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Dental radiography: Cherry picking evidence

by adminjay


Sir, we write to respond to the opinion article published in the previous issue of the BDJ (In our opinion. Br Dent J 2017;222: 918–921). We wish to thank David Davies for his continued interest in dental X-rays. His paper does nothing to change our view that these tests remain, on balance, inaccurate, unethical and inappropriate.

We did not enter this debate with an agenda, short of ensuring the best interests of both patients and practitioners. We are not ideologues or dogmatists, we are health professionals.

As an organisation we endeavour to follow the principles of evidence-based policy making. We arrived at our current position following considerable – and sustained – deliberation. We take our cues from the available science, ethical standards and of course with input from practitioners at all levels.

Mr Davies in contrast seems to favour policy-based evidence making. Certainly he has gone to some lengths to source academics that can support his position. Having claimed to have found a magic wand for establishing age – only to be roundly dismissed by both government and healthcare professionals – he has worked backwards to try and lend credence to his call.

Certainly his co-authors include notable ‘enthusiasts’ for the practice of dental age checks, who have provided ‘definitive’ evidence that is not quite so clear in wider academic research. We respect dissenting voices. The scientific method demands their presence to challenge and move the debate forward. However we do not set out to cherry pick our evidence with the sole intention of justifying a pre-baked position. We want to be guided by the science, not by ideological commitment.

And on ethics we must again part company with the authors. They have gone to great lengths to state that the risks to the individual of a medically unnecessary and potentially harmful procedure can be weighed against the perceived benefit to society. Frankly, these are not principles we can sign up to. Yes we have made a choice, and we will not be venturing down a path trodden by eugenicists in the name of the ‘Greater Good’.

We are conscious that both the current and former Chief Medical Officers for England have raised significant concerns about age test trials co-author Prof Roberts has conducted in the past, which have subjected children to X-rays without ethical approval. We recognise these age tests do have a handful of passionate and highly motivated advocates, but there is a question of judgement here. And that passion can leave us unclear where the science ends and the fan club begins.

As the professional association for dentists, we also have a duty to ensure our members are not placed in what could be compromising positions. And we are heartened by the weight of support our position has generated among colleagues.

From the very start Mr Davies has presented these tests as a silver bullet to establish a migrant’s ‘true age’. Our contention, again based on the overwhelming weight of scientific evidence, is that such claims of ‘precision’ cannot be made. Yes the science may evolve. We are open-minded. As for the ethics, it may be time the authors found some new arguments.

References

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    Liversidge H M, Marsden P H . Estimating age and the likelihood of having attained 18 years of age using mandibular third molars. Br Dent J 2010; 209: E13.

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    Clement J . Summary of: Estimating age and the likelihood of having attained 18 years of age using mandibular third molars. Br Dent J 2010; 209: 406–407.

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    Aynsley-Green A . Unethical age assessment. Br Dent J 2009; 206: 337.

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    Meikle J . Border Agency halts x-ray programme for child asylum seekers. The Guardian, 27 April 2012. Available at: https://www.theguardian.com/uk/2012/apr/27/border-agency-xray-asylum-seekers.

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    Kumar V, Patil K, Munoli K B . Comparative evaluation of dental age, bone age, and chronological age in the human immunodeficiency virus positive children. J Pharm Bioallied Sci 2014; 6 (Suppl 1): S90–S96.

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Armstrong, M., Ladwa, R. & Lockyer, A. Dental radiography: Cherry picking evidence.
Br Dent J 223, 4 (2017). https://doi.org/10.1038/sj.bdj.2017.562

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