Identification - Age estimation

age estimation in living and dead

1. Dr Nikita Prabhakaran Junior Resident Department of Forensic Medicine Thiruvananthapuram

2. Gaurav Mukhi case “Youngest best player in ISL” “ Emerging player of the match” Award Alleged to be of over age ???????

3. Identification - 2

4. Race Sex Age Stature

5. Not the duty of other doctors !!!!!!!!!

6. How to estimate age in the living and the dead?????

7. Major things to look for: (1) TEETH (2) BONE-ossification of bones (3)Secondary Sexual Characters (4) General Development- stature + psychomotor

8. Note: Infants - in utero features Children - general developmental milestones

9. Teeth

10. Alveolar cavity in mandible 3-4 month IU life Cellular tooth germ (crown) Root grows Lifting the crown outside Temporary tooth eruption At birth Rudiments of all temporary teeth + 1 st permanent molars Root reabsorbs Unsupported crown falls off Permanent teeth erupts

11. Temporary Teeth = 2 incisors + 1 canine + 0 premolars + 2 molars (5 * 4 = 20 teeth) 2102 2102 Permanent Teeth = 2 incisors + 1 canine + 2 premolars + 3 molars (8 * 4 = 32 teeth) 2123 2123

12. Temporary teeth Permanent Teeth Smaller, lighter, narrower (exception temporary molars >>> permanent premolars) Heavier, stronger, broader Anterior teeth - vertical Inclined a little forward Milk white in colour Ivory white in colour Quick attrition – less mineralisation Less attrition Enamel- thinner Thicker ( less constant) Marked constriction between crown and root No such constriction

13. Temporary teeth Permanent Teeth Anterior teeth - Labial surface Smoother Perikymata (depressions) Incisal edges No mamelons Mamelons present (wear away quickly) Posterior teeth - Molars Buccal and lingual surfaces-flatter Less flat Roots of molars Smaller + more divergent Larger+ less divergent

14. (8-12m) 8 10 18 14 24 6 (6-8m) 12 (12-14 m) 18 (18-20m) 14 24 (20-24m) Upper Lower Medial Lateral

15. 6 8 10 12 18 18 14 14 24 24

16. 7 (7-8) 8 (8-9) 11 (11-12) 9 (9-11) 10 (10-12) 6 (6-7) 12 (12-14) 18 (>17) Central Incisor Lateral Incisor Canine PM-1 PM-2 M-1 M-2 M-3

17. 7 8 9 10 11 6 12 18

18. Mixed Dentition Age= (No: of permanent teeth – 5) * 4 Between the age of 6-11 years

19. Successional & Superadded teeth Successional - those permanent teeth that replace other teeth Super added - those added to the existing set of teeth, do not replace any teeth ( eruption  increases the number of teeth )

20. >21 years old Physiological changes of age in dental tissues 6 characteristics

21. (1) Attrition - due to wear and tear from mastication (2) Periodontosis - regression of the gums (3) Secondary dentin – develop from the walls within the cavity (4) Cementum apposition - secondary cementum  incremental lines (5) Root Resorption - starts at the apex (6) Root Transparency - >30 years – canals in the dentine (deposition)

22. Take the sum of scores  formula AGE

23. Bone

24. CLAVICLE Medial end 18-20 Yrs 22-23 Yrs

25. 6 m IU 7 m IU 9 m IU 60 Yrs 40 Yrs STERNUM

26. acromion coracoid 14 Yr 18 Yr SCAPULA

27. head greater lesser tuberosity 1 Yr 3 Yr 5 Yr 6 Yr (16-18Yr) capitulum trochlea Lateral epicondyle 13 Yr 11 Yr 2 Yr 14Yr (14-17Yr) Medial epicondyle 8 Yr

28. Upper end -radius Lower end -radius 6 Yr 2 Yr 6 Yr 10 Yr Upper end -ulna Lower end -ulna RADIUS AND ULNA (14-17Yr) (14-18Yr)

29. P TQ L S C TM H TD 1- capitate 2-hamate 3-triquetral 4-lunate 5-trapezoid 5-scaphoid 6-trapezium 11-12-pisciform CARPAL BONES 2 2-4 2-4 2-4 2-4 14-17 Yr

30. 14 yr (18 yr ) (11-14 yr ) (7-8 yr ) 16 yr (19 yr -F) (21 yr -M) PELVIS Triradiate cartliage Ilia crest Ischial tuberosity Ischiopubic ramus

31. 4-5 m IU 6-7 m IU I II III IV V 8m IU (14 Yr ) (20-25) Yr SACRUM

32. Head Lower end of femur 1 yr 4 yr 11 yr 9 m IU (15 yr ) (14- 17 yr ) (14- 17 yr ) (14- 17 yr ) FEMUR Greater trochanter Lesser trochanter

33. Upper end -Tibia Lower end -Tibia Just after birth (14-17 yr ) 2 yr (14-17 yr ) 4 yr Upper end -Fibula Lower end -Fibula TIBIA AND FIBULA

34. (14-17 Yr ) TARSAL BONES Calcaneum 5 m IU Talus 7 m IU Cuboid 9 m IU

35. 40-50 50 30-40 40-50 50-60 50-60 60-70 40-50 80 Cranial Sutures

36. Case A school student has won long jump in district level in the sub-junior category (sub-junior  << 14 ) Allegations came that she was above 16 years ????

37. Tanners staging

38. Rule of Hasse First 5 months of IU life  Crown-heel length= square of the months of gestation After that Age in lunar months * 5

39. 1 st month/ 4 weeks I cm in length 2.5 g grey coloured oval mass = pigeons egg attached to the chorion with a very short cord limb buds  nodules

40. 2 nd month/ 8 weeks 4 cm Sex is indistinct Webbed hands and feet P

41. 3 rd month/12 weeks 9 cm long Eyes are closed, pupillary memb ++ Sex – rarely indistinguishable

42. 4 th month/ 16 weeks 13 to 16 cm long Sex distinguishable Convolutions of brain+ Breast buds seen as dots 1/4th

43. 5 th month/20 weeks 25 cm length Vernix caseosa ++ Light hair in the head Lanugo on the body

44. 6 th month/24 weeks 30 cm length Wrinkled appearance Eyebrows, eyelashes+ Testicles –close to kidneys

45. 7 th month/ 28 weeks Length:35 cm Thick finger nails( not reaching the tip) Eyelids partly open. Testes- ext inguinal ring Caecum in RIF+ Period of viability

46. 8 th month/32 weeks Length 40 cm Lanugo disappears from the face, Scalp hair thickens-1.5 cm length Nails have reached the tips Left testis descended

47. 9 th month/36 weeks 45 - 47 cm Lanugo hair has complete disappeared Vernix caseosa at the flexures of joints

48. 10 th month/40 weeks Full term Lanugo – absent except in shoulders Nails – project beyond, toenails reach tip Umbilicus-central part between xiphoid and pubis Rectum : Dark brown meconium +

49. Medicolegal Importance of Age 3 months First trimester- one doctor is enough for MTP 4 months Quickening – quick unborn child  Culpable Homicide > 5 months- illegal MTP 7 months  period of viability 1 year  Infant ( Infanticide)

50. 5 years  < 5 years in the custody of the mother (The Hindu minority and guardianship) 7 years  Criminal responsibility “ any act done by a child less than 7 years is not an offence (s 82 IPC)” 7-12 years: if he proves he did not attain such understanding-not punishable Exception : 5 years  Railway act : child above 5 years should be held responsible for wrecking a train

51. 10 years  Child < 10 years - kidnapped/ abducted punishment 10 years  property is stolen Kidnapping 16 years (males)  from local guardianship Kidnapping 18 years (females)  from local guardianship Kidnapping 21 years female- imported for illicit intercourse Kidnapping

52. Kidnapping Abduction Even with will by illegal means By decietfulness

53. 12 years Age of consent ( S 89 IPC) Age of consent for general physical examination No consent is valid if age <12 years( S 90 IPC) < 12 years- gives his evidence in the court of Law without oath

54. 14 years  <14 years not allowed to work in any factory cannot be employed for any work 16 years : child- < 16 years (old juvenile act) Now > 18 years ( JJA,2000 + POCSO) 16-18 years  rape / murder tried as adults No death penalty/life term imprisonment

55. 18 years : Age of majority Right to vote Marriage for girls Consent for undergoing surgery Consent for sexual Intercourse Consent for acts intended to cause grievous hurt (boxing, fencing) Age for donating organs

56. 21 years Age for marriage in adult males 60 years Senior Citizen- males (females- 56/58 years)

57. Discussion A child of age 6 years gave a rat poison ( offering it as a sweet) to his grandmother and the grandmother dies… will he be responsible????

58. A male of 21 years marries a female of 15 years … is it offence????

59. A child of 12 years is diagnosed with umbilical hernia . Should we take a consent???? From whom????

60. AGE in The LIVING General development Teeth Eruption Radiological Any disparity  Radiological Age in The Dead External features Teeth- Gustafson’s Ossification- reddish brown centre surrounded by bluish white cartilage Fusion- sutures+ sternum Others-Rib phase analysis Pubic symphysis

61. Important questions Temporary and permanent teeth Successional and superadded teeth Gustafson’s technique Age estimation in the living/dead MLI of age Practical  X-rays