Effects of long-term steroid therapy on the results of dental age estimation using pulp/tooth ratio

Forensic age estimation is performed by assessing pulp chamber constrictions due to physiological age-related changes in dental radiographs; however, the estimated ages occasionally deviate from the actual ages. In particular, long-term steroid users tend to demonstrate pulp chamber constrictions in all teeth. Because this is uncommon among younger age groups, caution should be exercised when evaluating pulp chamber constriction. This study investigated the estimated ages of eight PSL users by applying the ratio of pulp area to total tooth area from canine radiographs. Patients in their 30-40s were examined at a dental outpatient clinic for the prevention or treatment of adverse events associated with the use of bisphosphonates to prevent steroidal osteoporosis, and radiographs were obtained. The pulp and tooth areas were measured and the estimated age was determined using regression formulas calculated from the canine teeth of the general study subjects of Japanese. The mean absolute error between the estimated ages and the chronological ages of the patients was 19.24 years for the upper canines and 17.69 years for the lower. Moreover, the root mean square error was 23.18 years for the upper canines and 20.00 years for the lower. The estimated ages were far from the actual ages of the steroid users. When estimating an unidentified individual's age, if the patient has pulp chamber constriction that is inconsistent with other forensic physical findings, this information may assist in predicting their medical background.