Mapping the Importance of Pink Teeth in Forensic Medicine for Determining Cause of Death: Protocol of a Scoping Review

Abstract

Postmortem pink teeth have been described in forensic casework for more than a century and are frequently reported in association with deaths involving drowning, asphyxiation, trauma, or electrocution. Despite recurrent mention in forensic literature, the underlying mechanisms, prevalence, and diagnostic value of this phenomenon remain unclear and inconsistently interpreted. The aim of this scoping review is to map the existing evidence on postmortem pink teeth and to explore their potential relevance in determining the cause of death in forensic medicine. Specifically, this review seeks to identify how the phenomenon has been reported, which pathophysiological mechanisms have been proposed, and which contextual or en-vironmental factors may influence its occurrence. Particular attention will be given to the challenges of differentiating postmortem pink teeth from antemortem dental discolora-tions, such as those resulting from trauma or congenital conditions. This protocol was developed in accordance with the Joanna Briggs Institute (JBI) meth-odology for scoping reviews and the PRISMA-ScR guidelines. A comprehensive search strategy was predefined and applied across multiple databases. The study selection pro-cess was conducted at the protocol stage, and the results of identification, screening, and eligibility assessment are documented using a PRISMA-ScR flow diagram. A total of twelve studies met the predefined inclusion criteria and were identified as eligible for in-clusion in the final scoping review. Data extraction and synthesis will be performed following protocol publication, using a standardized JBI-based data extraction tool. The extracted data will be presented in narrative and tabular formats, enabling a structured mapping of the current evidence base, identification of knowledge gaps, and clarification of the potential forensic significance of postmortem pink teeth.