{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:52:37Z","timestamp":1793134357576,"version":"4.5.0"},"reference-count":39,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: The phenomenon of pink teeth represents a notable observation in forensic science, although its interpretation remains complex and not directly attributable to a specific cause of death. Methods: This systematic review provides an updated and comprehensive overview of the morphological and histological mechanisms associated with this finding, with a focus on hemoglobin diffusion and pigment accumulation during putrefaction rather than on detailed biochemical pathways. Results: Environmental conditions, especially high humidity and moderate temperatures, are identified as key facilitators. The synthesis of the available evidence, including case reports, observational series, and experimental studies, confirms that pink discoloration is primarily linked to postmortem hemoglobin diffusion following erythrocyte breakdown and release of heme groups into dentinal structures. This process occurs more frequently under conditions that preserve hemoglobin and facilitate its migration into dental tissues. Importantly, pink teeth have been documented across a wide spectrum of postmortem scenarios, such as hanging, drowning, carbon monoxide poisoning, and prolonged exposure to humid environments, indicating that their presence is neither pathognomonic nor exclusively associated with a specific cause of death. Assessment methods include semi-quantitative visual scoring systems (e.g., SPTC and SPTR), spectrophotometric assays, and histochemical analyses for hemoglobin derivatives. Recent advances in digital forensics, particularly micro-computed tomography and artificial intelligence\u2013based segmentation, may further support the objective evaluation of chromatic dental changes. Conclusions: This review underscores the need for standardized approaches to the identification, classification, and analysis, both qualitative and quantitative, of pink teeth in medico-legal practice. Although not diagnostic in isolation, their systematic study enhances our understanding of decomposition processes and contributes supplementary interpretive data in forensic investigations.<\/jats:p>","DOI":"10.3390\/diagnostics15162092","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T13:18:14Z","timestamp":1755695894000},"page":"2092","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Systematic Review About Postmortem Pink Teeth: Forensic Classification, Diagnostic Value, and Analysis Methods"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2481-6050","authenticated-orcid":false,"given":"Isabella","family":"Aquila","sequence":"first","affiliation":[{"name":"Institute of Legal Medicine, Department of Medical and Surgical Sciences, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Gualtieri","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, Department of Medical and Surgical Sciences, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Princi","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, Department of Medical and Surgical Sciences, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo Antonio","family":"Sacco","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, Department of Medical and Surgical Sciences, University \u201cMagna Graecia\u201d of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"168","DOI":"10.4103\/0975-1475.156200","article-title":"Histological appearance of postmortem pink teeth: Report of two cases","volume":"7","author":"Gowda","year":"2015","journal-title":"J. Forensic Dent. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/BF01225410","article-title":"Medico-legal aspects of postmortem pink teeth","volume":"106","author":"Borrman","year":"1994","journal-title":"Int. J. Leg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Sumi, N., Minegishi, S., Ohta, J., Utsuno, H., and Sakurada, K. (2023). Study on the Mechanism of the Pink Tooth Phenomenon Using Bovine Teeth: A Pilot Study. Diagnostics, 13.","DOI":"10.3390\/diagnostics13162699"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.1111\/j.1834-7819.2007.tb00519.x","article-title":"Management of tooth resorption","volume":"52","author":"Heithersay","year":"2007","journal-title":"Aust. Dent. J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Braga, S., Caldas, I.M., and Dinis-Oliveira, R.J. (2025). Forensic significance of postmortem pink teeth: A narrative review. Arch. Oral Biol., 169.","DOI":"10.1016\/j.archoralbio.2024.106092"},{"key":"ref_6","first-page":"27","article-title":"Clinical, radiologic, and histopathologic features of invasive cervical resorption","volume":"30","author":"Heithersay","year":"1999","journal-title":"Quintessence Int."},{"key":"ref_7","first-page":"E337","article-title":"The post-mortem pink teeth phenomenon: A case report","volume":"14","author":"Soriano","year":"2009","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/j.1747-4477.2008.00139.x","article-title":"Regeneration of dentine\/pulp-like tissue using a dental pulp stem cell\/poly(lactic-co-glycolic) acid scaffold construct in New Zealand white rabbits","volume":"34","author":"Massoud","year":"2008","journal-title":"Aust. Endod. J."},{"key":"ref_9","first-page":"17","article-title":"Observations on dental prostheses and restorations subjected to high temperatures: Experimental studies to aid identification processes","volume":"20","author":"Merlati","year":"2002","journal-title":"J. Forensic Odonto-Stomatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"53","DOI":"10.32553\/ijmsdr.v6i1.903","article-title":"Pink Tooth in Forensic Dentistry\u2014A Short Review: Pink tooth","volume":"6","author":"Shamsudeen","year":"2022","journal-title":"Int. J. Med. Sci. Diagn. Res."},{"key":"ref_11","first-page":"124","article-title":"The Post-Mortem Pink Teeth Phenomenon","volume":"6","author":"Stavrianos","year":"2011","journal-title":"Res. J. Biol. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101869","DOI":"10.1016\/j.jflm.2019.101869","article-title":"Case-specific characteristics of pink teeth in dental autopsies\u2014A systematic review","volume":"68","author":"Franco","year":"2019","journal-title":"J. Forensic Leg. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/j.1600-0714.1988.tb01336.x","article-title":"Postmortem pink teeth: In vitro production","volume":"17","year":"1988","journal-title":"J. Oral Pathol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1111\/1556-4029.15005","article-title":"Sixty-eight cases of postmortem pink teeth observed in dental autopsies of unidentified cadavers","volume":"67","author":"Minegishi","year":"2022","journal-title":"J. Forensic Sci."},{"key":"ref_15","first-page":"E47419","article-title":"From Color to Clue, Unraveling the Forensic Significance of Pink Teeth in Postmortem Analysis","volume":"15","author":"Meilana","year":"2025","journal-title":"Int. J. Med. Toxicol. Forensic Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"138","DOI":"10.5958\/0974-083X.2024.00058.0","article-title":"Humid Environment Pink Tooth Phenomenon in Deceased Bodies: A Case Report","volume":"24","author":"Pasaribu","year":"2024","journal-title":"J. Punjab Acad. Forensic Med. Toxicol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1520\/JFS10375J","article-title":"Postmortem pink teeth","volume":"22","author":"Kirkham","year":"1977","journal-title":"J. Forensic Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ataseven, T., Cetin, S., Simsek, U., Eren, B., and Koseo\u011flu, R.D. (2025). Evaluation of postmortem histopathological changes in dental pulp of rats after drowning in water. Forensic Sci. Med. Pathol., Epub ahead of print.","DOI":"10.1007\/s12024-025-01033-4"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102284","DOI":"10.1016\/j.legalmed.2023.102284","article-title":"Effects on oral tissues of asphyxiation caused by cervical compression: The pink teeth phenomenon in Kato\u2019s studies (1941)","volume":"64","author":"Sakurada","year":"2023","journal-title":"Leg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/oa.1390050404","article-title":"The Occurrence and Implications of Post-Mortem \u2018Pink Teeth\u2019 in Forensic and Archaeological Cases","volume":"5","author":"Dye","year":"1995","journal-title":"Int. J. Osteoarchaeol."},{"key":"ref_21","first-page":"29","article-title":"Postmortem pink teeth phenomenon: An experimental study and a survey of the literature","volume":"86","author":"Sainio","year":"1990","journal-title":"Proc. Finn. Dent. Soc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/01.paf.0000233544.58567.81","article-title":"Pink teeth in a series of bodies recovered from a single shipwreck","volume":"27","author":"Campobasso","year":"2006","journal-title":"Am. J. Forensic Med. Pathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00000433-198708020-00008","article-title":"Postmortem red coloration of teeth. A retrospective investigation of 26 cases","volume":"8","author":"Simonsen","year":"1987","journal-title":"Am. J. Forensic Med. Pathol."},{"key":"ref_24","first-page":"34","article-title":"Revisiting autopsies of death by mechanical asphyxia in the search for post-mortem pink teeth","volume":"38","author":"Brites","year":"2020","journal-title":"J. Forensic Odonto-Stomatol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Minegishi, S., Saitoh, H., Utsuno, H., Ohta, J., Namiki, S., Toya, M., Sumi, N., and Sakurada, K. (2022). Association of Cadaveric Factors with the Degree and Region of Discoloration on Pink Teeth: An Approach to Serial Cases. Appl. Sci., 12.","DOI":"10.3390\/app12094242"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Rai, B., and Kaur, J. (2013). Pink Teeth: An Important Aspect for Forensic Science. Evidence-Based Forensic Dentistry, Springer.","DOI":"10.1007\/978-3-642-28994-1"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1016\/j.forsciint.2018.08.011","article-title":"Forensic thanatology and the pink tooth phenomenon: From the lack of relation with the cause of death to a potential evidence of cadaveric decomposition in dental autopsies\u2014Case series","volume":"291","author":"Franco","year":"2018","journal-title":"Forensic Sci. Int."},{"key":"ref_28","first-page":"291","article-title":"Clinical Chronicles: A Case Report on Pink Tooth of Mummery","volume":"19","author":"Kriplani","year":"2024","journal-title":"Iran. Endod. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"650","DOI":"10.3390\/forensicsci2040048","article-title":"The Pink Teeth Phenomenon in Dogs and a Cat","volume":"2","author":"Stern","year":"2022","journal-title":"Forensic Sci."},{"key":"ref_30","unstructured":"Faculty of Forensic & Legal Medicine (FFLM) (2025, June 04). Recommendations for the Collection of Forensic Samples from Complainants and Suspects\u2014January 2025. Available online: https:\/\/fflm.ac.uk\/wp-content\/uploads\/2025\/07\/Rec-Collection-Samples-FSSC-July-2025.pdf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.semcdb.2013.12.013","article-title":"Evolution and developmental diversity of tooth regeneration","volume":"25\u201326","author":"Tucker","year":"2014","journal-title":"Semin. Cell Dev. Biol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tsokos, M. (2005). Postmortem Changes and Artifacts Occurring During the Early Postmortem Interval. Forensic Pathology Reviews, Humana Press.","DOI":"10.1016\/B0-12-369399-3\/00091-4"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Shkrum, M.J., and Ramsay, D.A. (2006). Forensic Pathology of Trauma. Forensic Medicine, Humana Press.","DOI":"10.1007\/978-1-59745-138-3"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lewis, M.E. (2006). The Bioarchaeology of Children: Perspectives from Biological and Forensic Anthropology, Cambridge University Press.","DOI":"10.1017\/CBO9780511542473"},{"key":"ref_35","first-page":"723","article-title":"An introduction to forensic dentistry","volume":"25","author":"Whittaker","year":"1994","journal-title":"Quintessence Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/clr.14238","article-title":"The use of digital technologies in peri-implant soft tissue augmentation\u2014A narrative review on planning, measurements, monitoring and aesthetics","volume":"35","author":"Strauss","year":"2024","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/joor.12483","article-title":"Computer-assisted technologies used in oral rehabilitation and the clinical documentation of alleged advantages\u2014A systematic review","volume":"44","author":"Jokstad","year":"2017","journal-title":"J. Oral Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Thurzo, A., Jan\u010dovi\u010dov\u00e1, V., Hain, M., Thurzo, M., Nov\u00e1k, B., Kosn\u00e1\u010dov\u00e1, H., Lehotsk\u00e1, V., Varga, I., Kov\u00e1\u010d, P., and Moravansk\u00fd, N. (2022). Human Remains Identification Using Micro-CT, Chemometric and AI Methods in Forensic Experimental Reconstruction of Dental Patterns after Concentrated Sulphuric Acid Significant Impact. Molecules, 27.","DOI":"10.20944\/preprints202201.0049.v2"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Thurzo, A., and Thurzo, V. (2025). Embedding Fear in Medical AI: A Risk-Averse Framework for Safety and Ethics. AI, 6.","DOI":"10.3390\/ai6050101"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2092\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:31:46Z","timestamp":1760034706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/16\/2092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":39,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["diagnostics15162092"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15162092","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]}}}