Growth Assessment Parameter

Growth Assessment Parameter

1. Md. Rifat Waliullah SDC-13,Roll-55,Is-33 Sapporo Dental College & Hospital Growth ASSESSMENT PARAMETERS

2. Contents Types of age according to Krogman Somatotypic Age Chronologic Age Height and Weight Age Sexual Age Facial Age Skeletal Age Dental Age Conclusion Reference

3. Types of age according to Krogman • Chronologic age • Biologic age - Morphologic age - Skeletal age - Dental age - Circumpubertal age • Behavioral age • Mental age • Self concept age

4. Somatotypic Age In the overall assessment of child a general somatotype may be appreciated. Sheldon defined somatotype by a series of 17 anthropometric measurements and is not related to nutritional status . - Endomorph: Stocky abundant subcutaneous fat, digestive viscera that highly developed.A person with an endomorphic body type has a tendency to put on fat,has a soft roundness of shape,short tapering limbs,small bones and wide hips - Mesomorph: Upright, sturdy, athletic,muscle bone and connective tissue predominate.A person with a mesomorphic body shape usually has a high proportion of muscle and bone,a large trunk,a heavy chest,broad shoulders and narrow hips. - Ectomorph: Tall, thin and fragile with minimal subcutaneous fat and muscle tissue.A person with an ectomorphic body shape has a lean,fragile,delicate body,small bones and is narrow at the shoulders and hips.

5. In terms of chronologic age ectomorph is a late maturer whereas endomorph is an early maturer . Although somatotype may give gestalt about child's developmental pattern,it is not on accurate predictor of growth.

6. Chronologic Age

7. • This is the most obvious and most easily determined developmental age parameter, which is figured from child's date of birth. • There might be difference in children of same chronologic age due to difference in thing of maturation, diseases and various environmental factors. • Although it is easy to determine but, chronologic age is not an accurate indicator of development nor is it a good predictor of growth.

8. Height and Weight Age • Height has been commonly employed as determinant of development age . ▪ The standard growth curve commonly employed to characterize a child's height compared, to that of children of same chronologic age is used to assess development age.

9. • Growth of all children up to puberty follows nearly the same curves but the difference in adolescent growth spurts change the growth curves during and after puberty greatly . • Because height of each child is related to genetic as well as environmental factors it is clear that a single measurement is limited as a predictor of development age . • If at all height age has to be considered then longitudinal height of a child which expresses the child's own growth curve is of more value . • Weight and height age are corelated well with each other but weight age alone is a poor indicator if growth or developmental age owing to a large number of variations. • Clinical implications of this age are that earlier the spurt occurs shorter it is and therefore late matures are taller which also accounts for the difference in males and females.

10. Sexual Age • At puberty differential hormones actions yield characteristic body charges . • These changes are classified into five stages according to Reynolds EL, Wines IV and Tanner JM . • They outlined the stages of secondary sexual characteristics and their relation to pubertal growth spurt in height and their relation with developmental age.

11. Stage Public hair ratings for girls and boys Breast development ratings in girls Genitalia matuirity rating in boys Stage 1 No pubic hair Elevtion of papilla only Testes,penis is same size and proportion as in childhood Stage 2 Sparse growth,straight hair Enlargement of breast bud with increase in areolar diameter Enlargement of testes and scrotum with change in texture of skin Stage 3 Dark,coarse,curled hair Further enlargement without separation of contour of areola from breast Enlargement of penis in length with continued growth of testes and scrotum Stage 4 Adult type hair but cover less area Projection of areola to form a secondary mound Increase in breadth of penis with glan development and continued enlargement of testes Stage 5 Adult quality and type with spread to medial surface of thigh Further projection of papilla Adult size and shape

12. Facial Age

13. • The ultimate goal of developmental growth assessment of children being evaluated for craniofacial intervention is facial age . • Ihe aim is to identify Whether they are on their own facial growth curve and to use this as a predictor of future growth . • Various methods used for measurement of facial age andprediction of craniofacial growth are anthropometric measurement, facial growth velocity curve and cephalometric radiographs

14. Skeletal Age • This is a very important aspect of assessing the developmental age of child as skeletal age was found to more highly correlate with the developmental age than any other growth parameter . • Each endochondral bone begins with a primary center of ossification which then changes shape, size and contour till its fusion . • Any of the skeletal growth centers can be used for skeletal age assessment but hand and wrist have been most commonly used for assessment of pubertal maturation . • Advantages of using skeletal age are readily recognizable stage of ossification; regular sequence of developmental changes occurring from birth to adulthood.

15. Dental Age • Dental age is estimated according to the last tooth erupted in oral cavity in normal sequence. • This is the simplest but, the least accurate method . • This involves recognizing the teeth clinically present in the oral cavity in comparison to dental eruption charts. • The disadvantages of this technique are the wide variations in time of eruption, influence of local and environmental factors and the fact that no or several teeth may erupt during the same time interval.

16. Conclusion The correct knowledge of facial age, developmental age,chronologic age, etc. is very necessary for formulating treatment plan . These anthropometric measurements are also uselul in the interdisciplinary evaluation of patients .

17. Reference Sheldon WH. Atlas of men a guide for somatotyping males at all ages. New York; Harper and brothers; 1954 . Krogman WM. Biological timing and dentofacial complex. J Dent Child. 1968;35:176. Reynolds EL, Wines TV. Physical changes associated with adolescence in boys. Am J Dis Child. 1951;82:529. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of hand and wrist. Ed. 2; Stanford, California: Stanford University Press; 1959 Tanner JM, Whitehouse RH, Marshall WA. Assessment of skeletal maturity and prediction of adult height. New York; Academic press Inc. 1975 Tarranger J, Bruning B, Classon I. New method of assessment of skeletal maturity MAT; ActaPaedtrScand , supplement. 1976;258:121 Grave KC, Brown T Skeletal ossification and the adolescent growth spurt. Am J Orthod . 1976;69:611 Guy Willems . A review of most commonly used age estimation techniques. J forensic odontostomotol . 2001;19:9-17 Gron A. Prediction of tooth emergence. J Dent Res. 1962;41:573 Moorrees CFA, Fanning EA, Hunt EE. Age variation of formation stages of 10 permanent teeth. J Dent Res. 1963;42:1490 C . Nolla . Development of the permanent teeth. J Dent Child. 1960;27:254. Demirjian A, Goldstein H. A new system of dental age assessment. Ann Hum Biol. 1976;3:411 Ricketts RM. A principle of archial growth of manidible . Angle Orthod . 1972;42:368.