The Contribution of Forensic Odontology in the Highland TowersCondominium Disaster _

Alhabshi SF, Nambiar P. The Contribution of Forensic Odontology in· the HighlandTowers Condominium Disaster. Annals Dent. Univ. Malaya 1995;2:25-28.

ABSTRACTAn apart:mentcomplexcollapsed in Malaysiakilling48 people trappedinside.Thedentaldisastervictimidentificationteamcomprisingofofficersfrom the Kuala Lumpur GeneralHospital,ArmedForcesand the DentalFaculty,UniversityofMalayaplayeda veryactiverolein theidentificationprocess. Most of the bodies were badly decomposedand some grosslydisfigured.Problemswere encountereddue to inadequate facilitiesandequipmentsat the mortuary.Difficultieswerealsoencounteredduring theprocurement and deciphering of information from dental records.Suggestionshave been made to improve facilities,expertiseand also tocreate awareness amongst dentists to ensure proper recordingof theirpatients' dental status.

Key Words: Forensic Odontology, disaster, identification, age determination.

INTRODUCTION

·Sharifah F. Alhabshi"Phrabhakaran Nambiar• Senior Dental Consultant

and Head of Dental DepartmentKuala Lumpur General HospitalKuala LumpUr

•• Lecturer, Dean's OfficeFaculty of DentistryUniversity of MalayaKuala Lumpur

11

In recent years there were numerous disasters due tonatural causes such as earthq~akes, cyclones, floods,fires and others due to vehicular accidents and explosivesat different parts of the world. Many of these disastersclaimed numerous lives and have caused great damageto property and the enviroment. On December 11th,1993a different kind of disaster occurred at Ulu Kelang,Selangor, Malaysia. A 12storey apartment complex builton a hill !.>lope- Block A of Highland Towers collapsedentombing everyone inside. Although the building wasbelieved to have been constructed on a stable foundation,autho~ties have great diffficulty in determining theactual cause for the crash. Others concede that it wasdue to land slides occuring in the n~ighboring areacausing water to seep and weaken the foundation.

Within the first hour of the collapse a Japanesehousewife, an Indonesian maid and her eighteen monthold toddler were rescued. However, the Japanese ladydied subsequently at the Kuala Lumpur GeneralHospital from massive internal injuires. The Malaysianemergency workers comprising of firemen, policemenand defence personnel were joined by rescue teamsfrom Singapore, Japan and France. They arrived withvery sophisticated equipments and were assisted withtrained sniffer - tracker dogs. They were cautious not tobe·very aggressive while carrying out their operationsfor the fear of endangering any surviving victims.Unfortunately, no rescue .was made after one week ofsearching which prompted the disaster managementteam to tear down the slabs of the building with heavymachinery. Emergency workers started removing bodieson 18th December and this work stretched for the next 6days. Bodies were then brought to the Kuala LumpurGeneral Hospital mortuary for postmortem. Two largerefrigerated freight containers were borrowed from a

shipping agency to complement the mortuary space.Bodies were recovered at different stages ofdt;Composition - some badly mutilated and fragmentedwhile others were actually skeletonised.

The disaster victim identification (DVI) team thatwas qui~kly assembled was headed by a seniorpathologist of the hospital. It comprised of forensicpathologists, dentists and also a geneticist to help in theidentification process. A forensic pathologist wasspecifically assigned to record and catalogue theidentifying information of each victim. The dental DVIteam comprised of ten officers. They were from theDental Department of Kuala Lumpur General Hospital,the Malaysian Armed Forces and the Dental Faculty,University of Malaya. The aim of this article is toillustrate the importance of dental identification donefor the first time in a mass disaster in Malaysia. It alsoreinforces the need for the inclusion of dental expertsfor confirming or supporting any identification ofunknown deceased persons in the future.

IMPORTANCE OF VICTIM IDENTIFICATION

The death of a Malaysian citizen is officially certified bythe issue of a death certificate. A death certificate isnecessary to solve many legal matters such as inheritanceand succession to property, the collection of insurancepolicies and pensions, settlement of business mattersand also the remarriage of the remaining spouse. Positiveidentification of victims following an unprecedentedaccident is imperative to bring to an end the distress onfamily members, relatives and friends. Furthermore,additional relief may be afforded to a family who learnsthat an unknown body is not the remains of a Iriissingrelative (1).

26 Annals af Dentistry, University af Malaya Val. 2 Jan. 1995

Visual recognition repres~ts the most frequentmethod of identification. Gener~lly the body must bewell preserved with intact facial features. Many victimsof this disaster could not be identified visually due tothe extensive trauma and advanced decomposition. Inthese conditions, it was deemed advisable not to inviterelatives and friends to provide any visual identification.Their judgement in recognizing anybody would bequestionable because of the emotional stress that theywere experiencing.

Personal effects such as clothing, identity cards,jewellery, .prescription spectacles and keys providedsome favourable leads' in the identification process.However, this is not scientifically reliable as they cap.beswitched with criminal intent or could have beenborrowed. The use of fingerprints was limited becauseof the decomposed nature of the bodies. The pathologistson their part worked to assess age, determine race, sex,stature, disease status as well as the cause and time ofdeath of the deceased. Comparison with the knownmedical history or prior surgical procedures of asuspected victim may serve to corroborate or excludean individual. Selected bone tissues were collected bythe pathologists and despatched to the geneticist forDNA fingerprinting.

DENTAL IDENTIFICATION

The procedures of dental identification are crediblebecause the human dentition has very good postmortempreservation - although it undergoes destruction duringa person's life. Dental restorations and prostheses areextremely resistant to physical and chemicaldeterioration and also to the changes to the environment.!he unique morphological characteristics of humanteeth and dental restorations have great individuality.The availability of routine dental records, especiallyradiographs provide exacting evidence for comparison.Sometimes the recovery of only a single tooth or jawfragment maybe unique enough to make a positiveidentification, provided the antemortem recording hasbeen made. Marking of dentures with names or numbersare recent introduction in the fabrication of dentures.This is followed stringently in 7 states of United Statesof America (2). Furthermore, it is also important to havea d~ntist at the site of disaster during body removal andevidence retrieval. This is important as many trainedfuvestigators at accident sites tend to overlook dentalevidence, which may be crucial for the positiveidentification of an indiviual.

VICTIMS OF THE DISASTER

Unlike in an airline crash where a passenger manifest isquickly made available, the Highland Towers disastermanagement team was unsure of the number of peopleinside the building. Being a Saturday a afternoon, manyhad not returned home thus escaping the fatal accident.The police recorded that 48 individuals lost their livesin this mishap.

Table 1 The nationality and ethnicity of the victims of thecondominium disaster.

Nationality No Ethnicity

Malaysians 38 (Chinese - 22, Malays - 10, Indians - 6)

Indonesians 3

Koreans 2

Britisher 1

Indians 2

Filipino 1

Japanese 1 (died at the hospital)

The above list sufficiently shows the diversity ofethnic, racial, cultural, national and religious affiliationof those who perished (3). This posed a special problemas all bodies had to be identified positively and returnedto their respective relatives for burial or cremation ritesin accordance to their own customary traditions.

DENTAL INVESTIGATION ANDINTERPRETATION PROCEDURES IN THISDISASTER

A total of forty six bodies were examined by the dentalidentification team. This did not include the victim whowas hospitalized before dying. Another did not haveany skull bones for examination. Forty bodies had .relatively intact maxilla and mandibular bones whilesix others had fragmented pieces for examination. Dentalstatus of all these bodies were charted on postmortemodontograms. Gaining access for dental examinationwas relatively easy because most of the bodies weredecomposed or skeletonized. Radiological recording ofdeveloping teeth of pre-school, school going childrenand juveniles were taken for estimation of age. As wehad access only to intra-oral dental radiographs, bothupper and lower jaws of either side were radiographedfor age assessment. In cases when all the teeth hadcompletely erupted, radiographs of the third molar wastaken to see if the root formation was complete. Thiswas to.ensure that the bodies' did not belong to anyonein the late teens: Age assessment of adults was based onthe attritional wear of the teeth. In addition, the level ofperiodontal attachment and the .amount .of alveolarresorption were other cumulative factors selected forthe same assessment. Difficulties were also faced due toimproper lighting and inadequate facilities at the hospitalmortuary for serious odontological work.

Numerous problems were alSo encountered whenattempts were made to obtain dental records. A fewdental surgeons were reluctant to release the recordsbut provided written statement of the treatmentrendered. Several others had to be coaxed and reassuredthat they would not be implicated for not havingadequate recording of their patients. In most cases dentaltreatment provided by the attending dentist were theonly information written on the records. There werealso problems in deciphering information due tounfamiliar terminologies and illegible writing. Dental

The Contribution of Forensic Odontology in the Highland Towers Condominium Disaster 27

records of a few were not traPjable because the wholefamily perished in the disaster. A limited number ofthem were treated by unqualified dentists who nevermantain any form of records. Some foreigners hadtreatment done in their home countries, while a fewMalaysians had their treatment overseas. Lastly, a fewfamilies had problems providing information regardingdental treatment received by their dead relatives becausethey never had a regular dentist.

Positve identification was possible for sixteen(34.8%)bodies because there was adequate antemortemdental records of the missing victim. Radiographsprovided excellent confirmatory evidence. Identificationof eight other bodies (17.4%) were only dentallysupported because there were insufficient dental historyor only jaw fiagments were retrieved from the site ofdiscovery. These included five edentulous ladies.However none of them had their dentures marked.Accurate age estimation was possible for nine children(19.6%),some of whom had mixed dentition. The dentalinvestigators employed the chart prepared by Schourand MassIer (4) which demonstrated stages of toothdevelopment and sequence of eruption at yearly interval.In thirteen adult cases (28.5%) age estimation fromattrition· of teeth, periodontal recession and alveolarresorption was made for possible association or exclusionwith other findings to help in the identification. Thisparticular method is not considered very reliable, but itis sometimes the only method possible under the givenconditionS.

Various other information were also gathered fromthe teeth. These include racial traits, oral hygeine status,smoking habits, socio-economic status and also detailedmorphology of the anterior dentition. In selected cases,photographs of supected missing persons expressinghis/her teeth were compared with those of the victims.The alignment, shape, size and any malformation orspacing in the anterior teeth were useful for positiveidentification. Even a video tape recording showing thesmiling face of a suspected victim was used foridentification. In another case, comparison of a siblingteeth morphology was mad~ The deceased had a featurecalled "double-shovel" shaped incisor teeth whichcorresponded with her sister's dentition. Both themesial and distal margins of the palatal and labialsurfaces of her upper anterior teeth were raisedsuggesting a familial trait. In extremely difficultsituations when antemortem dental records were notavailable, relatives and family members were sometimesquestioned to determine if their deceased relatives hadany restorations on their teeth or prosthesis inserted toreplace them artificially. Selected teeth were sometimesremoved for closer scrutiny and detailed examinationunder magnifying glass to detect any tooth colouredrestorations. Even the dye of an indelible pencil wasused to disclose them.

DISCUSSION

The collapse of the apartment building reinforced theimportant role of forensic odontology in mass disastervictim identification in Malaysia. For the first time therewere requests on television and the newspapers for thedental records of the victims. There was also a greaterrecognition of the role of dental experts by thepathologists, police officers and other governmentagencies. Suggestions have been made to improvefacilities such as proper lighting, availability ofradiological dental machines and provision of adequatedental equipments at the hospital mortuary. There isalso a need to have more dental surgeons trained inforensic odontological work by attending post-graduatecourses. This is imperative as those trained will becomemore confident when interpreting dental records anddeducing evidence from oral and dental structures.

The dental identification team had a reasonablyfavourable cooperation from the dental community,although some were hesitant to part with their patient'sdental records. In light of ~s accident, it is hoped thatthere is a greater awareness amongst practising dentistsfor the need to mantain adequate dental recording oftheir patients. They should also become aware thatwhatever treatment performed can become a potentiallegal issue later.

The authors also wish to record sincere thanks toMajor (Dr.)TanPeng Hui (Singapore) and Dr.Carl Leung(Hong Kong) for expressing their readiness to providetheir expert assistance. This form of internationalcollaboration is very healthy, especially in themanagement of mass disasters involving a larger numberof victims from several countries. As the number of thedeceased were only 48 in this disaster, these numberswere manageable by the dental disaster victimidentification team of Malaysia.

ACKNOWLEDGEMENTS

We wish to put to record that the following were part ofthe DVI ( Dental) team during the collapse; Dr. NorainiNun Nahar, Dr.Criistopher Vincent, Dr. Sharifah ShiumAlhabshi Dr. Norinah Mustapha, Dr. Anita RohiniNesadurai, Dr. Azida Abdul Aziz, Mejar (Dr.) DidarSingh, Mejar (Dr.)Heng SWeeHeong.

We also express our sincere thanlcs to Dr. Zaini ARahman ( Senior Pathologist, Kuala Lumpur GeneralHospital), The Forensic Pathology Team, The RoyalMalaysia Police Force and the mortuary attendents forhaving been very helpful in providing the necessaryassistance to the dental team.

28 Annals of Dentistry, University of Malaya Vol. 2 Jan. 1995

REFERENCESI. Cottone J A Dental identification. In Cottone J A, Standish S M, eds. Outline of 'forensic dentistry. 1stedn. Year Book Medical

Publishers, 1982, 73-87.2. McGivney J. Marking of removal dentures. In Averill D C, ed. Manual of forensic odontology. 2nd edn. American Society of Forensic

Science, 1991; 62-71.3. Remembering the innocent victims of the condo collapse. The Star (daily) 3/6/1994: 5.4. Ciapparelli L. The chronology of dental develop,ment and age 'assessment. In Clark D H, ed. Practical Forensic~Odontalogy. 1st. edn.

Butterworth - Heinmann Ltd, 1992; 29-30.