Nuzzolese, E

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TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  1DENTAL AGE ESTIMATION OF ASYLUM SEEKERS  IN SOUTHERN ITALY  Dr. Emilio Nuzzolese*                                                               * Forensic Odontologist, Bari, Italy  ABSTRACT  In Italy, as in other western countries, unaccompanied asylum seekers  deemed to be under 18 face a very different path through the immigration system from that experienced by adults. Generally adults are subject to immediate deportation or detention in jail, while minors are processed through the juvenile system, where detection is not mandatory, they will often have access to educational programs and may be granted a residency permit.  The Section of Legal Medicine of the University of Bari was approached by Immigration Police authorities and Justices of  the Peace to explore the possibility of examining unaccompanied asylum seekers, who claim do be below 18 in order to assess their ages. Age estimation is performed by a group of forensic pathologists and odontologists, inaugurating a joint consultation. The dental age estimation protocol described,  along with examples from four cases are set out later in this document.  *** In Italia, come negli altri Paesi occidentali, gli immigrati clandestini minorenni non accompagnati sono considerati per legge regolari o meglio inespellibili. I soggetti adulti sono sottoposti a procedimenti amministrativi di trattenimento e respingimento, mentre a coloro che sono riconosciuti minorenni è consentito il soggiorno compreso l’eventuale educazione scolastica.  La Sezione di Medicina Legale dell’Università di Bari è stata contattata dalle Polizia di Frontiera e dai Giudici di Pace del Tribunale di Bari con la richiesta di poter visitare gli immigrati clandestini che si dichiarano minorenni al fine di verificarne l’età. La valutazione dell’età è stata effettuata da un gruppo di medici legali e odontoiatri forensi, inaugurando un’inedita consulenza collegiale. Infine sono descritti quattro casi e la procedura odontologico-forense attuata.   Keywords: age assessment, asylum seekers, radiological, dental findings   TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  2INTRODUCTION The increasing volume of, and subsequent complexities resulting from migratory flows in the broader context of globalisation has led to a range of problems, such as the protection of human rights and disease control, but also the identification of those with the right to apply for refugee status, and the age assessment of unaccompanied minors. Italy is a magnet for immigration from other Countries bordering the Mediterranean sea, as the Italian coasts are within easy reach of these, especially during the summer months. In Italy, as in other western Countries, unaccompanied asylum seekers  deemed to be under 18 face a very different path through the immigration system from that experienced by adults. Generally adults are subject to immediate deportation or detention in jail, while minors are processed through the juvenile system, where detection is not mandatory, they will often have access to educational programs and may be granted a residency permit.  The Section of Legal Medicine of the University of Bari was approached by Immigration Police authorities and Justices of the Peace to explore the possibility of examining unaccompanied asylum seekers, who claim do be below 18 , in order to assess their ages  A group of forensic pathologists and odontologists performed this evaluation relying on the skeletal maturation as seen on an X-ray of the wrist, the ilium and an TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  3orthopantomograph, together with background information and clinical examination of each individuals.  MATERIAL AND METHODS  In this study 4 male individuals, coming from Afghanistan, deemed to me minors were examined during November 2006 at the Medical Legal Institute at the Policlinic in Bari. They were all held in a Temporary Reception Centre in Bari. Each examination was performed by a forensic pathologist and a forensic odontologist, and the results were given in the same day of the examination. For the purpose of this case report only the forensic odontology procedures are described.   The four individuals were interviewed for background information, with the help of a translator, and then went on a clinical, dental and radiological examination. Oral mucosa and teeth were examined and major caries, restorations,  teeth displacements and degree of attrition registered on an odontogram form. Finally, the dental examination ended in a visual assessment of the age based on the teeth. After the clinical and dental examination, X-rays of the left hand, the pelvis for iliac crests and an OPG were taken using digital X-ray devices (Fig. 1-3). Then the age of the individual was calculated from the root development and mineralization of third molars using tables from South Africa by Harris and Nortjè, from Sweden by Kullmann et al. and from Finland by Haavikko (Fig. 4). The techniques employ a visual guide to establish the TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  4level of crown and root development and then a simple scale for mean age estimation based upon analysis of the development of third molars. IOFOS guidelines for quality assurance were considered for the dental age estimation.  RESULTS The four individuals resulted to be one minor, K.W., age 16 (Fig. 3, 4, 5), and the other three adults of over 18 (A.A.), over 20 (M.M) and over 21 (U.F.) years of age. The results of our examinations were given within about two hours of the assessments being made. Written and detailed reports were delivered to the Justices of the Peace within two weeks. These reports included the X-ray reports.   DISCUSSION Dental and bone testing procedures are used by physicians, anthropologists, dentists and other forensic experts to assess the age of living individuals. The methods used rely on the skeletal maturation as seen on an X-ray of the left hand and wrist, clavicle, ribs and third molar teeth. For purposes of the dental age estimation the eruption, mineralization and root development of third molars as shown on the X-ray is considered together with a clinical examination. Most studies on wisdom teeth calculate only probabilities for an individual to be under or over 18 and do not reach 100% confidence. Moreover dental age research suggests that children of differing racial and ethnic TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  5background may well develop bones and teeth in a somewhat different manner. Some systemic conditions can cause delay in tooth eruption, while extraction of permanent teeth will cause the earlier eruption of teeth posterior to the extracted ones.  For this reason age estimation remains an expert opinion based on the extrapolation of different procedures  FINAL REMARKS Age estimation of unaccompanied minors is a fundamental principle of human rights and human dignity. In order to achieve and maximize effectiveness of the age assessment process, implementation of international standards, but also the inclusion of forensic odontology is needed. This can be achieved by placing greater emphasis on the role of the forensic odontologist and promoting co-operation among forensic pathologists and radiologists, as the accuracy in the age estimation process can be achieved only using multiple indicators. Finally more population studies for specific geographic and ethnic groups is needed. Dental and medical professions' ethical codes suggests one should give the child the benefit of the doubt if the exact age is uncertain.   TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  6ACKNOWLEDGEMENT The author would like to express his appreciation to Giuseppina Di Nubila, Justice of the Peace in Bari, for the legal assistance and the encouragement offered to this paper.      REFERENCES  [1] Blau S.,Hill A., Briggs A.C., Cordner S.M., Missing Persons–Missing Data: The Need to Collect Antemortem Dental Records of Missing Persons, J Forensic Sciences, March 2006, Volume 51(2): 386   [2] Hadley C., Your personal passport, EMBO Rep. 2004 Febbruary; 5(2): 124-126  [3]Gushulak B.D., Williams L.S., National Immigration Health Policy, Can J Public Health May-Jun 2004; I:27-29  [4] Castles S., International migration and the global agenda: reflection on the 1998 UN Technical Symposium, Int. Migr. 1999; 37(1): 5-19  [5] Mali WP., Skeletal maturation in assessing underage asylum seekers, Ned Tijdschr Geneeskd. 2004 Nov 12; 148(46): 2259-61  [6] United Nations, The State of the World's Refugees 2006, Human displacement in the new millennium  [7] United Nation High Commissioner for Refugees, 2004 Global Refugee Trends – Overview of refugee populations, new arrivals, durable solutions, asylum-seekers, stateless and other persons of concern to UNHCR, 17 June 2005  [8] UNHCR EXCOM 2005 Volume 25, Number 1, 2006  [9] Office of the United Nations High Commissioner for Refugees, Guidelines on policies and procedures in dealing with unaccompanied children seeking asylum, February 1997  TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  7[10]  G. Di Vella et al., “Il metodo Fels” in “Determinazione dell’età da resti scheletrici, a cura di Introna F. ed Dell’Erba AS, Essebiemme Ed., 2000.  [11] Buikstra JE, Ubelaker D.H., Standards for data collection from Human Skeletal Remains, Arkansas Archeological Survey Research series n. 44, 1994.  [12] Moore-Jansen P.M., Ousley S.D., Jantz R.L., Data Collection procedures for Forensic Skeletal Material, Forensic Anthropology Center, Knoxville, 1994 report of investigation n.48.  [13] Harris MJ, Nortjè CJ, The mesial root of the third mandibular molar. A possible indicator of age, J Forensic Odontostomatol, 1984 Jul-Dec;2(2):39-43.  [14] Kullman L, Johanson G, Akesson L., Root development of the lower third molar and its relation to chronological age, Swed Dent J. 1992;16(4):161-7  [15] Moorrees CF, Fanning EA, Hunt EE Jr., Age variation and formation stages for ten permanent teeth, J Dent Res (1963)42: 1490-502.   [16] Haavikko K, The formation  and the alveolar and clinical eruption of the permanent teeth: an orthopantomographic study, Suom Hammasläk Toim 66 (1970) 103-170  [17] Solheim T, Vonen A., Dental age estimation, quality assurance and age estimation of asylum seekers in Norway., Forensic Sci Int. 2006 May 15;159 Suppl 1:S56-60. Epub 2006 Mar 15.  [18] Introna F., Campobasso C.P., Biological vs legal age of living individuals, in Forensic Anthropoly and Medicine: complementary sciences from recovery to cause of death, Humana press (2006) 62-65.  [19] Herscahft E., Alder ME, Ord DK, Rawson RD, Smith ES, Manual of forensic odontology, American Society of Forensic Odontology, Impress printing & Graphics inc.2007, 53-64.  [20] http://www.iofos.org    CORRESPONDING AUTHOR: Emilio Nuzzolese, DDS, PhD Viale J.F. Kennedy 77 I-70124 Bari, Italy Tel +39 080 5042555 Email: emilionu@tin.it  TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  8  Fig. 1. K.W., male, X-ray of the left hand (age under 18).   TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  9  Fig. 2. K.W., male, X-ray of  the medial clavicles (age under 18).       Fig. 3. K.W, male, Orthopantomograph (age under 18).  TAGETE  - ARCHIVES OF LEGAL MEDICINE AND DENTISTRY        TAGETE 4-2007 Year XIII  10   Fig. 4. Schematic drawings of the developmental stages of molar teeth (Haavikko, Academic dissertation Helsinki, 1970).  

Dental age estimation of asylum seekers  in southern Italy

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Dental age estimation of asylum seekers in southern Italy

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