Professional paper

Dental Discoloration and Erosion Resulting from Addiction to Compound Analgesics

Vedrana Petrovečki ; Department of Forensic Medicine and Criminology, School of Medicine, University of Zagreb, Croatia
Mirela Čarapina ; Zabok General Hospital, Department of Pathology and Cytology, Zabok, Croatia
Davor Strinović ; Department of Forensic Medicine and Criminology, School of Medicine, University of Zagreb, Croatia
Zdravko Kovačić ; Department of Forensic Medicine and Criminology, School of Medicine, University of Zagreb, Croatia
Marina Nestić ; Department of Forensic Medicine and Criminology, School of Medicine, University of Zagreb, Croatia
Davor Mayer ; Department of Forensic Medicine and Criminology, School of Medicine, University of Zagreb, Croatia
Hrvoje Brkić ; Chair of Forensic Dentistry, Department of Dental Anthropology, School of Dental Medicine, University of Zagreb, Croatia

Abstract

Dental erosion is currently the most common non-carious change on the tooth resulting from longterm effects of acidic chemical (pH<7) factors on the tooth surface without the intervention of bacteria. These factors can be divided into intrinsic and extrinsic factors (1-3). The intrinsic chemical factors include acidic gastric contents reaching the oral cavity as a result of vomiting, whereas the extrinsic factors are any acidic substances taken into the mouth, primarily some types of foods and beverages and some medicines. The aim of this report was to show potential effects of a compound drug with analgesic properties (active ingredients - paracetamol, propyphenazone, codeine phosphate and caffeine) on changes occurring in the teeth. This paper describes very specific erosions on the labial portions of the teeth and the occurrence of purple-bluish tooth color found at autopsy of a 35-year-old severely malnourished man who died at admission to hospital treatment. Hetero-anamnestic information about a long-term dependence on a compound analgesic was provided. In addition to tooth changes, the autopsy showed erosions of the gastric mucosa, chronic ulcer in the duodenal region, chronic liver inflammation, and bone marrow hypoplasia. The cause of death was bilateral purulent inflammation of the lungs with an extensive gangrenous focus in the left lobe. Chemical toxicology analysis revealed the presence of all pharmacologically active ingredients in urine, bile fluid, liver and kidney tissues, gastric contents and teeth extracts. Long-term dependence on the compound analgesic as a probable mechanism for the development of tooth and other organ changes has been discussed. The paper stresses the importance of the tooth that in our example proves to be an adequate organ for toxicology analysis by gas chromatography, and the importance of interdisciplinary collaboration in solving forensic cases. Additionally, isolation of analgesic from the tooth is suggested to be a helpful diagnostic method in cases of suspected abuse of medicinal drugs.

Keywords

Tooth Erosion; Vomiting; Analgestics, Forensic Toxicology; Forensic Dentistry

Hrčak ID:

76025

URI

https://hrcak.srce.hr/76025

Publication date:

20.12.2011.

Article data in other languages: croatian

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