Skull from an occlusal perspective. The prosthesis and surrounding dentition provide valuable identifiers for comparative dental identification, prosthetic appliance tracing, and assessment of ante-mortem oral health status. Photo from Ernest Joie Guzman.
It was early morning after Christmas in 2004 when a magnitude 9.1 earthquake struck off the coast of Sumatra, Indonesia. Waves up to 30 feet (9 meters) tall ripped through the Indian Ocean, causing massive devastation in their wake.
In Thailand, the ensuing tsunami created what many call the largest disaster victim identification in history. Forensic experts from over 30 countries rushed to the beaches to identify almost 4,000 dead bodies and countless missing.
One might think that DNA, the gold standard in human identification, was responsible for identifying most of the bodies. “But actually, it was not,” said Dr. Ernest Joie Guzman. A forensic dentist and University of the Philippines Manila graduate, Guzman confirmed that around 54% of the bodies were identified relatively quickly using dental information, and not DNA.
Despite its power, using DNA to identify all bodies is expensive and can be prohibitively complex. In contrast, experts found that as long as the head of a body is kept, it typically retains some sort of dental structure that experts can use for identification.
Due to this, Guzman believes that forensic odontology should be tightly integrated in Philippine disaster or criminal investigations, especially when the goal is identifying victims and returning them to loved ones. But the field, like forensics as a whole in this country, is still in its challenging early phase. Are we ready to make the tough decisions to help it grow?
Dentists for the dead
Guzman served for a period of time as the dentist-consultant of UP Manila forensic pathologist, Dr. Raquel Fortun. Guzman defines forensic odontology or dentistry as the “handling, examination, and evaluation” of dental evidence in a crime or disaster scenario.
A forensic odontologist’s job not only involves identifying victims. Guzman says a trained dentist can, for instance, estimate people’s ages from their tooth development. During the height of President Rodrigo Duterte’s War on Drugs, Guzman also did “dental profiling,” or piecing together a victim’s ethnicity, lifestyle, and other information from their mouth and teeth. Odontologists can also do bitemark analysis when these are left on bodies in the aftermath of a crime.
What makes teeth so special? “Tooth enamel is the strongest substance in the human body,” Guzman noted. “Even compared to bone.” They don’t decay or incinerate like a fingerprint might. Also, teeth are typically less affected by nutritional or growth-related deficiencies that might deform a skeleton.
Each set of teeth, much like fingerprints, carries unique features, such as morphology, tooth number, the presence of restorations, etc., that are valuable for identification. “Teeth also contain DNA,” Guzman added, should further confirmation of identification be required. With these many benefits, it is no wonder that many experts agree that odontology should be integrated into any large-scale forensic effort.
Intricate juggle
Sadly, this doesn’t always happen. In a June 2025 co-written paper, Guzman highlighted several barriers that have hindered the integration of this technology in disaster and criminal cases. The first is simply economic: there are hardly any forensic odontologists in the country and, for those few, it is almost impossible to make a living doing that alone.
Now working in New Zealand, Guzman experienced this firsthand. “I entered the field because I wanted to do something significant,” he said. However, after completing his training from Dundee University, Scotland, he found that living his dream required compromises. Lots of them.
“To sustain yourself often requires supplementary income, usually through managing a private dental practice or pursuing an academic career,” Guzman uttered. “Dr. Fortun and I usually got pro bono cases. My other side jobs were teaching at UP Manila and teaching for board examinations.” This intricate juggling meant that, other than receiving very little compensation, he had to drop everything, including clients, when major cases arrived.
For dentists like Guzman, getting additional forensic training is a huge risk, especially when other specializations would bring a regular income. Even our country’s law enforcement agencies are not exempt from this privation.
he problem that I see is that agencies like the National Bureau of Investigation [which handles natural disasters] and the Philippine National Police [which takes man-made cases], they usually get just one forensic dentist each.” So hypothetically, when a murder case needs attention in Mindanao, they have no choice but to fly these experts out from Manila to handle it.
To compound this problem, the lack of reliable dental records across the country is an even bigger hindrance. That is because central to any forensic dentist’s work is a process called “reconciliation.” Specifically, the postmortem state of a person’s mouth and teeth is reconciled with the antemortem data from their dental records.
Without these records, it is very difficult for professionals to make airtight analyses. Guzman calls it “the Waterloo of forensic dental identification.”
You see this in the Thailand case. For context, many of the deceased foreign tourists had accurate dental records in their (mostly developed) home countries, and experts were able to identify many of them with the data.
The same could not be said of the Thai victims. “With locals, the percentage was very low,” Guzman said. Sources said that only 18.1% of Thai victims had any dental charts and only 2% of all Thai victims were identified using dental records. Unsurprisingly, Thai locals accounted for the largest percentage of unidentified cases.
Guzman warned that the situation in the Philippines is not so different, especially in places far from the big cities. This is exacerbated by uneven record keeping in clinics, the lack of accessibility to good dental care, and the proliferation of fake and unlicensed dental “practitioners.”
“Sometimes patients go to their clinics because they are cheap,” he said. “And they definitely do not keep records.” Because of this, Guzman bemoans the fact that, for many of the victims of extrajudicial killings he had to analyze over the years, consistent dental records that forensic scientists can use have been few and far between.
Not this one
Another person who thinks that forensic odontology should play a larger role in human identification is none other than Dr. Maria Corazon A. De Ungria of the UP Diliman Natural Sciences Research Institute’s DNA Analysis Laboratory.
A scientific pillar dedicated to developing DNA analysis as a tool for justice, De Ungria knows the strengths and weaknesses of the technique all too well. That is precisely why, during her stint at UP’s Philippine Genome Center, she took Guzman under her wing and helped him write his paper on the status of local forensic dentistry and how it could complement other subfields.
“A major barrier is that DNA is very expensive,” De Ungria stated, echoing the view earlier mentioned. “It also takes a lot of time. And when you have a mass disaster, we don’t have all our equipment on-site.”
Just how expensive? It depends on what you want analyzed. DNA experts like De Ungria prefer blood, and that would cost you around P60-80,000 for three blood samples. But things are seldom simple. “If it’s bone? We need to get the bone, clean the flesh, dry it, sand it, cut it, and then do several extractions. The likelihood of success is also much lower.” And the price? More than P100,000 each.
“So, as you see, we will not push DNA for everyone,” she asserted. “If there are already certain examinations that will identify (victims), then we can return their bodies to their families without the need for DNA.”
De Ungria mentioned cases where this exact scenario played out. A prominent one was the disappearance of UP students Karen Empeño and Sherlyn Cadapan in 2006. In 2013, she and Fortun were both called to examine a body exhumed in Pangasinan, which was believed to be that of one of the two girls.
“We asked for the antemortem dental records here in UP, but the antemortem teeth records of the two missing students did not match the postmortem odontological examination of the body,” De Ungria said. “So I told Dr. Tatie (Fortun): the parents wanted to pay us to do DNA analysis. But I answered, no, please save the money, because the teeth profiles did not match.”
“In our lab, we refuse to do DNA if there is no chance it will lead to an identification. So when we gave the money back to the mother we said, please use it for something else, or if there’s a new body we can identify, let’s try again. But not this one.”
Shallow graves
With things being so dire, are there any actionable steps to make things better? There are many protocols we could follow but De Ungria suggests the following after, say, a mass disaster: “we keep it simple, we keep things uniform, and, most importantly, we database.”
“This is my idea, I don’t know how crazy this is,” she began. “First stage, we tag the bodies. Even if we haven’t identified them. Let’s tag and number them. And then you get a blood sample. You can put them in newborn screening cards. Those just cost around P50 to P100. Then you include that in their files. So whatever protocol we use, we can have access to them for DNA if needed. No need to dig or to cut off a piece of bone from the body.”
Before you bury the bodies, they can also be subjected to dental examination and fingerprint identification.
“Then you put them in body bags and bury them in shallow graves. Not mass graves, mind you, shallow graves. "Because theoretically, you aren’t burying them there. They might have family and loved ones that might want to bury them based on their own culture or beliefs."
What really needs to happen, both De Ungria and Guzman concur, is that all forensic information should be systematically ordered in a searchable database. “Again, identification is information-based. And that is the challenge we discussed with the likes of the PNP and the Red Cross. We have all this information but we have no database.”
“If the body we found was neither of the UP two students,” De Ungria noted, going back to the previous case, “Then, who is it, and where do we place that information? If we had a database, we could put in all the information from missing people in a place for matching when necessary. I know the Commission on Human Rights was trying to do that, but I don’t know what happened there.”
Is there hope for improvement in all this? With UP’s planned National Forensics Institute, which broke ground on June 18, 2025, there might be. “I see this as UP’s investment in quality forensics education,” De Ungria said. With the blessing of the Philippine government, and the assistance of expert colleagues from Australia, the NFI intends to train local physicians in the cutting edge of four forensic subfields: odontology, pathology, forensic anthropology, and DNA.
The promise is that when it officially comes to life in 2029, the NFI will create the core of experts that will finally move Philippine forensics forward. “We’ve been talking about making changes in our systems,” she asserted. “But these systems will not change without trained professionals to make them. I have been here for over 25 years, and changes only last if you have trained people who understand the value of these changes leading them.”
That same promise is also inspiring Guzman to come home and share his knowledge if possible. “I told my significant other that if I have the chance to come back and I can make a living out of it, I will.” He views his time in New Zealand and everything he learned as part of its forensic society as “extended training” and a chance to give back in due time.
“I used to think about changing careers here to forget about it all. But dentistry always manages to pull me back in to serve. Just like UP always taught us to do. Because like I always say, the living have a right to live, and the dead to be identified.”
Republished courtesy of University of Philippines