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Tsunami-Mahidol Dental Taskforce

An underwater earthquake is a natural phenomenon that can create a tidal wave called a tsunami. Tsunamis can be initiated by the movement of the earth’s tectonic plates that registers greater than 7.0 on the Richter scale. The wave may cause major destruction to any coastal areas within the tidal wave’s reach. Usually, the deceased are identified and a sample of DNA can be analyzed soon after death. However as decomposition occurs, the identification becomes more difficult. Forensic dentistry is a valuable tool in this situation.

Sunday, December 26th, 2004 at 9:50 AM, the southwest coast of Thailand was crushed by an enormous tidal wave from an underwater earthquake near the Sumatra Island of Indonesia. The tsunami caused horrific destruction and brought out unimaginable remorse and shock from the coastal communities of the Indian Ocean.

On Wednesday, December 29th, The Dean of Mahidol University Faculty of Dentistry, Dr. Theeralaksna Suddhasthira, called an emergency meeting of our Faculty Board and arranged the relief force of our school to reach out to the Southern Coast affected by the disaster. The most damaged of the affected six Thai provinces affected, Phang-Nga at Takaul-Pa District, was the focus of the MU Team. It was reported that the beach areas of Phuket, Pathong, Kamala, Kata, Karon, and Niyang were in ruins.

Since there were thousands of unidentified bodies recovered from the ocean debris, it became the burden for forensic specialists to perform basic identification of the corpses. Dean Suddhasthira strongly encouraged MUFD staff to volunteer for this task. That Wednesday afternoon, more than four hundred volunteers showed up revealing the compassionate spirit of our institution.

The 60 volunteers of the first task force were transported the following day at 6 AM by Royal Thai Air Force from Bangkok to Phuket Province. Our team comprised instructors, dentists, dental students, dental assistants, dental technicians and other staff. A meeting of the representatives from different institutions was conducted to sort out a job description for each team in Phuket. Another team had to survey affected sites to manage situations in areas of Phuket and Phang-Nga. It was decided that MUFD would assist the forensic medicine team in Phang-Nga, where identification was the most needed. To identify the more than three thousand bodies, each team was instructed to perform basic identification and provide any necessary assistance to the primary forensic medical teams in Yan-Yaow and Bang-Moung Temples.

Dr. Khunying Porntip Rojanasunund, the Vice Director of the Thai National Forensic Institute, was in charge of the disaster response and was working tirelessly in the field. Needless to say, the bodies’ were horribly decomposed and the odor was unbearable. However, with inspiring fortitude the volunteers continued to open body bags to establish general and specific descriptions of the bodies.

Our dean inspired us to perform our best although some of the bodies were decayed to the point that race or nationality was indistinguishable. At the time, DNA examination also was required for positive identification. Some of our team members also performed tooth extractions and radiographic records to be used in conjunction with the DNA identification process. It was not easy extracting teeth or take radiographs since the drowning victims’ jaws were tightly closed. It took many resections of the muscles to remove the mandible for further examination.

More than three months after the disaster, volunteers from our faculty continued to take turns with the mission to identify victims. Nearly a year later, the institution still supports activities such as HRH Princess Maha Chakri Sirindhorn’s dental mobile services that offer dental treatment, oral health and hygiene recommendations, and providing consultation to the Ministry of Public Health among others. To date, more than 600 volunteers from MUFD have participated in the relief and recovery efforts.

Method of Dental Analysis

Analysis of the oral examination is an invaluable process in identification of the extensively decomposed bodies. The criteria are listed below. 1. General dental examination of the remaining dentition 2. Radiographic examination 3. Extraction of a tooth for DNA analysis Process of Identification 1. Dental charting: collection of data from oral examination. 2. Radiographic Examination: six periapical films (three maxillary and three mandibular). 3. Tooth extraction for DNA analysis with Siriraj and Ramathibodhi hospitals. 4. All data is recorded digitally for further cross matching of victims.

Lessons Learned

Forensic dental examination by nature is a difficult process and can be easily complicated by many factors. In this case, since there was a vast number (3,000) of bodies in the field that were decaying, dental examination was exceedingly difficult. Another specific problem was that there were inadequate personnel to perform this time-consuming task. It was not difficult to feel overwhelmed in a situation as this. Also, the accommodations for the volunteers were a long three hour journey from the site. This is not to detract at all from the generous hospitality of the Hilton Phuket Acadia that waived Mahidol’s expenses without hesitation. Suggestions for improvement are below.

1. Additional teams need to be sent to perform the unremitting identification process.
2. Panoramic examination should be used instead of periapical radiographs.
3. Accommodations should be closer to the site.