JMIR Publications

ABSTRACT

Background:

Postmortem pink teeth are an uncommon finding produced by color changes within dental tissues. They have been reported in several death contexts, including drowning, but neither their presence nor their intensity is specific for a cause of death. Inconsistent photographic, radiological, and histological methods have limited comparison across studies.

Objective:

This study aims to describe a reproducible multimodal workflow for postmortem pink teeth and to estimate the feasibility, measurement reliability, and exploratory associations of prespecified photographic scores, cone beam computed tomography structural measurements, and histological distribution scores.

Methods:

This is a retrospective laboratory case series using existing specimens and records from Indonesian forensic practice. Candidate teeth will undergo an eligibility audit for ethics coverage, provenance, and technical completeness. Photography will be scored with the 3-level Score of Pink Teeth Color and Score of Pink Teeth Region scales. Cone beam computed tomography will quantify dentin thickness and pulp-to-tooth area ratio after long-axis reorientation; gray values will not be interpreted as tissue density. Hematoxylin-eosin sections will be scored by the farthest dentinal zone containing recognizable erythrocytes or blood-compatible pigmented material, without claiming chemical identification of hemoglobin. Two blinded raters will evaluate each modality. Analyses will emphasize descriptive estimates, weighted kappa, intraclass correlation coefficients, and exploratory Spearman correlations with bootstrap 95% confidence intervals. Multiple teeth from one decedent will be handled by decedent-level clustering when linkage is available. No diagnostic accuracy or cause-of-death prediction analysis is planned.

Results:

As of July 19, 2026, the working catalog contains 25 candidate teeth with photographic and cone beam computed tomography records; histological review and integrated analysis are incomplete. Because the cited ethics approval covers 20 specimens, at least 5 candidates will be excluded. Any additional candidate without individual written coverage, provenance, or custody documentation will also be excluded; therefore, the final analytic cohort will contain no more than 20 teeth. Cohort membership will be determined from ethics and provenance records without reference to modality results. Eligibility adjudication and protocol-locked remeasurement are planned for 2026, followed by dissemination of the results after the final dataset is frozen.

Conclusions:

The protocol prioritizes traceable acquisition, conservative biological interpretation, and reliability over diagnostic claims. It is intended to standardize documentation of a rare forensic finding and to identify methods suitable for subsequent prospective validation.