32) permanent teeth with 

four incisors, two canines, four premolars, and six molars in each upper and lower jaw. 

Tooth development, the formation and mineralization of the dental tissues (enamel, dentin, and cementum), begins at the most 

occlusal or incisal portion of each tooth and continues until each root tip is fully formed. Simultaneous with tooth formation is the

movement of the forming teeth through the alveolar bone toward the surface of that bone and the overlying gingival tissues. This 

movement is the process of emergence of the forming teeth first through the bone, then through the gingiva, and normally 

continuing to the level of occlusion with teeth in the opposing jaw. 

Dental development begins before birth and development and emergence can continue for more than twenty (20) years after 

birth. Visualization of the stages of dental development and emergence of multiple teeth by various imaging techniques facilitate 

dental age assessment. The assessments result in estimations of the chronologic age of individuals based on comparison to 
ADA Technical Report No. 1077 – 2020 11

data from a robust collection of peer-reviewed reference studies. Specific techniques should be selected based on case-specific 

factors, including the general estimated age interval (prenatal, infant/child, adolescent, adult), sex, identifiable human group and 

whether the individual is living or deceased. In general, techniques based on dental development are more accurate than tooth

emergence techniques. Techniques based on gingival emergence, the clinical appearance of the teeth through the gingiva, are 

the least dependable. Other techniques exist based on post-development changes to teeth for cases in which all teeth are fully 

developed.

Teeth are well suited for use in the analysis of age assessment. Dental enamel is the hardest tissue in the human body and teeth 

can survive many perimortem insults and postmortem conditions. Dental development is less affected by environmental factors,

socioeconomic status, nutritional variation, dietary habits, endocrinological, or disease influences than other age assessment

methodologies. Relatively simple techniques for assessing age based on dental development are available.

5.1 Tooth Development Stages

This is defined as the various degrees in the development of human teeth that represent specific points of mineralization 

discernible through a variety of diagnostic imaging modalities.

Tooth development and emergence of human teeth through alveolar bone, as previously mentioned, are more accurate in 

human dental age assessment than dental emergence through soft tissues. Those tooth development staging systems that use 

crown/root development or emergence through alveolar bone should be used where indicated over those techniques that are 

dependent on tooth emergence through soft tissues.

Different dental age assessment techniques use different tooth developmental staging systems. Currently, there is no consensus 

on what staging system is better. Dental developmental staging systems are method dependent and it is recommended that they 

be utilized based upon the appropriate reference study.

5.1.1 Assessment of Tooth Stages

When assessing tooth development from dental radiographs or other imaging modality, one can distinguish between consecutive 

developmental stages more easily using internal hard tissues, such as the shape of the pulp chamber or root canal. This 

improves sensitivity and performance measures. 

5.1.1.1 Crown assessment: The practitioner should assess the thickness and continuity of enamel in the incisal or occlusal 

surface of any tooth, followed by the presence of dentin and ending with the shape of the roof of the pulp.

5.1.1.2 Root assessment: The practitioner should assess the root as initiated when small divergent spicules appear from 

the edges of the crown. Thereafter, the amount of root developed should be compared to the size of the crown (lengthwise) until 

the length of the root exceeds the length of the crown, then attention should be on the root apex in terms of maturity (open, 

closed and the width of the apical periodontal ligament space). 

5.2 Basic Theory of Age Assessment

Most age assessment processes and techniques conform to a specific mathematical probability function called normal 

distribution. Typical normal distribution can be demonstrated by bell curves that define the extent of the variation for the specific 

feature(s) the technique investigates. Bell curves can have very similar or very different shapes and are based on the data 

gathered using the specific method. The bell curves for the different techniques may be similar with a midline peak and symmetry 

around the midline. They can also appear dissimilar with different height, width, and peak location based on the dispersion of the 

data and the location of the mean (signified by the peak). Most bell curves demonstrate normal distribution of data; however, the 

shape may show variations to illustrate the terminal developmental stage. 

There are multiple statistical expressions to describe the dispersion of data or level of uncertainty. That statistical expression will 

be dependent on the specific population reference study used for the dental age assessment.
12 ADA Technical Report No. 1077 – 2020

The use of databases in the evaluation of tooth maturation and post-developmental dental changes is an essential component of 

dental age assessment. There is still no uniform consensus concerning the appropriate statistical methodology that considers 

both the age intervals reported in the tables as well as the age interval among the individual teeth utilized in the assessment. 

Therefore, the reporting of an appropriate standard deviation methodology is beyond the scope of this document.

5.3 Scientific Basis for Dental Age Assessment and Age Interval Calculations

Tooth maturation, which includes developmental and post-developmental changes, as with most biological processes, follows a 

continuous progression. In addition, the assignment of a predicted time range for a specific stage of maturation is the basis of 

numerous fields of science and medicine, including embryology, obstetrics, pediatric medicine, and child psychology. The 

success of key diagnostic and therapeutic decisions based on time intervals listed in published development tables is an 

established principle of modern medicine.

6 AGE ASSESSMENT DATABASES

6.1 Databases

A dental age assessment database is one or more reference data sets from one or more reference studies. It uses robust, 

reproducible methods of analysis to estimate the distribution of ages associated with dental development, maturation, and postdevelopmental dental changes. 

The desired attributes of a database include:

1. Adequate sample size: Defined by individual reference studies, or of a combined dataset based on more 

than one reference study. 

2. The provenance of the data: (i.e., The source(s) or identifiable human group from which the data came).

3. Methods and units of measurements clearly defined and described.

4. The ability to assess the impact of varying assumptions or analytic methods on the results.

5. A sufficient level of detail provided in published materials or available from study authors to provide the 

practitioner with the information needed to address items 1-4 above. 

Note 1: Each dental age assessment database uses different metrics and the practitioner shall be responsible for understanding those differences 

when applying the data to a specific human dental age assessment technique.

Note 2: Dental age assessment database information changes regularly. Current resources for databases can be found in the bibliography section 

of this document. 

6.2 Sexual Dimorphism of Databases

The differences in tempo of development and maturational changes in teeth between males and females are well established. It 

is recommended that databases reflective of each sex be maintained separately.

Dental age assessment databases need to have distinct sex categories for males and females. Additionally, if sex is not known,

then include an unknown category in the database.

6.3 Ancestral Diversity of Databases

The differences in tempo of development and maturational changes in teeth between identifiable human groups are well 

established. It is recommended that data reflective of a specific identifiable human group be maintained separately.

Dental age assessment databases need to have distinct, identifiable human group categories for ancestry or population 

specificity. Additionally, if the identifiable human group is not known, it is recommended that an unknown category be added to 
ADA Technical Report No. 1077 – 2020 13

the database.

6.4 Validation Studies

In dental age assessment, reference datasets and methodologies are created by researchers to develop statistical information 

for calculating a dental age interval. Testing the reliability of the reference datasets and methodologies to an unrelated 

population-specific database of a statistically appropriate size and with subjects of a confirmed chronological age can be an 

important tool for evaluating the dental age assessment process. Dental age assessment research projects should utilize these 

independent databases and include calibration and testing of the dental age assessment examiners. Once the age interval for 

each individual is calculated, the test should report how often the chronologic age falls within the assessed age interval. An 

appropriate accuracy rate for legal purposes is beyond the scope of this document.

7 CONSENT AND PROFESSIONAL CONSIDERATIONS 

Forensic dental analysis on living and deceased individuals, including issues of consent, are subject to legal regulations and 

ethical considerations beyond the scope of this document.

8 COLLECTION OF EVIDENCE

Evidence collection for dental and maxillofacial age assessment techniques should follow the published criteria for the 

technique(s) selected. Technique selection should be based on criteria specific to the individual case. Evidence can include 

radiographs, photographs, and teeth or portions of teeth. Teeth or portions of teeth should only be collected as evidence 

following ethical considerations. It is recommended that the evidence collected be comprehensive and specific to the 

circumstances of each case. When applicable, the case identification and biographical information data discussed below should 

also be collected.

8.1 Case Identification Data

To the greatest extent possible and practical, it is recommended that the following case identification data be recorded and 

archived:

8.1.1 Case Number: A unique alphanumeric identifier. When appropriate, this identifier can be of a type agreed to or 

designated by the referring agency.

8.1.2 Referring Agency: The agency or authority requesting the analysis. This agency may or may not be responsible for 

the case investigation or disposition of the case. The referring agency address should also be documented.

8.1.3 Name(s) of the Examiner(s): Full name and pertinent degree(s) of the individual(s) conducting the examination, 

evidence collection, or analysis of case evidence. 

8.1.4 Date of the Examination: Month, day, year, as per the convention of investigating agency.

8.1.5 Setting of Examination: The specific location where the dental age assessment occurred.

8.1.6 Name of Subject: Full or partial name as reported by the subject or by family, witnesses, agencies, or authorities, or 

provided in documents. It is recommended that known aliases or nicknames be included. If the subject’s name is unknown, a 

suitable unique pseudonym or alphanumeric case number identifier can be used.

8.1.7 Birth Data: Record the date and place of birth claimed or stated by the subject or other information related to the 

subject’s date, and place of birth . Supporting information from family members, witnesses, agencies, authorities, or other 

documents can be used to reinforce the claimed date and place of birth.

8.1.8 Other Data: Any additional data that may affect the assessment results.

8.2 Biographical Information of the Individual
14 ADA Technical Report No. 1077 – 2020

In addition to the case identification data collected, collect and consider biographical information for each subject.. The 

biographical data evidence collected should include information that is as comprehensive as possible and practical. 

Include in the biographical data available information related to the subject individual’s sex, identifiable human group, geographic 

origin, subsequent places lived, current and former health issues, current and former nutritional status, current and former habits 

that may relate to skeletal, oral, or dental development or conditions, current and former medications or addictions that may

relate to skeletal, oral, or dental development or conditions, and any other environmental or cultural factors that may have 

affected skeletal, oral, or dental development or contributed to post-development skeletal, oral, or dental changes.

8.3 Dental Evidence Observed, Collected and Measured

The dental evidence observed, collected, and measured is case-specific and may be limited by medical ethics, quality and 

quantity of dental and maxillofacial remains, best practice techniques available, and permission granted or denied by the medical 

examiner or pathologist to extract, section or expose dental/maxillofacial structures. Although all dental/maxillofacial structures 

should be considered, the practitioner needs to list specific teeth or other structures utilized in the assessment of age. It is the 

responsibility of each practitioner to apply the appropriate scientific methodologies that are consistent with the reference studies’ 

methods and designs. 

8.3.1 Dental age assessment Criteria

1. Morphologic developmental tooth staging

2. Dental emergence pattern

3. Any other measured dental developmental or post-formation characteristics

4. Chemical or isotopic analysis

8.3.1.1 Occlusion

This may present as one of several factors contributing to the development of variables utilized in dental age assessment in 

adults, especially attrition and secondary dentin formation. Factors to consider when evaluating occlusion can include:

incisal/occlusal wear, traumatic occlusion, lack of occlusion, enamel quality, diet, function and habits, dental restorations, 

occlusal adjustments, dental therapy, and dental appliances.

8.3.1.2 Oral Hygiene

Plaque, calculus and debris present risk factors for the development of caries and periodontal disease and are conditions that

should be considered in many dental age assessment methods. The practitioner should collect oral hygiene data that may affect 

dental age assessment outcomes.

8.3.1.3 Pathology

In addition to clinical and radiographic findings of common dental diseases, localized and systemic conditions may affect tooth 

development or post-developmental changes. Hard and soft tissue lesions of the maxillofacial complex may indicate factors 

potentially affecting the rate of development or aging. Systemic conditions leading to the absence of teeth and disease 

processes or therapies affecting morphology or rate of development can preclude dental age assessment.

8.3.1.4 Photographs

A series of extraoral and intraoral clinical or postmortem photographic images are useful in documenting gross clinical or 

postmortem findings in dental age assessment. Use macro and microscopic photographic techniques when the dental age 

assessment technique warrants it. 

8.3.1.5 Radiographs
ADA Technical Report No. 1077 – 2020 15

Intraoral or extraoral radiographic images consistent with clinical diagnostic views for both living and deceased individuals can be 

used for most dental age assessment techniques. Standard 2-dimensional radiographic images are typically used in reference 

studies, although emerging 3-dimensional images show great promise for the future of dental age assessment. Radiographs 

reveal the current state of morphologic development of dental structures for individuals still undergoing developmental and 

maturational changes. Also, post-maturational dental changes can be demonstrated and measured in radiographs of teeth and 

maxillofacial structures. In addition, the detection of dental disease, trauma, and systemic conditions that may affect dental age 

assessment can often be detected in dental radiographs.

9 DENTAL RADIOLOGY

Dental radiographs are an adjunct to the physical and visual examination of the dental and maxillofacial structures. Depending 

on the precise context of the issues to be resolved, radiographs provide significant and detailed information enabling accurate 

age estimation. Radiographs that have been shown to be useful are the dental periapical, panoramic, computed tomography 

(CT) scans, and cone-beam computed tomography (CBCT). In addition, views comprising lateral, lateral oblique, and anteriorposterior (AP) cranial views may be useful. In both the living and the deceased, dental and maxillofacial radiographs are the

source of the most accurate information for age estimation.

Although the primary objective in obtaining radiographs is for age estimation, practitioners are bound by ethical and clinical best 

practices when assessing subjects. Even though this is a nonmedical or dental referral, the primary responsibility is to ensure 

that the individual is provided appropriate and accurate information for an individual to give informed consent. In addition, make 

the subject and those responsible for his or her medical and dental care aware of any clinical issues that are detected during that 

process. 

Obtain the radiographs under review in compliance with all applicable federal, state, and local health requirements and privacy 

laws. 

9.1 Image Acquisition

Practitioners who take radiographic images need to: 

1. Establish and maintain operating and safety procedures that ensure radiation exposures are as low as 

reasonably practicable. This applies to both the subject receiving ionizing radiation and staff who are in the area of 

the ionizing radiation-emitting device. 

2. Provide personal protective equipment (PPE) for the individual being irradiated if appropriate. The best 

method for minimizing radiation dose for a subject is to limit the irradiated field and reduce the number of exposures. 

3. Establish and monitor the designated zone of radiation. This includes correcting breaches of radiation 

protection protocols. In the unlikely event of overexposure to the subject, immediately refer to a radiation protection 

physician. 

4. Ensure the radiation safety of all persons accompanying the individual, especially when imaging is 

performed outside a dedicated lead-lined x-ray room. This may occur if handheld imaging equipment is used. 

5. Ensure that all images have the correct subject information, identification number, date of birth, date of 

radiographic exposure, sex, and correct labeling of right or left sides. 

6. Be trained in forensics and ionizing radiation methods and competent in the operation of the respective 

imaging technique.

7. Understand imaging techniques and appropriately explain the reasons for selecting a specific technique 

to answer the legal question(s) posed, based on knowledge of the capabilities and limitations of the various aspects 

of imaging.
16 ADA Technical Report No. 1077 – 2020

8. Be familiar with the most frequently used image processing tools and techniques. [1]

10 DENTAL AGE ASSESSMENT METHODS AND TECHNIQUES

Base the age assessment method or technique selection upon the specific circumstances and evidence available for each case 

(See 4, Scientific Methods of Dental age assessment). When practical, practitioners should utilize multiple independent statistical 

methodologies. Additionally, the practitioner should utilize and apply the most appropriate statistical data in the assessment of an

individual’s chronologic age. This includes consideration of the individual’s sex, identifiable human group, population specificity,

and environmental factors when known. The practitioner needs to precisely follow the methodology of the reference study 

utilized. This includes but is not limited to the methods for morphologic staging and criteria measurement(s). The use of 

malformed, diseased, or extensively restored teeth should be avoided when the dental age assessment technique dictates.

Staging methods are based on subjective interpretation of observations, and methods have some level of rater variability (interand intra-variability). Best practice includes the use of independent assessments of the development stage, with a predefined 

and documented method for recording each evaluator’s results and resolving differences.

Dental age assessment methods/techniques are categorized based upon their applicability to the perceived estimated age 

interval of each subject and ethical considerations for both living and deceased subjects. 

A dental age assessment procedure selection chart can be found in the ABFO Diplomate’s Reference Manual, Section IV, 

Standards, and Guidelines. [2] https://abfo.org/resources/abfo-manual/

An additional resource is published through the European Asylum Support Office, EASO Practical Guide on Age assessment. It 

is available at: [3] https://www.easo.europa.eu/sites/default/files/easo-practical-guide-on-age-assesment-v3-2018

10.1 Atlas

Atlas-based dental age assessment techniques utilize graphic and diagrammatic representations of the morphology of 

developing tooth structures. Some include the associated emergence patterns. Most, but not all, atlas techniques are non-sex 

specific and have a limited number of population-specific data sets resulting in a higher degree of variability, particularly in midchildhood through adolescence. In addition, Atlas techniques are often based on mixed population and ethnic data. Atlas 

techniques are particularly useful in mass victim identification and clustered victim situations to assist investigators to more 

efficiently characterize remains by estimated age interval.

A dental age assessment procedure selection chart can be found in the ABFO Diplomate’s Reference Manual, Section IV, 

Standards and Guidelines. [2] https://abfo.org/resources/abfo-manual/

10.1.1 Infant/Child

For the purpose of forensic dental age assessments, the infant/child interval has been defined in the “Terms and Definitions” 

Section 3 of this document. 

Infant/child dental age assessment techniques utilize radiographic evaluation to stage the degree of morphologic development of 

the primary or secondary dentition as well as resorption of the primary dentition. Infant/child methods/techniques should 

consider sex, identifiable human group, and population specificity. Therefore, these methods/techniques will generally provide a 

more accurate and reliable estimate of age over eruption and atlas methodologies. Additional factors that may affect dental age 

assessment are prenatal conditions and preterm birth. The significance of each condition may vary with the dental age 

assessment methodology.

The rights of children are enshrined in the United Nations Convention on the Rights of the Child (UNCRC) [4]. This framework 

underpins all international guidance in relation to children. The1989 UNCRC is a universally agreed set of non-negotiable 

standards and obligations that set minimum entitlements and freedoms that should be respected by governments.

Article 37 relates specifically to children who are in conflict with the law and states that they have a right to be treated “in a 
ADA Technical Report No. 1077 – 2020 17

manner which takes into account the needs of persons of his or her age” [4]. Therefore, a credible age assessment is crucial in 

safeguarding children and juveniles, thus ensuring appropriate treatment. Where the age is not known, the benefit of the doubt 

should prevail, and he or she is presumed to be a child. The Committee on the Rights of the Child (CRC) recommends that each 

State party:

...give the benefit of the doubt in age-disputed cases of separated children seeking asylum and seek experts’ 

guidance on how to determine age. [4,5]

A dental age assessment procedure selection chart can be found in the ABFO Diplomate’s Reference Manual, Section IV, 

Standards and Guidelines. [2] https://abfo.org/resources/abfo-manual/

10.1.2 Adolescent

For the purpose of forensic dental age assessments, the adolescent interval has been defined in the “Terms and Definitions” 

Section 3 of this document.

Adolescent dental age assessment techniques utilize radiographic evaluation to stage the degree of dental development toward 

the latter half of dental morphologic maturation. Although the third molar exhibits the highest degree of morphologic 

developmental variability, it remains extremely useful in the assessment of age. Utilize early adolescent age assessment 

methodology when teeth other than the third molar continue to undergo morphologic development. Utilize late adolescent age 

assessment techniques when the third molar is the only remaining tooth continuing to undergo morphologic development. These 

techniques play a useful role in assisting legal authorities in determining the disposition of cases involving immigration, asylum 

seekers, and legal age of majority or license.

A dental age assessment procedure selection chart can be found in the ABFO Diplomate’s Reference Manual, Section IV, 

Standards and Guidelines. [2] https://abfo.org/resources/abfo-manual/

10.1.3 Adult

For forensic dental age assessments, the adult interval has been defined in the “Terms and Definitions” Section 3 of this 

document.

Adult dental age assessment techniques may utilize either radiographic morphological evaluation or gross/microscopic 

observation of post-formation changes within the dentition following the cessation of morphologic dental development. Although 

others have been described, six traditional post-formation variables have been utilized in the assessment of adult chronologic 

age. They are: 

1. Root translucency – The phenomenon that occurs from the deposition of hydroxyapatite crystals within the dentin 

tubules over time; it begins at the apex and progresses coronally after the approximate chronologic age 20 years.

2. Secondary dentin deposition – The physiologic or reparative process of laying down additional dentin in the pulp 

throughout a tooth’s lifecycle.

3. Periodontal attachment – The epithelial and ligamentous attachment between the tooth and the gingival tissues 

and alveolar bone.

4. Cementum apposition – The continual and usually regular process of depositing new cementum on the root of a 

tooth throughout its lifecycle; often greater at the apical region than near the cementoenamel junction.

5. Attrition –The gradual wearing away of the tooth surfaces because of chronic, tooth-to-tooth frictional contact,

often due to mastication.

6. Root resorption – Resorption of root cementum and dentin by multinucleated odontoclast activity, often 

associated with traumatic injuries and prolonged inflammation; it may be internal or external.

Ethical considerations may restrict the use of many adult dental age assessment methodologies due to the requirement of 
18 ADA Technical Report No. 1077 – 2020

sacrificing tooth structure.

A dental age assessment procedure selection chart can be found in the ABFO Diplomate’s Reference Manual, Section IV, 

Standards and Guidelines. [2] https://abfo.org/resources/abfo-manual/

10.2 Biochemical

Biochemical dental age assessment techniques require the sampling of dental tissues to evaluate amino acid racemization within 

the dentin or level of radioactive carbon 14 within the dental enamel. Aspartic acid racemization can estimate the age at tooth 

extraction or death, while radioactive carbon 14 may estimate the date of birth for individuals born after World War II. These 

techniques are useful in all age groups and do offer a report of relatively low estimated age intervals. Currently, available 

biochemical techniques pose ethical considerations for use in the living because of the amount of tooth structure required for 

testing. The testing methods are complex and laboratory procedures require considerable time to process. 

A dental age assessment procedure selection chart can be found in the ABFO Diplomate’s Reference Manual, Section IV, 

Standards and Guidelines. [2] https://abfo.org/resources/abfo-manual/

11 REPORTED FINDINGS FOR DENTAL AGE ASSESSMENT

Label the forensic dental age assessment report, “Dental Age Assessment Opinion or Expert Report,” and include the following: 

11.1 Introduction

This section provides background information, including:

• Organization requesting report (to include address of individual or organization making request);

• Reason for the request, date of examination, name, and position of practitioner;

• Whether the subject in question was accompanied by a guardian (if so, with name of guardian);

• Documentation of written informed consent and the setting in which the examination was undertaken. 

The type of information collected, and the amount of information collected is specific to the circumstances of each case.

11.2 Case Identification Data

This section includes a case identification number and if any age-related legal documents were presented at the date of subject 

examination, birth certificate, national identification, passport, vaccination certificate, etc.

11.3 Biographical Information regarding the Individual 

This section includes the identifiable human group of the individual in question, sex, and the presence or absence of any 

syndromes or diseases. Also, include a written note regarding the mental and cognitive ability of the individual in question, their 

general status, and their height and weight. 

11.4 Inventory of Evidence

This section lists all evidence received, observed, or collected, including a list of the dentition and anatomic structures analyzed 

by the practitioner and details the source of the evidence.

11.5 Method(s) of Analysis

This section describes the analytic method(s)/scientific technique(s) and population-specific reference data used in the dental 

age assessment. A list of anatomic structures analyzed (number and type of teeth analyzed and why specific teeth and 

structures were used), unit of measurement used, tooth numbering system used, specific technique(s) utilized, and the published 

reference study where statistical information was obtained should be included in this section of the forensic report. 
ADA Technical Report No. 1077 – 2020 19

11.6 Opinion/Conclusions:

This section summarizes the practitioner's results. The final age assessment is a matter of the practitioner's expert judgment by 

synthesizing all available information. Conclusion statements specific to each methodology employed includes estimated age, it's 

corresponding level of uncertainty, and an estimated age interval. If a reference study utilized to assess chronologic age does 

not provide this, then state it in the forensic report. For cases involving immigration, asylum seekers, and legal age of majority or 

license, include a probability statement that the individual has attained the age in question. When statistical mean age and 

standard deviation are known, statistical probability can be calculated. The practitioner needs to keep in mind the best interest of 

the subject undergoing dental age assessment evaluation as the priority.

The report is signed by the practitioner and dated. 

11.6.1 Disclaimer

A disclaimer statement indicating that the opinion is subject to review or modification if additional information or evidence 

becomes available should be added.

12 DATA BACKUPS

Back up digital data on a local computer server and on at least one secure stand-alone backup hard drive; and on secure off-site 

media or cloud storage. In all cases, follow the appropriate security protocols. Maintain hard copies of material that cannot be 

readily digitized in a master file and follow security protocols in place for other types of physical evidence for these hard copies 

as well.

12.1 Cloud Storage of Data

Traditionally, forensic data have been stored on a local server or a personal computer. Cloud storage of data is the use of remote 

hosting servers on the Internet to store, manage, and process these data. When processing and analytical software are included 

on the same remote server with the forensic data, and delivered over the network, this type of cloud computing is called Software 

as a Service, or SaaS. Cloud computing has raised issues for the practitioner. These issues are covered in ADA Technical 

Report No. 1091, Cloud Computing: Implications and Recommendations for Dental Practice.

12.2 Data Disposition Guidelines

The practitioner maintains data acquired during a dental examination, records received, written reports and any documented 

communications in accordance with standard dental/medical protocol. 

The examining practitioner may also retain copies of the data in age assessment cases, if security protocols allow, in order to 

refer to the data should the need arise. However, if security protocols require the ultimate destruction of the data, dispose of the 

data following approved data destruction protocols. Shred paper documents shredded using crosscut shredding devices. Do not 

delete electronic media but utilize “wiped clean” specialized software. In addition, encourage physical destruction of electronic 

media as an additional security measure.

13 DE-IDENTIFICATION OF DATA FOR RESEARCH AND EDUCATIONAL PURPOSES

There are currently no approved guidelines for the proper protocol to anonymize forensic dental data for research and 

educational purposes. Due to the sensitive nature of this data, exercise extra care in its use and consultation with the appropriate 

institutional review committees is strongly advised.

It has been suggested, that at a minimum, to follow federal HIPAA de-identification protocols for the Electronic Health Record 

prior to using this data. This includes the removal of all 20 HIPAA "Identifiers" of an individual as listed at the government web 

site for “Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health 

Insurance Portability and Accountability Act (HIPAA) Privacy Rule” at 

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/De-identification/guidance.html
20 ADA Technical Report No. 1077 – 2020

Remove the following identifiers of the individual or of relatives, employers, or household members of the individual:

1. Names

2. All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP code, and their 

equivalent geocodes, except for the initial three digits of the ZIP code if, according to the current publicly available data from the 

Bureau of the Census:

i. The geographic unit formed by combining all ZIP codes with the same three initial digits contains more than 20,000 

people; and

ii. The initial three digits of a ZIP code for all such geographic units containing 20,000 or fewer people is changed to 000.

3. All elements of dates (except year) for dates that are directly related to an individual, including birth date, admission 

date, discharge date, death date, and all ages over 89 and all elements of dates (including year) indicative of such age, except 

that such ages and elements may be aggregated into a single category of age 90 or older.

4. Telephone numbers.

5. Fax numbers.

6. Email addresses.

7. Social security numbers.

8. Medical record numbers.

9. Health plan beneficiary numbers.

10. Account numbers.

12. Certificate/license numbers.

13. Vehicle identifiers and serial numbers, including license plate numbers.

14. Device identifiers and serial numbers.

15. Web Universal Resource Locators (URLs).

16. Internet Protocol (IP) addresses.

17. Biometric identifiers, including finger and voiceprints.

18. Full-face photographs and any comparable images.

19. Any other unique identifying number, characteristic, or code.

Researchers need to also consider that eliminating all 20 identifiers would still allow for the possibility of re-identification of the 

individual. In those cases, consider additional aggregation of data to de-identify individuals further.

14 DISPOSITION OF RADIOGRAPHS

Like other forms of digital data, digital radiographs should be backed-up with on-site as well as off-site media or cloud storage 

media. If photographic (film) media was utilized to image the remains, double pack intraoral film is recommended. Retain one set 

of films by the practitioner for his/her case file. In identification cases, the second set may be mounted and forwarded with a 

written report to the referring entities for the master file. As a general guideline, back up digital radiographs in the same manner 

as other digital media.

15 QUALITY ASSURANCE (QA)
ADA Technical Report No. 1077 – 2020 21

Blinding includes avoiding personal contact with living individuals and obtaining any unnecessary information that can alter the 

practitioner’s perception. It can originate from many sources, including biases, workplace pressures, or even the introduction of 

external relevant or irrelevant data from the actual investigation.

Independent verification includes an assessment of the use of proper technique, methodology, and conclusions.

16 CONCLUSION

The use of proper methodology and procedure in estimating chronologic age is of utmost importance. Dental age assessment is

a common method of estimating age in both the living and the deceased. It is recommended that Forensic dental age 

assessment practitioners implement these developed guidelines to the fullest extent applicable, practical, and appropriate.
22 ADA Technical Report No. 1077 – 2020

17 BIBLIOGRAPHY

[1] International Commission on Radiological Protection 2007. The 2007 Recommendations of the ICRP. ICRP Publication 103.

[2] ABFO Diplomate’s Reference Manual, Section IV, Standards, and Guidelines. Available: https://abfo.org/resources/abfomanual/

[3] European Asylum Support Office Practical Guide on Age Assessment. Available:

https://www.easo.europa.eu/sites/default/files/easo-practical-guide-on-age-assesment-v3-2018.(pdf Included).

[4] United Nations.1989. Convention for the Rights of the Child [Online]. Available: 

http://www.ohchr.org/Documents/ProfessionalInterest/crc.pdf [Accessed 18/12/2016].

[5] United Nations. 2008. Committee on the Rights of the Child (CRC) [Online]. Available: 

http://www2.ohchr.org/english/bodies/crc/docs/AdvanceVersions/C

18 ADDITIONAL RESOURCES

ADA Technical Report No. 1094, Quality Assurance for Digital Intra-Oral Radiographic Systems

ADA Technical Report No. 1091, Cloud Computing: Implications and Recommendations for Dental Practice

ISO 1942, Dentistry – Vocabulary

ISO 3950, Dentistry — Designation system for teeth and areas of the oral cavity

ASTM E1732 – 12, Standard Terminology Relating to Forensic Science

ASTM E1459 – 13, Standard Guide for Physical Evidence Labeling and Related Documentation

ASTM E1188 – 11, Standard Practice for Collection and Preservation of Information and Physical Items by a Technical 

Investigator

ASTM E678 – 07, Standard Practice for Evaluation of Scientific or Technical Data

ASTM E620 – 11, Standard Practice for Reporting Opinions of Scientific or Technical Experts

HIPPA 45 CFR (Code of Federal Regulations) 

ANSI/ADA Standard No. 1058, Forensic Dental Data Set