The “pink tooth” phenomenon describes a pink discoloration of dentin visible through the enamel. It can occur both in living patients and postmortem.
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✅ Introduction
Dental discolorations are a frequent reason for consultation. Among them, a pink hue in a tooth crown is of particular interest due to its varied etiology. For years, the pink tooth was thought to be exclusive to drowning or asphyxia victims. However, the literature shows that it may also occur in clinical ante mortem cases, associated with pathological or iatrogenic factors. This article aims to provide an updated and precise overview of this phenomenon.
✅ Etiology
➤ Ante mortem / Clinical
° Internal resorption: the most classic cause in living patients; inflamed and vascularized tissue behind the enamel gives rise to a pink shade.
° Dental trauma: intrapulpal hemorrhages diffuse blood pigments into dentin, creating a transient pink discoloration.
° Early pulp necrosis: tissue breakdown releases byproducts that stain dentin.
° Endodontic materials: some sealers and cements may cause pink or reddish staining in the crown.
➤ Post mortem / Forensic
° Caused by hemolysis and hemoglobin diffusion into dentinal tubules.
° Commonly observed in drowning, asphyxia, and cranial trauma, although not exclusive to these causes.
° Environmental factors such as temperature, humidity, and postmortem interval influence the intensity of discoloration.
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° Medical and dental history: trauma, pulp vitality, prior treatments.
° Vitality tests (cold, heat, electric pulp test).
° Periapical radiography or CBCT to assess resorption extent.
° Differentiate from discolorations caused by systemic conditions, medications, or restorative materials.
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° Initial internal resorption: root canal treatment with disinfection and obturation.
° Intracanal medications: calcium hydroxide between appointments.
° Prosthetic restorations or crowns in cases of structural loss.
° Extraction: last resort when the tooth is unrestorable or has extensive perforations.
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° The pink tooth may suggest drowning or asphyxia but is neither exclusive nor pathognomonic.
° Its probative value is limited and must be interpreted alongside other evidence.
° Intensity and localization of discoloration vary depending on anatomical and environmental factors.
📊 Comparative Table: Pink Tooth — Clinical vs. Forensic Causes
| Aspect | Clinical Causes | Forensic Causes |
|---|---|---|
| Etiology | Internal resorption, pulp necrosis, dental trauma, endodontic sealers with pigments. | Drowning, mechanical asphyxia, severe cranial trauma, postmortem hematic diffusion. |
| Characteristics | Pink coloration visible in the pulp chamber or crown; may progress to reddish hues. | Intense pink coloration in the crown, usually homogeneous and associated with postmortem findings. |
| Relevance | Important for differential diagnosis in clinical dentistry to avoid confusion with forensic cases. | Auxiliary indicator in forensic investigations of criminal or accidental death. |
| Limitations | May be confused with staining caused by endodontic materials or chronic pulp lesions. | Not exclusive to asphyxia; must be correlated with other forensic findings. |
💬 Discussion
The belief that the pink tooth is exclusive to drowning or asphyxia victims has been disproven. In living patients, it may result from internal resorption, trauma, pulp necrosis, or endodontic materials. Postmortem, it is more frequent in asphyxia or drowning, but may also occur under other conditions. Clinically, early diagnosis is essential for tooth preservation, while in forensic dentistry it should be interpreted as a nonspecific finding requiring correlation with other data.
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° The “pink tooth” is not exclusive to drowning or asphyxia.
° It may occur in both living patients (trauma, necrosis, resorption, materials) and postmortem (hemolysis).
° Early diagnosis improves clinical prognosis and prevents tooth loss.
° In forensic dentistry, it has indicative but not conclusive value for determining cause of death.
📚 References
✔ Carney, K. A., Colloc, T. N. E., & Kilgariff, J. K. (2024). Management of rarely seen internal tunnelling root resorption associated with a maxillary permanent incisor. British Dental Journal, 236(7504), 955–961. https://doi.org/10.1038/s41415-024-7504-7
✔ Nilsson, E., et al. (2013). Management of Internal Root Resorption on Permanent Teeth. Journal of Endodontics, 39(12), 1521–1527. https://doi.org/10.1016/j.joen.2013.08.020
✔ Minegishi, S., et al. (2022). Association of Cadaveric Factors with the Degree and Region of Discoloration in the Phenomenon of Pink Teeth. Applied Sciences, 12(9), 4242. https://doi.org/10.3390/app12094242
✔ Sumi, N., et al. (2023). Study on the Mechanism of the Pink Tooth Phenomenon. Diagnostics, 13(16), 2699. https://doi.org/10.3390/diagnostics13162699
✔ Regalado-Barrera, J. D., Hernández-Salas, C., Murillo-López, E., Reyes-Moreno, D. C., Cano-Sánchez, D., & Rosales-González, H. (2023). Etiology of the pink tooth: a curious postmortem phenomenon. Contexto Odontológico, 13(25), 23-28. https://revistas.uaz.edu.mx/index.php/contextoodontologico/article/view/2568
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