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Moze fills the gaps
Medical protagonist, Dr Kevin Moze, is set to make a huge contribution to the dental industry in T&T. Moze is the first dental and maxillofacial radiologist of Trinidadian origin, and his expertise is critical for filling the gaps within the healthcare system.
As a dentist, he treats with the diagnosis of oro-facial disease and the early detection of lesions. As a radiologist, he deciphers the nature of certain lesions and conditions, discerns whether they may be benign or malignant tumours, developmental or inflammatory odontogenic and non odontogenic, and interprets fractures of the orofacial region.
Moze is also a lecturer in oral radiology at the University of the West Indies’ (UWI) School of Dentistry (SoD). He forms part of a dental age assessment group in Trinidad and Tobago and he also works in conjunction with the Dental Age Research London Information Group (DARLInG).
In his capacity as researcher, Moze was recently published in the International Journal of Forensic and Legal Medicine. This latest research sought to assess and document the mean ages of attainment for the various tooth developmental stages (TDS) in ethnic specific Afro-Trinidadian children, adolescents and emerging adults of known chronological age. These mean ages of attainment for the various TDS have been organised to develop a reference data set partitioned by ethnicity and gender.
This is the first time a database was developed to scientifically estimate the chronological age of living or deceased Afro-Trinidadian subjects, with a high degree of accuracy. Moze explained: “I wanted to sensitise T&T to the local research I am conducting.” It is a collaborative effort with DARLInG at King’s College School of Medicine and Dentistry in London, and UWI, SoD.
DAATT DARLInG project
Building on Moze’s recent publication, he seeks to assign ages to children of unknown date of birth in this country, specifically those children and adolescents who have been unscientifically assigned an age by the State. He said: “This will be done by taking an X-ray of the child’s dentition, called a dental panoramic radiograph (DPR).” He indicated there are three major issues that require national discussion:
• The accuracy of dental age assessment (DAA) and the age assigned to the individual
• The medico-legal exposure of subjects to ionising radiation (X-rays) for the purposes of determining age and not for the customary purpose of health reasons
• The benefits to be derived by both the individual and the society as a whole from assigning an age to an individual
Moze explained: “I would like this research to begin at the root, and this involves a national participation so we can all critically analyse and scrutinise all of the relevant issues pertaining to the DAATT DARLInG project in-depth.”
Accuracy of DAA
There is a consensus that biological human growth patterns are genetically intricate. Well-defined gauges of physiological maturity provide a more reliable assessment of age rather than the “holistic approach”, which is flawed as put forward by Moze. He suggested an approach that is quantifiable and almost exact in age assessment.
According to Moze and DARLInG, the technique is one of the most accurate methods for estimating the age of an unknown person. DAA is currently used in some countries as part of their asylum policy. “DARLInG has recently made a contribution to a discussion paper by invitation of the Australian Human Rights Commission.
Australia is facing an issue with individuals seeking asylum from Indonesia with no birth records. If they are under 18, the Australian State will provide for them. If they are over 18, they are returned to Indonesia. When issues like these arise, we must have a highly accurate method of assessing the individual’s age,” said Moze.
He pointed out: “What we assess is dental maturity and what we have recognised in previous studies presented abroad is that Afro-Trinidadians will get to a given stage of dental development approximately 1-1.9 years earlier than an Indo-Trinidadian person; therefore, I cannot use my Afro-Trinidadian database to assess the age of an Indo-Trinidadian person, because I am going to be off by almost two years.”
The database of ages of attainment for the various TDS is ethnic specific. Moze advocated: “The teeth do not lie. Development of teeth is relatively uninfluenced by metabolic and endocrine diseases; relatively uninfluenced by nutritional diseases; its rate of development is ethnic specific; and highly correlated with biological maturity.”
The medico-legal context
Moze posits that: “X-ray exposure of patients using DPR, as the imaging modality for matters related to the diagnosis of oro-facial disease, has set a criteria. Each X-ray taken in medicine and dentistry must be justified on the basis that the patient stands to benefit from the exposure.” Medico-legal exposures must take into account:
• An appraisal of the potential benefits and detriments to both the exposed individual and society
• Are the exposed individuals disadvantaged by the potential consequences of the exposure?
• Informed consent
• An appropriateness for radiating citizens of T&T for the purposes of age assessment.
Not only is an input from members of the radiation protection and scientific community required, but a conversation and input from the broadest possible social base of T&T is also necessary, if the DAATT DARLInG project is to go further.
Moze further explained: “To put the dose from this imaging modality into perspective, the dental panoramic X-ray unit will deliver a dose of approximately three to six microsieverts of radiation to the subject.” With a bit of humour, he said that a banana has radioactive potassium and will deliver a dose of ten microsieverts and the radiation from a six-hour flight from LA to NYC is 400 microsieverts.
“Does this mean that we are going to stop eating bananas and stop using air travel?” He assured that it is highly unlikely that a cancer will be induced from the radiation at this low dose and that the subject being radiated will die from the exposure.
Children who are off the radar
“The issue of the risk versus benefit ratio must arise when using radiation,” said Moze. His preliminary and unscientific enquiries revealed that there are about 1,000 children of unknown ages existing in this country. He said: “These children effectively have no identity. They are off the radar. These children cannot get a national identification card, a driver’s license, a job or access to health care.”
Moze said: “This research would help to define people legally, socially and demographically. It would also afford them interaction with medical care, schooling, interactions within peer groups, commensurate with their biological maturity.” In the criminal context, there are far-reaching consequences for both State and individual when juveniles have been wrongly assigned ages and are charged for a crime.
“The current method in use in Trinidad and Tobago in terms of age assessment is based solely on phenotypical appearance as I am reliably informed. This means that a 14-year-old, depending on the stage of physical maturity and phenotypical appearance, can be easily assigned an age of 18. This is too big a gap coming from a legal and medical standpoint,” argued Moze.
“Interestingly, the Scottish department of Forensic Science, through the British Association of Forensic Odontology and DARLInG, asked for access to my database recently.” “They said that an Afro-Caribbean male of unknown age was charged for a crime in Scotland. The age assessment was in dispute since the parents had not registered the child’s birth. They thought he could have been between 16 and 18 years old.
“In order to be certain of age they sent a DPR of the subject and he was assigned an age of 10.91 years. This marked the first time that this Afro-Trinidadian data set had been formally used in a court of law.” Reviewer comments from The Journal of Forensic and Legal Medicine stated:
“Moze’s paper has a large amount of data from both the UK Caucasian and Afro-Trinidadian Reference Data Set. The use of the Validation Study Group to test the reliability of the Reference Data Set is a relatively new approach for which the authors must be commended.
A general shortcoming of many Dental Age reports is the lack of independent testing of the Reference Data Set. The Weighted Averages Method using the Mathematical Techniques of Meta-Analysis appears to have much to commend it. This paper provides a model for the comparison of dental maturity data from subjects of different ethnic groups, as it enables appropriate comparisons at the Tooth Development Stage level, and the output variable of Dental Age.
Perhaps one of the greatest strengths of this is the use of Chronological Age as the Gold Standard for comparing the Dental Age. This work shows clearly the need to have the data partitioned by gender as well as ethnicity.” Dr Moze has invited the public to participate with contributions, questions or insights to his follow-up research at email@example.com.
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