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tal practice. Discrepancies among these ages can amount to as much asfive years; this is substantial when one is considering a span as short as thefirst two decades of life.” 157The Radiographic Atlas of Skeletal Development of the Hand andWrist by William Walter Greulich and S. Idell Pyle (2ed. p. 2), 158 the mostcommonly used bone age standards in the United States, 159 explicitly recognizesthe discrepancies in chronologic, bone and dental ages:“Because of this variability, the chronological age of a child during theearly part of the second decade of life is often but little more than a measureof the length of time that he or she has lived; it bears no necessarilyclose relationship to the amount of progress which the child has madetoward attaining [skeletal] adulthood.” 160Furthermore numerous studies of the Greulich and Pyle standards andother dental and bone age standards have found similar discrepancies andvariability.One medical study resulted in the authors questioning “whether thesestandards [the Greulich and Pyle standards] apply to the current assessmentof bone age in children of diverse ethnicity.” 161 The Greulich and Pyle standardswere derived from white children of the upper socioeconomic classfrom 1931-1942. The authors determined that using the standards ofGreulich and Pyle to determine bone age must be done with reservations,particularly in black and Hispanic girls and in Asian and Hispanic boys inlate childhood and adolescence. 162 Another study of US children of Europeanand African descent, published in 2001, concludes that new standardsare needed to make clinical decisions that require reliable bone ages andaccurately represent a multiethnic pediatric population. 163A Swedish study investigated the accuracy of the development of onemolar often used in to estimate chronological age in certain young foreignindividuals with uncertain birth records and concluded that the differencebetween estimated and true chronological age was large. 164 The associa-157Ferraro, INS Public Comment. See Appendix A.158NY Times, Crucial Gatekeeper.159Ontell FK, Ivanovic M, Ablin DS, Barlow TW. Bone age in children of diverse ethnicity.AJR Am J Roentgenol. 1997 Aug;169(2):597-8. [Ontell, Bone age, diverse ethnicity].160Radiographic Atlas of Skeletal Development of the Hand and Wrist by William WalterGreulich and S. Idell Pyle (2ed. p. 2).161Ontell, Bone age, diverse ethnicity.162Ontell, Bone age, diverse ethnicity.163Mora S, Boechat MI, Pietka E, Huang HK, Gilsanz V. Skeletal age determinations in childrenof European and African descent: applicability of the Greulich and Pyle standards. PediatrRes 2001 Nov;50(5):624-8.164It was +/- 4.5 years in girls and +/- 2.8 years in boys with a 95 per cent confidence interval;Thorson J, Hagg U. The accuracy and precision of the third mandibular molar as anindicator of chronological age. Swed Dent J 1991;15(1):15-22.AGE DETERMINATIONS/DENTAL EXAMINATIONS 131