Download Sheet #10 Teeth discoloration

 Sheet #10 Teeth discoloration
* Causes of teeth discoloration :
1- Food & beverages
2- Endo treatment materials
3- Drugs & Smoking
*Teeth discoloration divide to : A- Extnsic B- Intrensic
* Extrensic teeth discoloration ( outside surfaces ) : • Causes : 1- Dental plaque and
calculus 2- Food and beverages 3- Tobacco 4- Tromogenic material 5- Metallic
compounds 6- Topical material
" Note : medication can lead to either extrinsic or intrinsic discoloration " *
Explaination :
1- Dental plaque and calculus due to poor oral hygiene which is the most common
cause of staining . Accumulation of dental plaque can cause yellow , brown even
black discolored teeth . This stain starts at the site of accumulation = cervical region
and can extent . Degree of color depend on oral hygiene .
2- Food and beverages : as coffee , tea .. Deposition of Tannis found in these drinks
lead to internal and external discoloration . In east Asia some women die their teeth
with Betel nut juice to match their hair and eye color !!
3- Tobacco : discoloration by tobacco is difficult to be removed ,, it's yellowish ,
brownish even black in color ,, it starts cervically then extent all over the tooth .
4- Tromogenic bacteria : Most types of bacteria which is part of our oral flora doesn't
harm our teeth except by staining ... this stain look like a line ( surveying line ) around
the cervical area You can remove these lines by bolishing but they reform - because
the bacteria part of oral flora - The most common type of this bacteria is black
staining bacteria ( actenomyces ). Sometimes it's green stain attributed to fluorescent
bacteria and fungi as penicillium and aspergillus (rare ).
5- Metallic compound : interaction of hard metal with dental plaque stain teeth
surface . E.g : - iron , manganese and silver >> brown plaque stain - mercury , lead ,
copper and nickel >> blue-green - iodine solution >> brown
6- Topical medication : E.g : A- iodine solution B- chlorhexidine (most common
mouth wash) , pts shouldn't use it regularly because : - stain teeth and restoration - kill
part of good oral flora bacteria •Any type of mouth wash we can use it for 5 days or
up to one week maximum . C- iron containing oral solution ( for anemic pt ) : black
stain D- mouth washing containing potassium permanganate lead to violet-black stain
E- silver nitrate and oral fluoride (brown stain)
* Intrensic discoloration -Deeper internal stain in enamel and dentin - More
complicated to treat - By taking the history from the pt we can know the type of stain
• Causes of internal stain : 1- Dental material ( amalgam ) :
A- After removing of amalgam restoration you notice that part of tooth structure has
discolored " bluish " because erosion of amalgam enter the dentinal tubules and stain
them .
B- old composite
C- pins by corrosion
D- sealer
E- formocresol (pulp killer) F- eugenol
2- Dental caries : caries discolor dentin -With age our teeth become darker because
enamel become thinner , more transparent , more permeable and dentine become more
visible . " the color of the tooth become from dentin " -caries lesion -incipient caries :
lead to chalky white area (decalcification) -extensive caries : all of the tooth become
stained
3- Truma ( turner tooth ): Truma to primary tooth within underlying permenant tooth
still under development lead to enamel hypoplasia >> end up by discolored permenant
tooth . Enamel Hypoplasia : problem in the formation of dentin and enamel of
permenant teeth due to truma of primary tooth so the permenant one appear with
chalky pits (mild truma) or pitted cavity (sever truma) . The most common affected
teeth by truma : incisors . 4- Infection : infection affect priary tooth lead to
pulpitis>>abccess formation>>affect permenant tooth formation . - intra pulpal
hemorrahage produce bluish black discolored tooth ; treatment by internal bleaching
using hydrogen peroxide.- * infection :
A- periapical infection of primary teeth can disrupt of underlying successors resulting
in localized enamel hypoplasia (affect permenant teeth ).
B- Maternal rubella or CMV infection and toxemia ( affect primary teeth ) . * Note : •
Any infection during pregnancy affect primary teeth and any infection within the first
3 years of children life affect the permenant teeth . • if one tooth is discolored : local
cause if more than one : systemic discolored
- systemic postnatal infection : high fever , measles , streptococcal infection can cause
enamel hypoplasia . - upper and lower incisors erupt at the same time so if it is
systemic cause of staining both of them should be discolored . - the same tooth may
affect by both internal and external causes of discoloration .
5- Medication : Tetracyclin affects bone and teeth ( both of them compose of
hydroxyapatite ) .. tetracyclin produce yellow-orange up to dark blue-gray
discoloration .
- severity of staining depend on : Dose , Age , Duration . - Tetracycline doesn't lead to
discoloration once the tooth formation is completed , however studies showed that
permenant teeth in adults can experience a gray discoloration if they are exposed to
minocycline
- the teeth when they erupted after exposure to they appear with bright yellow band
but once they expose to fluorescent and UV light the color gradually change to bluegray or red-brown . -Dental fluorosis starts with chalky white , normal smooth tooth
structure appearance then in sever cases appear as v. dark brown with cavities ( also
calcified as enamel hypoplasia ). - when you deal with a pt has dental fluorosis , the
first Q you should ask is : where did you live ? - fluorosis could affect primary and
permenant teeth - to differentiate between fluorosis and incipient caries ? ,, in
fluorosis most of the teeth and most parts of a single tooth are discolored . - Sources
of fluoride :
A- over ingestion of highly fluoridated water
B- highly fluoridated tooth p
C- Some wash and vitamin
• U can know when the discoloration began when u look at the teeth
6- Genetic defect :
a-Amelogenesis imperfecta : abnormal formation of enamel or external layer of the
crown of the tooth
b-Dentinogenesis imperfecta (DI) is a genetic disorder of tooth development. This
condition is a type of dentin dysplasia that causes teeth to be discolored (most often a
blue-gray or yellow-brown color) and translucent giving teeth an opalescent sheen.
Teeth are also weaker than normal, making them prone to rapid wear, breakage, and
loss ... and it has three types : -type one : Type of dentinogenesis imperfecta with
similar dental formalities usually an autosomal dominant trait with variable
expressivity but can be recessive if the associated osteogenesis imperfecta is of
recessive type -type tow : Occurs in people without other inherited disorders (i.e.
Osteogenesis imperfecta). It is an autosomal dominant trait. A few families with type
II have progressive hearing loss in addition to dental abnormalities. Also called
hereditary opalescent dentin -type three : Type is rare; its predominant characteristic
is bell-shaped crowns, especially in the permanent dentition. Unlike Types I and II, it
involves teeth with shell-like appearance and multiple pulp exp
* Note : You should take a history from the pt and ask him few question as : which
teeth where discolored primary or permenant ? is there another member with this
symptom ? in order to determine if it inviromental or genetic cause ,,, e.g : if both
primary and permenant teeth were discolored you will think of something genetic !!
osures c-Dentinal dysplasia (heek sme3tha :/)
** Treatment : ( depend on the cause ) :
1- Microabrasion : s a quick and painless solution for removing white, yellow and
brown spots, stains, and discolorations on your teeth. This dental stain removal
procedure uses hydrochloric acid and pumice to take off very thin layers of tooth
enamel to remove teeth stains. It is a safe procedure that won’t harm your teeth
because it removes only micro layers.. it is a conservative procedure because it
remove stain that doesn't extent more than tenth of millimeter of tooth structure .
granule of pumice : physical abrasion HCL : chemical abrasion We use it only for
external mild discoloration Teeth may develop sensitivity but it is selflimited by
saliva and remineralization * Microabrasion : pumic > HCL > bolishing > putting
fluoride (to remove roughness and prevent demineralization)
2- Macroabrasion : by using finishing burs ,, less conservative
3- Veneer ( facing )
4- Crown in sever cases ,, the least conservative
5- Bleaching : divide into : a- vital / external bleaching : which divide : - in office :
better control ,, more rapid result - at home : (less conc.) b- non vital / internal :
closing canals after RCT by glass inomer then do what u want on chamber
• when we do bleaching we have to protect the soft tissue . • 1% of internal bleaching
lead to cervical resorption •bleaching and microabrasion at the same level of being
conservative .
There are some info. from google . Have Fun ! Fatima Khalil
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