The London atlas of dental development and eruption
Submitting InstitutionQueen Mary, University of London
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Dentistry, Public Health and Health Services
Summary of the impact
Dr Helen Liversidge's research from 1995 to 2013 has focused on age
variation in tooth formation and the use of indices of dental development
to estimate a person's age. The London Atlas of Dental Development and
Eruption is an original and accurate diagnostic tool for dental age
estimation in individuals up to 22 years. It has proved an invaluable
resource for a number of groups, notably disaster recovery workers (to
identify the ages of tsunami, war and earthquake victims) and to
archaeologists (who seek to learn more about archaeological remains). It
has also been called on as courtroom evidence in the cases of
asylum-seeking minors. The Atlas has global reach as it is freely
available as a web download.
The research team is led by Dr Liversidge, who joined the Institute of
Dentistry as a Lecturer in Paediatric Dentistry in 1995. Building on
previous PhD work elsewhere, she began systematically to collect data from
dental radiographs of London children. This involved large samples and the
beginning of a unique worldwide collaboration investigating ethnic
differences in tooth formation.
Dental charts are used by disaster victim identification teams to
estimate age and thereby help identify children (see a review of this
topic Hill et al Forensic Science International 2011; 205, 44—47). The
2004 Tsunami highlighted the need for an evidence-based atlas as well as
testing which of the many methods of age estimation was most accurate. The
London Atlas began as a PhD project of Dr Sakher AlQahtani and consists of
a series of drawings of dental development for 31 age categories from
before birth to 23 years of age. It is based on tooth data from foetal and
skeletal remains of individuals with known age-at-death as well as dental
radiographs, from Maurice Stack's Collection at the Royal College of
Surgeons of England and Spitalfields Collection at the Natural History
Museum in London. The London Atlas was published in a peer-reviewed
journal in 2010 (see references 1-9). Dr AlQahtani has world copyright for
the image and it is freely available online in sixteen languages and as
free software in English.
Dr Liversidge and her team have designed an atlas specifically to
estimate age, to overcome the major flaws of the previous dental atlas.
Improvements include detailed tooth stage descriptions, clear illustration
with internal and external features of each tooth, adequate and
representative sample size, age variation for each tooth stage and
consecutive age categories.
To underpin the development of the London Atlas, Dr Liversidge has tested
the accuracy of more than 50 methods of dental age estimation. This has
improved the way we assess ageing methods and highlighted the importance
of the age range and the structure and features of reference data, clearly
defined tooth stages and expression of uncertainty in estimated age.
Dr AlQahtani validated the London Atlas on skeletal remains and dental
radiographs of known age individuals and showed it to be the most accurate
method to estimate age from developing teeth. When piloted, the Atlas was
also found to be easier and clearer than previously used dental charts.
Dr Liversidge has collaborated with colleagues around the world since
2001 to investigate ethnic differences in tooth formation by comparing
average age of tooth formation stages for each geographic group. She and
her collaborators have compared more than 10 000 dental radiographs (from
United Kingdom, South Africa, West and East Africa, Malaysia, Japan,
Australian Aborigine, Maori, Pacific Islanders, Inuit and Native
Americans) and shown that the timing of tooth development is similar
between ethnic groups and remarkably unaffected by environmental
influences. This underscores the importance of the London Atlas as being
suitable to estimate age worldwide.
The work was part-funded by The Ministry of Education, Saudi Arabia. Six
years £168,000. Dr Liversidge received travel funds from Central
University Fund (University of London) and Daiwa Anglo-Japanese Foundation
An example diagram from the atlas is reproduced below: Each tooth and
eruption level represents the median tooth stage from children aged 7 and
References to the research
3. Liversidge HM, Smith BH, Maber M. Bias and accuracy of age estimation
using developing teeth in 946 children. American Journal of Physical
Anthropology 2010; 143: 545-554. http://www.ncbi.nlm.nih.gov/pubmed/20623675
4. AlQahtani S.J., Hector M.P., Liversidge H.M. Testing the performance
and quality of three dental age estimation charts: Schour and Massler,
Ubelaker and the London Atlas. American Journal of Physical Anthropology
(response to reviewers' comments submitted).
5. Liversidge HM, Marsden PH. Estimating age and the likelihood of having
attained 18 years of age using mandibular third molars. British Dental
Journal 2010; 209 (8): E13 http://www.ncbi.nlm.nih.gov/pubmed/20953166
7. Liversidge HM. The assessment and interpretation of Demirjian,
Goldstein and Tanner's Dental Maturity. Annals of Human Biology 2012, 39:
9. Elamin F, Liversidge HM. Malnutrition has no effect on the timing of
human tooth formation. PLoS ONE 8(8): e72274.
10. Liversidge HM.2004. Chapter: The Dentition. In: The Juvenile
Skeleton. Scheuer L and S Black. London: Elsevier Academic Press,
Details of the impact
The inspiration for the research described above was the 2004 Tsunami,
which highlighted the need for an evidence-based tool, presented in an
accessible format, to accurately estimate the ages of victims to help
identification. It is accessible in various web formats including a
training video . It has been widely covered in the scientific  and
lay press  and listed as a key source in textbooks .
The London Atlas was subsequently used to estimate the ages of victims in
the air crash in Libya in May 2010 and the earthquake in New Zealand in
February 2011. Professor Jules Kieser, Director, Sir John Walsh Research
Institute, University of Otago, Dunedin, New Zealand commented: "...as
a forensic dentist I, together with my team, used your atlas when we did
the identification of the victims of the tragic Christchurch Earthquake.
The atlas enabled even inexperienced volunteers to understand dental
ageing, and possibly most importantly, it was hugely useful when
presentations were made to the Coroner's Board. They were able to get a
visual appreciation of what we were telling them. In summary, thank you
again for providing us with a landmark in the field of dental ageing."
The London Atlas has now been adopted by the New Zealand Society of
The London Atlas is now an accepted method of age estimation around the
world, and is used in training workshops run by the American Academy of
Forensic Sciences, the International Organisation of Forensic Odontology,
and the Biological Anthropology Research Centre and Bio-archaeology,
Warsaw. Professor Bob Wood, Forensic Dentist and Disaster Victim
Identification (DVI) trainer, Toronto University, says the Atlas is part
of the standard information pack given to the Canadian DVI team .
In November 2010 Dr Liversidge was invited to present at the
`International Workshop on methods for age estimation in teenagers and
young adults' held by the Norwegian Directorate of Immigration and the
Baltic Medico-Legal conference. This resulted in a policy change of
practice dealing with estimating age of age disputed asylum seekers in
Norway. Dr Liversidge's paper on third molars in different ethnic groups
is used to estimate age of asylum seekers from Afghanistan.
The London Atlas is used in teaching of forensic anthropology (UK,
Canada, USA, Israel, Italy), disaster victim identification (UK,
Australia, Canada, Pakistan), forensic dentistry (UK, Belgium, Canada,
American Board Forensic Odontology, USA) and archaeology (Bradford,
Liverpool John Moore, University College London UK, New Mexico, USA). The
Atlas has been used to estimate age of forensic cases in UK, Switzerland,
Israel, Australia, New Zealand, Libya, Canada, New Mexico, Texas and
Washington State USA.
The teaching of dental anatomy and development of the dentitions also
relies heavily on the London Atlas: it is currently used in most dental
schools in the UK, as well as those in Belgium, Croatia, China, Finland,
Germany, Greece, Israel, Iceland, Norway, Switzerland, USA, Canada, Japan,
Malaysia, Middle East, Australia, New Zealand and Venezuala.
The London Atlas has also been used by archaeologists for ageing skeletal
remains in USA, Greece and Peru. Finnish forensic archaeologist Dr Jana
Hurnane and her team consulted the atlas to learn more about child mummies
found in Peru.
A well-executed dissemination strategy has been key to the widespread use
and success of the London Atlas. Worldwide copyright was taken out in 2009
to allow free access on the internet . Since the launch in April 2012
to August 2013 there were 56150 hits from 73 countries, and the website
gets on average 130 hits a day. The Atlas has been translated into 16
languages including Chinese, Arabic and Japanese. The app has been
downloaded many thousands of times. A training video has been developed
and is freely available on the internet.
The project was shortlisted for Research Project of the year by Times
Higher Education Supplement in 2012 . The London Atlas was shown in
'History Cold Case' documentary on BBC2 in May 2010.
Sources to corroborate the impact
- Internet links
- Articles in the scientific media:
- Articles in the lay press:
- Books: The London Atlas has been included in the 3rd editions of "The
Human Skeleton in Forensic Medicine" (Iscan and Steyn) and " Manual of
Forensic Odontology " (Senn and Weems).
- Prize: Times Higher Education Supplement Research Project of the Year
Award shortlist 2012: http://www.timeshighereducation.co.uk/421042.article
- Feedback comments by email (available on request):
- Director, Sir John Walsh Research Institute, University of Otago,
Dunedin, New Zealand
- President of the British Association of Forensic Odontology
- Forensic Dentist and Disaster Victim Identification (DVI) trainer,
Toronto University, says the Atlas is part of the information pack given
to the Canadian DVI team.