Aplicación de Radiografías Para la Estimación Forense de la Edad Dental
Una Perspectiva Bioética
Palabras clave:
estimación de la edad, radiación ionizante, radiografía panorámica, terceros molares, bioéticaResumen
Uno de los aspectos más relevantes del actual mundo globalizado reside en las incesantes corrientes migratorias, donde un gran número de menores de edad se encuentran desprotegidos de sus derechos esenciales. En tales contextos, la estimación forense de la edad se sustenta en la aplicación multidisciplinaria de diferentes criterios científicos validados internacionalmente. La exposición a la radiación ionizante es común en técnicas destinadas a analizar los periodos de mineralización y cierre apical de la dentición definitiva, generando controversias respecto a la invasión que ello supone sobre la salud de las personas involucradas, cuestionándose que el acto pericial realizado no redunda en beneficios terapéuticos que justifiquen tal exposición. En ámbitos penales donde se busca dilucidar la mayoría de edad de jóvenes que han delinquido, la evaluación de los terceros molares representa una estrategia crucial para estimarla, constituyendo el índice de madurez (I3M) desarrollado por Cameriere et al., el método cuantitativo más difundido. El presente artículo reflexiona sobre aspectos bioéticos inherentes a tales procesos, poniendo énfasis en la autonomía, beneficencia, no maleficencia y justicia como principios insustituibles que deben respetarse en ámbitos afines a la edad forense.
Citas
Angelakopoulos, N., Galić, I., De Luca, S., Campobasso, C. P., Martino, F., De Micco, F., Coccia, E. y Cameriere, R. (2020). Skeletal age assessment by measuring planar projections of carpals and distal epiphyses of ulna and radius bones in a sample of South African subadults. Australian Journal of Forensic Sciences, 54(1), 75–87. https://doi.org/10.1080/00450618.2020.1766111
Aynsley-Green, A., Cole, T. J., Crawley, H., Lessof, N., Boag, L. R. y Wallace, R. M. (2012). Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. British Medical Bulletin, 102, 17–42. https://doi.org/10.1093/bmb/lds014
Beauchamp, T. L. y Childress, J. F. (2001). Principles of biomedical ethics. (5th edition). Oxford University Press.
Cameriere, R., Ferrante, L., De Angelis, D., Scarpino, F. y Galli, F. (2008). The comparison between measurement of open apices of third molars and Demirjian stages to test chronological age of over 18 year olds in living subjects. International Journal of Legal Medicine, 122(6), 493–497. https://doi.org/10.1007/s00414-008-0279-6
Chakraborty, A., Kundu, A., Sarkar, S. y Silajiya, D. (2022). A review on clinical and forensic perspective of dental age estimation in children. International Journal of Ethics, Trauma and Victimology, 8(1), 31–35. https://ijetv.org/index.php/IJETV/article/view/1138
Código Civil y Comercial de la República Argentina. (2014). Ley 26.994, 7 de octubre del 2014. http://servicios.infoleg.gob.ar/infolegInternet/anexos/235000-239999/235975/norma.htm
Council of Europe. (1997). Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) [en línea]. https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164
Council of the European Union. (1997). Council Directive 97/43/Euratom of 30 June 1997 on health protection of individuals against the dangers of ionizing radiation in relation to medical exposure, and repealing Directive 84/466/Euratom [en línea]. http://data.europa.eu/eli/dir/1997/43/oj
De Micco, F., Martino, F., Velandia Palacio, L. A., Cingolani, M. y Campobasso, C. P. (2021). Third molar maturity index and legal age in different ethnic populations: accuracy of Cameriere's method. Medicine, Science, and the Law, 61(1_suppl), 105–112. https://doi.org/10.1177/0025802419900686
Demirjian, A., Goldstein, H. y Tanner, J. M. (1973). A new system of dental age assessment. Human biology, 45(2), 211–227. https://www.jstor.org/stable/41459864
European Asylum Support Office. (2018). EASO practical guide on age assessment. (2nd. ed.). https://euaa.europa.eu/sites/default/files/easo-practical-guide-on-age-assesment-v3-2018.pdf
European Migration Network. (2017). Approaches to unaccompanied minors following status determination in the EU plus Norway: EMN synthesis report [en línea]. https://emn.ie/publications/approaches-to-unaccompanied-minors-following-status-determination-in-the-eu-plus-norway-emn-synthesis-report/
European Parliament and The Council of the European Union. (2013). Directive 2013/32/EU. Official Journal of the European Union [en línea]. https://www.easo.europa.eu/sites/default/files/public/Dve-2013-32-Asylum-Procedures.pdf
Galić, I., Lauc, T., Brkić, H., Vodanović, M., Galić, E., Biazevic, M. G., Brakus, I., Badrov, J. y Cameriere, R. (2015). Cameriere's third molar maturity index in assessing age of majority. Forensic Science International, 252, 191.e1–191.e1915. https://doi.org/10.1016/j.forsciint.2015.04.030
Gulsahi, A., De Luca, S., Cehreli, S. B., Tirali, R. E. y Cameriere, R. (2016). Accuracy of the third molar index for assessing the legal majority of 18 years in Turkish population. Forensic Science International, 266, 584.e1–584.e6. https://doi.org/10.1016/j.forsciint.2016.04.034
Have, H. ten. (2016). Encyclopedia of global bioethics. Springer Cham. https://doi.org/10.1007/978-3-319-05544-2
Klas, J., Grzywacz, A., Kulszo, K., Grunwald, A., Kluz, N., Makaryczew, M. y Samardakiewicz, M. (2022). Challenges in the medical and psychosocial care of the paediatric refugee-A systematic review. International Journal of Environmental Research and Public Health, 19(17), 10656. https://doi.org/10.3390/ijerph191710656
Kullman, L., Johanson, G. y Akesson, L. (1992). Root development of the lower third molar and its relation to chronological age. Swedish Dental Journal, 16(4), 161–167.
Lei, G., Liu, F., Liu, P., Zhou, Y., Jiao, T. y Dang, Y. H. (2019). Worldwide tendency and focused research in forensic anthropology: a bibliometric analysis of decade (2008-2017). Legal Medicine (Tokyo, Japan), 37, 67–75. https://doi.org/10.1016/j.legalmed.2019.01.008
Levesque, G. Y., Demirijian, A. y Tanguay, R. (1981). Sexual dimorphism in the development, emergence, and agenesis of the mandibular third molar. Journal of Dental Research, 60(10), 1735–1741. https://doi.org/10.1177/00220345810600100201
Liversidge H. M. (2010). Interpreting group differences using Demirjian's dental maturity method. Forensic Science International, 201(1-3), 95–101. https://doi.org/10.1016/j.forsciint.2010.02.032
Mincer, H. H., Harris, E. F. y Berryman, H. E. (1993). The A.B.F.O. study of third molar development and its use as an estimator of chronological age. Journal of Forensic Sciences, 38(2), 379–390. https://doi.org/10.1520/JFS13418J
Oficina de Apoyo al Asilo. (2018). EASO: Informe general anual de 2018 [en línea]. http://hdl.handle.net/10234/188055
Okano, T. y Sur, J. (2010). Radiation dose and protection in dentistry. Japanese Dental Science Review. 46(2), 112–121. https://doi.org/10.1016/j.jdsr.2009.11.004
Olze, A., Schmeling, A., Taniguchi, M., Maeda, H., van Niekerk, P., Wernecke, K. D. y Geserick, G. (2004). Forensic age estimation in living subjects: the ethnic factor in wisdom tooth mineralization. International Journal of Legal Medicine, 118(3), 170–173. https://doi.org/10.1007/s00414-004-0434-7
Olze, A., van Niekerk, P., Ishikawa, T., Zhu, B. L., Schulz, R., Maeda, H. y Schmeling, A. (2007). Comparative study on the effect of ethnicity on wisdom tooth eruption. International Journal of Legal Medicine, 121(6), 445–448. https://doi.org/10.1007/s00414-007-0171-9
Pinto, P. H. V., Borges, B. S., Machado, A. L. R., Guimarães, M. A. y Silva, R. H. A. da. (2021). Uso de acervos de imagens em pesquisas na Odontologia Legal: reflexões éticas, bioéticas e legais. Medicina (Ribeirão Preto), 54(1), e172960. https://doi.org/10.11606/issn.2176-7262.rmrp.2021.172960
Redding R. E. (1993). Children's competence to provide informed consent for mental health treatment. Washington and Lee Law Review, 50(2), 695–753. https://scholarlycommons.law.wlu.edu/wlulr/vol50/iss2/13
Regulla, D. F. y Eder, H. (2005). Patient exposure in medical X-ray imaging in Europe. Radiation Protection Dosimetry, 114(1-3), 11–25. https://doi.org/10.1093/rpd/nch538
Santiago, B. M., Almeida, L., Cavalcanti, Y. W., Magno, M. B. y Maia, L. C. (2018). Accuracy of the third molar maturity index in assessing the legal age of 18 years: a systematic review and meta-analysis. International Journal of Legal Medicine, 132(4), 1167–1184. https://doi.org/10.1007/s00414-017-1766-4
Sauer, P. J., Nicholson, A., Neubauer, D. y Advocacy and Ethics Group of the European Academy of Paediatrics (2016). Age determination in asylum seekers: physicians should not be implicated. European Journal of Pediatrics, 175(3), 299–303. https://doi.org/10.1007/s00431-015-2628-z
Schmeling, A., Schmidt, S., Schulz, R., Olze, A., Reisinger, W. y Vieth, V. (2010). Practical imaging techniques for age evaluation. En Black, S., Payne-James, J. y Aggrawal A, eds. Age estimation in the living: the practitioners guide. John Wiley & Sons, 130–149. https://doi.org/10.1002/9780470669785.ch8
Separated Children in Europe Programme (2012). Position paper on age assessment in the context of separated children in Europe [en línea]. https://www.refworld.org/docid/4ff535f52.html
Sieffien, W. Law, S. y Andermann, L. (2020). Immigrant and refugee mental health during the COVID-19 pandemic: additional key considerations [blog post]. Canadian Family Physician. https://www.cfp.ca/news/2020/06/23/06-23-1
Sulmasy, L. S., Bledsoe, T. A. y ACP Ethics, Professionalism and Human Rights Committee (2019). American College of Physicians ethics manual: seventh edition. Annals of Internal Medicine, 170(2_Suppl), S1–S32. https://doi.org/10.7326/M18-2160
The Australasian Pediatric Endocrine Group, The Royal Australasian College of Physicians, The Australian & New Zealand Society for Pediatric Radiology y The Royal Australian and New Zealand College of Radiologist. (2011). Assessment of age of refugees and those persons accused of providing refugees with illegal access to Australia: the unethical use of ionizing radiation (XRays) and/or genital examination [en línea]. https://www.rch.org.au/uploadedFiles/Main/Content/immigranthealth/Letter_bone_age_MD_Jan_2012.pdf
Thevissen, P. W., Fieuws, S. y Willems, G. (2010). Human third molars development: Comparison of 9 country specific populations. Forensic Science International, 201(1-3), 102–105. https://doi.org/10.1016/j.forsciint.2010.04.054
Thevissen, P. W., Kvaal, S. I. y Willems, G. (2012). Ethics in age estimation of unaccompanied minors. The Journal of Forensic Odonto-Stomatology, 30 Suppl 1, 84–102. http://www.iofos.eu/Journals/JFOS%20sup1_Nov12/IDEALS%209-123.pdf
Ubelaker, D. H. y Khosrowshahi, H. (2019). Estimation of age in forensic anthropology: historical perspective and recent methodological advances. Forensic Sciences Research, 4(1), 1–9. https://doi.org/10.1080/20961790.2018.1549711
United Nations Children's Fund (UNICEF). (2010). Progress for children: achieving the MDGs with equity [en línea]. https://data.unicef.org/resources/progress-for-children-achieving-the-mdgs-with-equity-number-9-september-2010/
United Nations Children's Fund (UNICEF). (2013). Age assessment: a technical note [en línea]. https://www.refworld.org/docid/5130659f2.html
United Nations Children's Fund (UNICEF). (2016). Age matters! Age-related barriers to service access and the realisation of rights for children, adolescents and youth. Final report - October 2016 [en línea]. https://agemattersnow.org/downloads/YPL_Age_Matters_Final_Report_Oct2016.pdf
United Nations Commission on Human Rights. (1990). Convention on the rights of the child [en línea]. https://www.refworld.org/docid/3b00f03d30.html
United Nations Committee on the Rights of the Child (CRC). (2005). General comment no. 6: treatment of unaccompanied and separated children outside their country of origin [en línea]. https://www.refworld.org/docid/42dd174b4.html
United Nations High Commissioner for Refugees. (2019). Global Trends. Forced displacement in 2018 [en línea]. https://www.unhcr.org/statistics/unhcrstats/5d08d7ee7/unhcrglobal-trends-2018.html
United States Nuclear Regulatory Commission. (2020). Backgrounder on biological effects of radiation [en línea]. https://www.nrc.gov/reading-rm/doc-collections/fact-sheets/bio-effects-radiation.html
Wenke, D. (2017). Age assessment: Council of Europe member states’ policies, procedures and practices respectful of children’s rights in the context of migration [en línea]. Council of Europe. https://rm.coe.int/168074b723
Yurdakal, I. H. (2022). Pre-service teachers' opinions on the problems of refugee-asylum-seeking children. European Journal of Alternative Education Studies, 7(1), 97–113. https://eric.ed.gov/?id=ED619616
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Revista de la Facultad de Odontologia de la Universidad de Buenos Aires
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
