Diagnostic utility of cytomorphometric evaluation of exfoliated buccal mucosal cells in age estimation: a systematic review and meta-analysis

Abstract

Age estimation is a critical aspect of forensic odontology for victim identification. Exfoliative cytology has frequently been investigated for this purpose with variable results, necessitating further exploration. This systematic review and meta-analysis aims to analyze the diagnostic utility of cytomorphometrically evaluated exfoliated buccal cells in living individuals for age estimation. A thorough search was conducted using PubMed, Google Scholar, and Cochrane Library databases. Original research articles that performed exfoliative cytology on healthy individuals and evaluated cytomorphometric parameters were included in this review. The risk of bias was analyzed for each study using the Joanna Briggs Institute criteria, and Review Manager was used for the meta-analysis. Twelve studies, and two subgroups included for qualitative and quantitative data synthesis, revealed a significant decrease in cellular parameters and an increase in nuclear parameters in healthy individuals as age progressed. The random-effects model also confirmed that significantly decreased cellular parameters were associated with an increased risk of advanced age. Mounting evidence confirms that cytomorphometric evaluation of exfoliated buccal cells, specifically cellular parameters, is a useful tool for age estimation. However, it still lacks the credibility to be used as a sole factor for predicting an individual’s age. Therefore, a combination of factors should be considered for age estimation to provide more reliable results. © 2025 The Biological Stain Commission.