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growth is a distinctive aspect in the life of a child that differentiates him or her from an adult .
growth activity begins from the time of conception and continues tills the child becomes a full - fledged adult .
growth signifies enlargement in the size of tissues , in contrast to development , which designates maturation of functions . genetic , environmental , societal , emotional , gender , and nutritional factors together or independently
iron - deficiency anemia causes poor growth rate and developmental delay in animals and humans .
the appearance and amalgamation of various calcification centers follows certain order and timetable from birth to full maturation .
the radiographic study of these calcification centers provides a definite clue regarding the amount of bone maturity in an individual .
many childhood diseases and disorders , particularly those causing growth problems , show characteristic relation between bone and chronological age .
hormonal deficiencies , notably those of thyroid and growth hormone , usually cause the most severe degrees of bone age retardation , however , depend , of course , on the duration of the deficiency ; moreover , there may be greater disparities with increasing age of the untreated child .
most chronic disorders that impair growth , as a consequence of metabolic causes or undernutrition , will , however , also result in a variable degree of retardation of bone age .
dental age determination depends on the quantity of mineralization of tooth buds and the particular order of their eruption in the mouth .
rate of mineralization of teeth is a constant activity , which is a more desirable physiologic development of an individual than teeth eruption .
various systems are in practice to determine the dental age depending on the amount of teeth calcification .
demirjian system has been extensively practiced by many scientists to determine the dental age . to expand the opportunity of reasoning regarding the impact of growth process on dental maturation and to refine the clinical wisdom ,
dental and bone maturation is crucial for dentists in formulating treatment plan , and is also convenient as supportive data for various medical specialties .
the association of dental age , bone age , and chronological age is useful for determining the level of growth in various tissue systems of an individual .
ample data is not available in the indian literature regarding the growth failure in dental and bone development in anemic children , hence , this investigation was undertaken to estimate and compare dental age , bone age , and chronological age in a group of south indian children affected with iron - deficiency anemia .
the study participants were chosen from the pedodontics department . the children who had clinical symptoms of anemia
after confirmation through clinical and laboratory tests , which included serum ferritin , transferrin , iron and hemoglobin level , as well as morphology of red blood cells ( rbcs ) and hemoglobin , the children were included in the study .
prior to the commencement of the study , ethical clearance was obtained from the institutional ethical clearance committee of the college .
parents were explained about the importance and process of the study , following which the informed consent was obtained from them .
one hundred study participants comprising 58 males and 42 females were selected among the age group of 814 years , with the help of random sampling .
sample size was calculated based on the formula n = za pq / d where za is the normal standard variable value [ ( 2 for 94% confidence interval ( ci ) ] , p the prevalence , q the alternative prevalence , and d the permissible error in the prevalence rate .
orthopantomograms ( opg ) , handwrist radiographs , and x - ray viewers were the materials used for the study .
date of birth of the child was known through school birth records or by parental statement .
the age of the child was calculated with the help of birth date . the age obtained with the birth date
selected 7 left permanent mandibular teeth starting from the central incisor to the 2 molar ( in case of missing tooth contralateral tooth was taken into account ) .
split the tooth maturation into 8 calcification levels starting from a to h. demirjian s dental calcification ( developmental ) levels [ figure 1 ] are as follows : stage a : start of calcification of cusps stage b : union of cusps stage c : dentin deposition starts stage d : crown fully formed up to cementoenamel junction stage e : root is smaller than crown height stage f : root is equal or more than crown length stage g : tooth formation completed but apex is open stage h : tooth formation completed with apical closure .
demirjian 's tooth calcification stages after obtaining opgs [ figure 2 ] for the study participants , they were carefully visualized under the x - ray viewer to check the level of tooth calcification of 7 teeth in accordance with the demirjian system [ figure 1 ] .
the calcification levels of 7 teeth were evaluated , and each tooth was designated with a certain score as per the demirjian table [ tables 1 and 2 ] .
the summation of scores of 7 teeth is known as the maturity score of an individual .
the maturity score was transformed into the dental age with the help of a conversion chart .
self - weighted scores of dental stages of 7 teeth ( mandibular left side ) in boys self - weighted scores of dental stages of 7 teeth ( mandibular left side ) in girls maturity score = calcification scores of 31 + 32 + 33 + 34 + 35 + 36 + 37 31 : left mandibular central incisor 32 : left mandibular lateral incisor 33 : left mandibular canine 34 : left mandibular 1 premolar 35 : left mandibular 2 premolar 36 : left mandibular 1 molar 37 : left mandibular 2 molar .
bone age determination was performed by taking hand - wrist radiographs of the study participants .
bjork , grave , and browns method was followed to calculate bone age . as per this method ,
each level constitutes a different bone age . after obtaining hand - wrist radiographs of the study participants ,
the calcification level of hand - wrist bones was evaluated as per bjork , grave , and brown 's method .
the comparison of 3 ages was done with the help of students t - test and pearson 's correlation coefficient .
selected 7 left permanent mandibular teeth starting from the central incisor to the 2 molar ( in case of missing tooth contralateral tooth was taken into account ) .
split the tooth maturation into 8 calcification levels starting from a to h. demirjian s dental calcification ( developmental ) levels [ figure 1 ] are as follows : stage a : start of calcification of cusps stage b : union of cusps stage c : dentin deposition starts stage d : crown fully formed up to cementoenamel junction stage e : root is smaller than crown height stage f : root is equal or more than crown length stage g : tooth formation completed but apex is open stage h : tooth formation completed with apical closure .
demirjian 's tooth calcification stages after obtaining opgs [ figure 2 ] for the study participants , they were carefully visualized under the x - ray viewer to check the level of tooth calcification of 7 teeth in accordance with the demirjian system [ figure 1 ] .
the calcification levels of 7 teeth were evaluated , and each tooth was designated with a certain score as per the demirjian table [ tables 1 and 2 ] .
the summation of scores of 7 teeth is known as the maturity score of an individual .
the maturity score was transformed into the dental age with the help of a conversion chart .
self - weighted scores of dental stages of 7 teeth ( mandibular left side ) in boys self - weighted scores of dental stages of 7 teeth ( mandibular left side ) in girls maturity score = calcification scores of 31 + 32 + 33 + 34 + 35 + 36 + 37 31 : left mandibular central incisor 32 : left mandibular lateral incisor 33 : left mandibular canine 34 : left mandibular 1 premolar 35 : left mandibular 2 premolar 36 : left mandibular 1 molar 37 : left mandibular 2 molar .
bone age determination was performed by taking hand - wrist radiographs of the study participants .
bjork , grave , and browns method was followed to calculate bone age . as per this method ,
each level constitutes a different bone age . after obtaining hand - wrist radiographs of the study participants ,
the calcification level of hand - wrist bones was evaluated as per bjork , grave , and brown 's method .
the comparison of 3 ages was done with the help of students t - test and pearson 's correlation coefficient .
after comparative evaluation of the three ages among females [ tables 3 and 4 ] , we found that chronological age was significantly ahead of bone and dental age .
the correlation of the three ages in females was significantly positive [ table 5 ] .
mean chronological age , dental age , and bone age of females and males comparison of chronological age , dental age , and bone age in females correlation between chronological age , dental age , and bone age in females comparative assessment of the three ages in males [ tables 3 and 6 ] showed significant increase of chronological age in comparison to bone and dental age . between bone age and dental age
after correlating the three ages in males , we discovered that all three ages were significantly positive [ table 7 ] .
comparison of chronological , dental age , and bone age in males correlation between chronological age , dental age , and bone age in males
bone and dental age are important parameters to assess the overall growth and development of an individual .
iron - deficiency anemia is one of the systemic diseases , which causes growth failure in children .
discovered that iron - deficiency anemia in children caused significant physical and mental growth retardation .
discovered that iron therapy in an iron - deficiency child could bring back the psychomotor development . in our investigation , we assessed the level of bone maturation and dental maturation in order to compare chronological age in iron - deficiency anemic children of the south indian group .
radiographic method of assessment of the level of mineralization in hand wrist bones is a highly reliable method of bone age estimation in an individual . to estimate bone age
, we have performed radiographic assessment of calcification levels of hand - wrist bones following bjork grave , and brown method .
iguma et al . found that both martins and sakima and grave and brown methods proved to be valuable for the determination of bone age with the help of hand - wrist radiographs .
dental age is a very useful parameter to investigate the overall maturation of an individual .
tooth mineralization is a constant process which can be determined by radiographs whereas tooth eruption is a fluctuating event where its exact time is difficult to analyze .
hagg and matsson , nanda and chawla , and hegde and sood suggested that the demirjian method offers more precise and greater reliability for dental age estimation .
advancement of chronological age in comparison with dental and bone age was our finding in both the sexes .
, takano et al . , keller et al . , sarnat et al . and vallejo - bolanos et al .
vallejo - bolanos et al . observed retardation of dental and bone maturation in a sample of 54 familial short - statured children .
. found lagging of dental age in both growth hormone deficiency patients and laron type dwarfism ( ltd ) patients .
our investigation proved a significant decrease in dental and bone age in both genders , which is in accordance with the findings of vallejo - bolanos et al .
evaluated the utility of the demirjian method for dental age assessment among tunisian children and stated that the method was not suitable for tunisian children and each population deserves a separate set of standards to assess the chronological age .
patel et al . assessed the accuracy of various age estimation methods and concluded that the willem 's method ( modified demirjians ) can be used to calculate chronological age in 616 year old gujrati children .
conducted a study to evaluate the use of the london atlas of human tooth development and eruption for age estimation in saudi arabian children and adolescents ( aged 220 years ) , and concluded that there was variation in age estimates that may have significant impacts on results .
radiographically assessed the third molar development in relation to dental and chronological age and found a strong correlation between left third molars and dental age in males .
the study also highlighted the importance of third molar calcification stage as an important phase in age prediction for all the mandibular teeth in both the genders .
as per our observation , we found that the dental , bone , and chronological ages were positively correlated .
these findings are supported by related studies such as those of vallejo - bolanos et al .
green , hegde and sood , prabhakar et al . , and alqahtani et al .
many previous studies have also validated that different growth maturation tissue systems exhibit positive relationship .
estimation of bone maturation and dental maturation is a valuable investigation to observe the growth status of different tissues in the body .
bone age and dental age is very helpful in dentistry to plan dental treatment and is also useful in medicine as supportive information .
our findings validate that growth failure has an impact on dental and bone maturation in iron - deficiency anemic children .
aims and objectives : dental and bone age is very essential for the dental practitioner in planning treatments and is an extra source of information for the pediatrician , orthopedician , and endocrinologist . 
 there are few published data regarding collation between dental age , bone age , and chronological age in iron - deficiency anemic children . 
 this study has been undertaken to evaluate and compare dental age , bone age , and chronological age in children with iron - deficiency anemia.materials and methods : one hundred iron - deficiency anemic children were selected in the age group of 814 years . 
 chronological age of the child was recorded by asking birth date from parents or checking school records . 
 dental age was calculated by demirjians method and bone age was evaluated using bjork , grave , and brown 's method . 
 unpaired student 's t - test and pearson 's correlation coefficient were the two statistical tests applied to compare dental , bone , and chronological age.results:dental and bone age was significantly lower ( p < 0.001 ) compared to chronological age . 
 the correlation between the three ages was positive in both sexes.conclusion:dental and bone age retardation was a significant feature in our sample of 100 iron - deficient anemic children . 
 bone age and dental age are valuable parameters in assessing the overall growth of the child . 
 further studies are required to corroborate our findings .