Journal de recherche médico-légale

Pink Teeth Phenomenon and Asphyxia: A Reassessment and Update

Abstract

Pawan Mittal*, Prateek Karagwal, and Deepa Gupta

The history of pink teeth phenomenon [PTP] dates back to 1829 when it was first described by Bell. Thereafter a number of publications were made on this topic. Initial observations on pink teeth tend to correlate it with asphyxial deaths, especially drowning and strangulation. However with the passage of time, the phenomenon was also observed in non asphyxial and unknown causes of death. On account of nonspecific nature and unclear mechanisms, the finding, however, gradually lost it medico-legal acumen. The basic process behind post-mortem pink teeth is congestion/ hyperemia of pulp capillaries followed by hemolysis causing hemoglobin release where after its subsequent diffusion into dentinal tubules stains them pink. The process, as stated, requires humid and moist surroundings along with a prolonged postmortem interval, so the majorities of the
cases belong to putrefied and drowned corpses that frequently depict adipocere formation too. One reason behind this is the head down position of submerged cases which predisposes them to a strong cranial congestion especially in the areas of declivous lividity. A minimum time of one week has been suggested for the first appearance of pink coloration. After a thorough review of literature, including the recent ones and from our own observations, the association of pink teeth in certain asphyxial deaths, particularly fatal neck pressures like strangulation and hangings, appears to be reemerging. Furthermore the cases depicted in the text have substantiated the truth of Clark and Law (4) that an invariable allocation of the hypostatic congestion to the pink teeth formation is not justified, although due to scarcity of enough case material and literature, a definite opinion
cannot be put straightforward.