Dental News - Interview: “Development of tooth crowns tends to occur earlier than stated in previous works”

Dental Tribune International

Thu. 22. August 2019

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Dr. Richard J. Sherwood is Professor of Pathology and Anatomical Sciences and Vice Chair of Research at the University of Missouri School of Medicine. In an interview with Dental Tribune International, he explained how his new research shows that tooth development occurs much earlier than previously thought. The results of the study set new standards of reference in dental development and could provide dentists with an opportunity to improve evidence-based decisions.

Dr. Sherwood, could you explain a little more about the study and what your main goals were in conducting it?
The main goal of this study was to provide new reference values for the timing of the development of the permanent mandibular dentition. The first author of the paper, Dr. Maja Šešelj, was my postdoctoral student at the Lifespan Health Research Center at Wright State University in Dayton, Ohio. We worked with the Fels Longitudinal Study (FLS), the longest running study of human growth and development. The FLS began in 1929 and ran continuously until 2018, following participants from birth through their entire lives. In 1963, a classic study of dental development was published by Moorees et al.which used some dental radiographs from the FLS. As radiographs continued in the FLS until 1984, we wanted to update the previous work using the dense longitudinal sample available. Results from our paper are based on the largest sample of dental maturation analyzed (6,000 radiographs from 590 participants). A number of other papers have been published by researchers in different countries or using different samples. We thought it would be a good opportunity to compare the results of our new standards with those works.

What were the most surprising results to come out of the study?
From this work, we did note that the development of tooth crowns tends to occur earlier than stated in previous works, and the development of roots occurs at increasingly later ages. This wasn’t necessarily surprising because we expected the addition of a more temporally and geographically disparate sample to expand upon the standards developed by Moorees et al. Whenever you change the sample significantly, a difference can be expected. The value of the study is, in part, in expanding the known range of developmental variation. In other words, it helps to clarify our understanding of normal development. By understanding the range of normal development, it becomes easier to meaningfully identify those cases that are not normal and in need of treatment.

What does your study mean for the field of dentistry?
There are a number of points that I’d like to make. One of the unusual aspects of this paper is the level of detail in the analyses, thanks to the efforts of our statistician, Dr. Lyle Konigsberg. There are two basic ways of reporting dental development, “stage for age” or “age for stage”. The former identifies the probability at any given age that an individual will be at each stage of dental development. Alternatively, in an age for stage analysis, one seeks to estimate the age of an individual based on the stages of development. For each of these, sex-specific as well as combined sex samples are analyzed and a set of statistical parameters e.g., mean, median, mode, as well as a measure of variation is provided. As the data is analyzed and presented in multiple forms, this means that other researchers will find it easy to compare our work with theirs.

Additionally, a detailed method is described for estimating age from dental development in a forensic context. This is done using a powerful Bayesian approach. The method described also provides the means to calculate the error of the estimated age, which is critical, although not always discussed, in a forensic context.

Do you think the results of the study will bring about practical changes to the way dentists work in future?
Dentists routinely assess the developmental status of their patients’ teeth. The results from this study provide an updated reference set for comparison with data from a given patient. Therefore, this work doesn’t necessitate a substantial change to treatment, but it will provide an opportunity to improve evidence-based decisions.

Do you plan on continuing your research?
We are continuing with our research on craniofacial growth and development. For the past few years, we have been collecting data from six of the largest growth collections in North America. In this work, we are collecting cephalometric landmarks from lateral cephalographs. We have currently analyzed over 15,000 lateral cephalographs from approximately 1,800 individuals. We have begun publishing aspects of this research and are currently working on a number of publications making use of this remarkable longitudinal resource.

Editorial note: The study, titled “Timing of development of the permanent mandibular dentition: New reference values from the Fels longitudinal study,” was published on March 9, 2019, in the Anatomical Record, ahead of inclusion in an issue.

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