Abstract
A postmortem case of suicide by hanging is described where pink teeth and pink nails were found during autopsy. One highly putrefied dead body belonging to a middle aged man was found hanging from the branch of a tree amidst a forest. Multiple permanent teeth and bilateral little fingernails displayed pink discolorations. After considering the circumstances of the case and autopsy findings including the ambiguity over pink tissue phenomenon, the cause of death was finally given as ante mortem hanging. The pink teeth phenomenon [PTP] is an infrequent and dubiously explained finding in forensic literature while a single case report exists in relation to pink nails. Although many authors have stressed that post-mortem pink teeth should not be considered as a reliable dental parameter for determining the cause of death, the results of other studies have shown that the pink teeth commonly occur in cases of asphyxia such as strangulation, drowning or suffocation. The finding, although initially related to an intravitam cranial congestion, was subsequently refuted on account of its discovery in non-asphyxial and other modes of deaths. A potential role of postmortem hypostatic congestion in this regard has been proposed especially in drowned corpses due to their frequent floatation in a head down position. A moist and humid environmental milieu along with certain degree of putrefaction has been considered as a prerequisite for the enhancement of the process. The repeated discovery of the finding in autopsy cases has been almost a continuing conundrum for the pathologists. The pink tissue phenomenon mandates a sound and goal oriented investigation in order to clarify its role in ascertaining the cause of death.
Highlights
Permanent or transient pigmentation of the teeth can occur due to extrinsic or intrinsic causes [1]
There are several theories to explain the phenomenon of pink teeth and all of them suggest that the pink color is induced by the presence of hemoglobin inside the pulp chamber, due to the accumulation of blood in the cephalic segment [2, 12]
The coloration has been predominantly found in postmortem cases of asphyxial and other congestive modes of deaths that cause increased cephalic venous pressure leading to rupture of vessels and leakage of blood in the pulp chamber [16, 17]
Summary
Permanent or transient pigmentation of the teeth can occur due to extrinsic or intrinsic causes [1]. The first description of pink teeth phenomenon [PTP] was made by Thomas Bell in 1829 [1]. The path gnomic value of pink teeth has been more than doubtful since it has been described in a variety of unnatural and violent deaths such as asphyxiation, blunt, sharp and gunshot trauma, poisonings and intoxications [2,3,4,5,6,7], as well as with unknown/unsolved cause and manner of deaths [8] and archeological situations [9]. Similar discoloration has been described in a case involving multiple fingernails in a mummified body [10]
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