Amalia Widya Larasati, Muhammad Galih Irianto, Eka Cania Bustomi I The Role of Forensic Odontology Examination in

Identifying the Identity of Mass Disaster Victims

The Role of Forensic Odontology Examination in Identifying

Identity of Mass Disaster Victims

Amalia Widya Larasati1,Muhammad Galih Irianto2, Eka Cania Bustomi3

1Faculty of Medicine, University of Lampung

2Forensic Medicine, Faculty of Medicine, University of Lampung

3Section of Community Medicine, Faculty of Medicine, University of Lampung

Abstract
Mass disasters are unexpected events that come from nature or not nature and cause many casualties. Most of the victims did
not have an identity so that a forensic examination was needed to determine the identity of the victim. One of the primary
examinations carried out is by examining the victim's teeth or forensic odontology. Teeth are members of the body that have a
high level of individuality so that there are no similarities between the teeth between individuals, are resistant to the effects of
decay, and their growth is not influenced by nutrition and socioeconomic so that they show less variation. The role of forensic
odontology examinations in identifying victims can reach the individual level, namely being able to find out the identity of the
identified person if there is dataantemortem from hospital dental clinics, educational institutions, and private practice dentists.
In Indonesia, dataantemortem teeth are difficult to obtain because not everyone has the data, only certain professions have the
data antemortemsuch as TNI/Polri, pilots, and flight attendants/i. If there is no dataantemortemTherefore, the results of the
forensic odontology examination can only estimate the age of the victim using several examination methods, namely
radiography using the Blenkin-Taylor method, clinically using the method of calculating the number of erupted teeth,
biochemistry using the aspartic acid racemization method, and histology using the Gustafson method. The selection of the
examination method depends on the condition of the victim, age, number of victims, and the means of examination.

Keywords: Forensics, Identification, Odontology

Role of Forensic Odontology Examination to Identfying

Victim Identity on Mass Disaster

Abstract
Mass disaster is an unexpected event that comes from nature or humanwhich causes many victims. Most of the victims don't have an identity, so forensic examination is
needed to determine the identity. One of the primary examinations is with forensic odontology. Teeth are part of the body that has a high level of individuality means each
individual won't have the same tooth shape, resistant to effects of damage, and their grow does not depend by food and socioeconomy so it shows less variety. The results of
forensic odontology in identifying victims are until individual level, means it can identify the identity of the person if there is an accurate antemortem data from government
hospital, educational institutions, and dentist's private practice. In Indonesia, antemortem data are hard to find because not everyone has it, only certain profession has it for
example soldier, police, pilot, and flight attendance. If there is no antemortem data, the results of the forensic odontology examination can only estimates the age of the victim
with several examination methods, such as radiographic with Blenkin Taylor's method, clinical with calculation of the number of erupting teeth, biochemical with racemization
aspartic acid method , and histological with Gustafson's method. Choosing the examination method depends on the victim's condition, age, number of victims, and facility.
clinical with calculation the number of erupting teeth, biochemical with racemization aspartic acid method, and histological with Gustafson's method. Choosing the
examination method depends on the victim's condition, age, number of victims, and facility. clinical with calculation the number of erupting teeth, biochemical with
racemization aspartic acid method, and histological with Gustafson's method. Choosing the examination method depends on the victim's condition, age, number of victims,
and facility.

Keywords: Forensic, Identifying, Odontology

Correspondence: AmaliaWidya Larasati, Address Jl. Prof. Soemantri Brojonegoro LK 01 RT 09 Gedong Meneng Rajabasa Bandar
Lampung, Phone 082280591601, E-mail iamlwdyl@gmail.com

preliminary typhoons and hurricanes hit almost all

Disasters can be caused by nature parts of Indonesia. Disasters caused by
and humans. Natural conditions play an humans such as terror bombs, conflicts,
important role in the emergence of a sinking ships, and plane crashes. This
disaster, including in Indonesia. Indonesia series of natural disasters has resulted in
is geographically and geologically located many casualties, property losses, and
in an area prone to natural disasters. environmental damage.1.2
Various disasters, such as: earthquakes,
tsunamis, floods, landslides,

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Amalia Widya Larasati, Muhammad Galih Irianto, Eka Cania Bustomi I Role of Forensic Odontology Examination in
Identifying the Identity of Mass Disaster Victims
Mass disasters that occur violently
and unexpectedly will cause many people
to die who are not recognized or have no
identity. Difficulties in identifying victims
due to disasters or mass accidents often
cause problems in the field of forensic
medicine.3 Thus, the identification of
victims of mass disasters
(Disaster Victim Identification) becomes a
very important activity and is carried out
in almost every incident that occurs
cause large numbers of casualties. The
main purpose of this examination is to
identify the identity of the victim, then
further efforts can be made to care for,
pray for, and hand over to the victim's
family to be buried according to their
respective beliefs. In addition, the
identification of the victim's identity also
aims to provide psychological peace to
the victim's family with the certainty of
identity.1
Disaster Victim Identification (DVI)
is a procedure for
identify the victims of death due to mass
disasters scientifically and can
accountable and refers to Interpol
standards. The DVI process uses a variety
of methods and techniques.
Interpol has determined that there are Primary
Identifier (PI) which consists of fingerprints,
odontology, and DNA as well as Secondary Identifier
(SI) which consists of medical, accessories, and
photography. According to Interpol standards,
identity identification is said to be valid and correct if it
has been successfully tested by at least one person
Primary Identifier or two Secondary
Identifier.4
Forensic odontology is a science
that applies dental science to solve crime
problems for the benefit of the court. One
aspect of its scope is its role in assisting
the task of the forensic medical service
function in handling cases.
cases requiring identification of with
dental facilities.3
In case disaster mass,
examination with dental facilities can
provide results up to the individual level
or only limited to the estimated age of the
victim. It depends on the dataantemortem
victim.5.6 Teeth in the oral cavity
is the hardest part of the body, has
individual characteristics and is resistant to
temperature, chemicals, and trauma, so it is
very suitable for identification. This forensic
odontology method has high accuracy and
is almost the same as fingerprinting.7
Contents
Every mass disaster that occurs
will cause many victims who may be
intact, half intact, decomposed, broken
into fragments, burned to ashes, half
burned, or buried. In victims who
experience decay, identification through
fingerprints will be difficult to do so it can
be replaced with dental examination
because teeth are more durable in the
decay process.8
Teeth are used as a useful medium
in the identification of victims' identities and
age estimation because they have several
advantages. Teeth are eligible to be used as
a means of identification because they have
the following factors:9,10,11,12
1. A high degree of individuality, the
probability of finding two people with
the same teeth is one in two trillion.
The eruption pattern of 20 baby teeth
and 32 permanent teeth as well as
special treatments such as extraction,
fillings, root canal treatment, plus
other characteristics make the teeth
very unique to an individual.
2. Growth stage and
Dental development is controlled
by genetic factors, so that dental
age shows less variation than bone
or other body parts where growth
and development are influenced
by nutrition and socioeconomics.
3. Has a degree of strength and
resistance to various
high damage effect, this happens
because the tooth structure
contains inorganic
for example calcium phosphate and
bicarbonate ions which later form
hydroaxapetite compounds which
functions as a hardener, stiffener,
and bone and teeth reinforcement
in the mouth which provides
sufficient protection
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Amalia Widya Larasati, Muhammad Galih Irianto, Eka Cania Bustomi I Role of Forensic Odontology Examination in
Identifying the Identity of Mass Disaster Victims
to various influence
damage, such as mechanical,
thermal, chemical and decomposition
trauma. In carrying out identification
humans through teeth, we get 2
possibilities, namely;13
1. Obtaining information through
dental and oral data to limit or
narrow identification. Information
that can be obtained includes age,
gender, race, blood type, facial
shape, and DNA.
2. Look for characteristics that are
special signs of the victim. Such
characteristics include, for example,
teeth wrapped in metal, a number of
missing or broken teeth, or holes in
the front that can be recognized by
acquaintances/friends/family of the
victim.
Identity identification method with
dental facilities, one of which is in a way
to compare the data (the results postmortem
of the victim's examination) and data
antemortem (dental data previously that
made by the victim). With way
comparing these, can give results to the
individual level, i.e. can
know the identity of the identified person. If
the results of the comparison are the same,
then the identification result is positive, which
means that the victim being examined is the
same as the person estimated. On the other
hand, if the identification result is negative,
then the victim is not the person who is
expected so it is necessary to look for other
dental data to compare.3
If identification by way of
comparison will be applied, then the data
antemortem the victim's teeth is the main
requirement that must exist. Data
antemortem can be:9,10,11,12
1. dental records, written statement
about state tooth on
examination, treatment, or
dental care.
2. Photo x-ray tooth.
3. Dental impressions.
4. Dental prostheses or orthodontic appliances.
5. Photos close up the face or the profile of the tooth
or mouth area.
6. Information from the victim's family
or closest friend taken under oath.
Data antemortem it can
obtained through:7
1. Dental clinics in government/TNI-Polri and
private hospitals.
2. Health Center.
3. Home Sick Education
University/Faculty of Dentistry.
4. Private dental clinic.
5. Dentist's private practice.
Data antemortem The data obtained must
meet accuracy, such as completeness of
data, clarity of data, and the same criteria
for comparison.3
For data postmortem, Things to
note at a dental examination are:9,10,11,12
1. Existing and absent teeth, missing
teeth marks whether old or new.
2. Filled teeth, types of materials and their
calcifications.
3. Anomalies of tooth shape and position.
4. Caries or existing tooth decay.
5. Types and materials of restoration, treatment
and rehabilitation that may be available.
6. Attrition or erosion of the chewing plain due
to the chewing process. The degree of
attrition will be directly proportional to age.
7. Growth of the third molars.
In Indonesia, to obtain dental data
antemortem is still a difficult thing because
not all individuals have archived data about
their teeth. Only a few professions have
written information regarding teeth, such as
the TNI and workers in the aviation world.
When the dataantemortem
is not owned, then identification by means
of teeth cannot reach the individual level
but can only predict the age, race, and
dental characteristics of the victim.3
In addition to examination with dental
facilities, bone examination can also predict the
age of the victim if the victim who wants to be
identified does not have any remaining and
available teeth. Disadvantages of bone
examination are that it can only estimate age
within a certain age range and has a large
standard deviation. Meanwhile, the
odontological examination to estimate the age of
the victim has a narrow standard deviation.14.15
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Amalia Widya Larasati, Muhammad Galih Irianto, Eka Cania Bustomi I Role of Forensic Odontology Examination in
Identifying the Identity of Mass Disaster Victims
Table 1. Age of tooth emergence16
Teeth Type Age
Milk teeth / deciduous
I1 6-8 months
I2 7-9 months
M1 12-15 months
C 16-18 months
M2 20-24 months
permanent teeth
M1 7 years
I1 8 years
I2 9 years
P1 10 years
P2 11-13 years old
M2 11-15 years old
M3 18-20 years old
Age estimation by examining the
victim's teeth can be done by four methods,
namely clinical, radiographic, histological, or
biochemical examination. Each of these
methods has its own advantages and
disadvantages. The selection of methods is
based on individual status (living or dead),
age, type of case (single or mass), and
availability of facilities and equipment.8
Odontological examination of living
victims can be carried out using non-invasive
methods (without extraction) such as
radiographs, while dead victims can be carried
out by all types of methods because tooth
extraction can be performed on dead victims.
In the dead victims, panoramic extraoral
radiography was chosen.17
Meanwhile, based on age, there are
several methods that can be chosen for
odontological examination. For victims of the
age category of children and adolescents, the
most suitable method is the clinical method.16
Biochemical examination can be performed in the
age group of children to adolescents when the teeth
have been extracted. Histological examination was
selected for the adult age category (over 21 years).
18,19
The number of victims at the time of
the disaster also affects the selection of the
method to be used for age identification of
victims. In a single case, more than one
method according to age characteristics can
be selected to ascertain age
victims for more accurate results.
However, in the usual mass disaster
cause a lot of casualties and limited time
for identification then only
the most effective and efficient method
can be selected. For example, in cases of
natural disasters such as volcanic
eruptions or ship accidents, radiographic
or clinical examinations are simpler and
shorter than conventional methods.
biochemistry and histology. In addition,
digital radiography technology also allows
shortened inspection time because it does
not require film washing.5
Mass disasters that occur in rural
areas will make it difficult to provide
radiographic, histological and biochemical
examination facilities. So for
To identify victims of mass disasters in rural
areas, clinical methods were chosen by
calculating the number and pattern of tooth
eruptions for children to adolescents and
the method of pattern and degree of
attrition in adults.15,20
The wear and tear of the tooth surface
is the next criterion in determining age. For
that arranged 5 degrees of tooth wear:16
0. No visible wear at all;
1. The enamel is slightly worn, but the chewing
protrusion is still intact;
2. In some places some yellow dentin
has been seen;
3. On the entire surface of the enamel has worn
4. Most of the crowns are worn out
sd neck teeth
The role of odontology forensics that
is Primary Identifier in
identifying victims who do not have identity
is very important and contributes greatly. In
the mass disaster of the sinking of the ship
KM. Senopati Nusantara in the waters of
Rembang, Central Java in
In 2006, only 13 of the 36 bodies found were
identified, due to the length of time it took
for the bodies to be found so that the
decomposition process took place quickly.
Of the 13 bodies identified, 3 bodies (23%)
were identified through combination data
primary and secondary examinations.
The primary examination used to identify
the three bodies was a dental
examination (dental records)
as many as 2 bodies (66.7%) and DNA
examination (33.3%).1
In the mass disaster of the Garuda
GA 200 PK-GZC Boeing 737-
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Amalia Widya Larasati, Muhammad Galih Irianto, Eka Cania Bustomi I Role of Forensic Odontology Examination in
Identifying the Identity of Mass Disaster Victims
400 majors Jakarta - Yogyakarta, during
the landing. the plane that
carrying 133 passengers and 7 crew
members, this plane caught fire and killed
21 passengers (20 passengers, 1 crew
member). Twenty of the 21 bodies found
(95%) experienced a condition of being
half charred and only 1 body that was
relatively not charred. A total of 14 bodies
(66.7%) were pristine identified only by
primary examination (Primary Identifier)
based on dental data (dental records). The
remaining 6 bodies (33.3%) were identified
through a combination of primary and
secondary examinations. Of these 6 bodies,
primary examination based on dental data
succeeded in identifying all the identities of
the bodies. So that the primary examination
using dental data on the plane crash was
able to identify 20 bodies out of a total of 21
bodies (95%).1
record teeth (dental records) is
priority the main checks that must be
carried out before a secondary examination in
a mass fire disaster because the integrity of
the teeth in fire victims is still good, while in
drowning victims the primary examination is
in the form of dental recordsdental records)
cannot be made a top priority so a secondary
examination is absolutely necessary to
confirm the identity of the victim. Primary
examination (Primary Identifier)
Using fingerprint data is difficult in
situations of mass disasters such as fires,
landslides, plane accidents, and
drownings because it is estimated that
the victim's fingerprints are not perfect
for identification. While DNA examination,
although sensitive and requires a long
time and relatively expensive costs, so it
will be difficult to apply to mass disasters
that have a large number of victims.
Lots. 1
Conclusion
Examination odontology forensics
is an examination that plays an have
important role and includes category
primary examination to identify the
identity of victims of a mass disaster.
Summary
Teeth are strong members of the
body, their growth is influenced by
genetics, and have a high value of
individuality so that teeth can be used as
primary data to identify victims of mass
disasters whose identities are not known.
Forensic odontology examination will
provide identity results to the individual
level if there are data
antemortem, but if the data antemortem
If not available, dental examination can predict
the age of the victim by clinical, radiographic,
histological, and biochemical methods.
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Identifying the Identity of Mass Disaster Victims

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