Enamel incremental lines as recorders for disease in infancy and their relation to the diagnosis of SIDS

The sudden infant death syndrome (SIDS) is a major diagnosis of post-neonatal mortality in the industrialised countries. The cause of death is, however, still elusive. The development of complementary diagnostic methods widening the possibility to analyse the postmortem findings is therefore important. The aim of this study was to histologically examine the enamel of teeth from children dying suddenly and unexpectedly in order to disclose if the presence of enamel disturbances corresponded to neo- or postnatal disorders. During enamel formation ameloblasts are susceptible to local and systemic disturbances which may be reflected in the fully formed enamel as hypoplasia, hypocalcification or accentuated incremental lints. Nineteen consecutive cases of deaths in infants between 1-19 months of age were investigated at the Department of Forensic Pathology, Stockholm, Sweden. The analyses of anamnestic and postmortem data and the analyses of incremental lines were done independently without knowledge of the conclusion of the other part. The results show a good agreement between enamel changes on one hand and the antemortem history and the autopsy findings on the other. This type of investigation may be a valuable complement to the ordinary postmortem investigations of a child who has suddenly and unexpectedly died.