• Tooth discolouration may be extrinsic or intrinsicin nature.• Extrinsic stains are superficial & occur after tootheruption.• Intrinsic discolouration may result fromdevelopmental defect of enamel or internal staining ofthe tooth.
Causes of tooth discolourationExtrinsic staining Intrinsic discolouration Green/orange stains Generalized intrinsic staining of teeth Black stains Localized staining of one or several teeth Yellow stains Chronological staining of Brown stains dentition
Extrinsic Staining Agents responsible are deposited in enameldefects or become attached to the enamel withoutbringing out a change in its surfaces. Aetiological agents causing extrinsic stains are : * Beverages / food * Smoking * Poor oral hygiene * Drugs - Iron Supplements - Minocycline - Chlorhexidine
1. Green / orange stain Poor oral hygiene Chromogenic bacteria Usually in cervical & gingival areas of tooth More common in mouth – breathers & young persons Occur more readily on the labial surface of the maxillary anterior teeth
2. Black stains Tobacco Drugs Iron supplements Minocycline chlohexidine
The stain may be seen as a line following thegingival contour or it may be apparent in amore generalized pattern on the clinicalcrown.If it collects in pitted areas, it is difficult toremove.Black staining by iron supplements is caused
3. Yellow stains Caused by beverages / foods Due to bile pigments from gingival crevicular fluid (biliary atresia & jaundice)
4. Brown stains Arrested caries Chromogenic bacteria Discolouration is due to sub-surfacedecalcification with intact surface which has undergone
Intrinsic discolouration Factors causing these conditionsinclude blood-borne pigments, blooddecomposition within the pulp, anddrugs used in procedures such as rootcanal therapy.
a. Generalized intrinsic staining of teeth: i. Yellow brown to dark yellow Due to Amelogenesis Imperfecta Both dentitions affected The term A.I. is applied to inherited defects of the enamel of both primary and permanent teeth
Amelogenesis Imperfecta Hypoplastic A.I.Types Hypomineralized A.I. Hypocalcified A.I. Enamel may be rough, smooth or randomly pitted Enamel is thin & yellow to brown in colour
• Blue brown (Opalescent) Dentinogenesis Imperfecta All teeth are uniformly affected Often associated with osteogenesis imperfecta
Dentinogenesis Imperfecta D.I. is an inherited disorder of dentin Dental manifestations are – * Amber, bluish-brown discolouration or opalescence * Pulpal obliteration * Relatively bulbous crowns * Short, narrow roots
iii. Reddish brown Congenital erythropoietin porphyria The porphyrias are inherited & acquired disorders in which the activities of the enzymes of the haeme biosynthetic pathway are partially or almost completely deficient Discolouration is due to deposition of porphyrin in developing structures All teeth are affected
iv. White Fluorosis / non-fluorotic The mildest form of fluorosis is manifest as hypomineralization of the enamel, leading to opacities. Opacities range from tiny white flecks to confluent opacities throughout the enamel, making the crown totally lacking in translucency Usually only permanent dentition is affected
v. Green - blue Hyperbilirunaemia Seen in children with end stage liver disease and premature infants Common disorders that cause thisintrinsic staining are erythroblastosis fetalis and biliary atresia
Erythroblastosis Fetalis Leads to Rh-incompatibilityCauses anaemia & Jaundice due to red cell destruction Which in turn leads to Hyperbilirunaemia Persistent Jaundice during the neonatal period, also can cause such discolouration
b. Localized staining of one or several teeth i) Pink Internal resorption Seen before exfoliation of primary tooth after trauma (Pink tooth of mummery) Pink colour is seen when vascular resorptive process approaches the surface i.e. the coronal pulp
ii) Grey – black Amalgam staining Leakage of old amalgam restoration causing discolouration around the restoration Mostly occurs in younger patients who have open dentinal tubules Large class II proximal restorations of posterior teeth & deep lingual metallic restorations on anterior incisors significantly stain underlying dentin & produce greyish discolouration
iii) Yellow brown / White Developmental defects Subsurface decalcification Turners hypoplasia in permanent teeth after Enamel defects seen in permanent trauma or infection teeth are caused by periapical inflammatory disease of the overlying deciduous tooth. The altered tooth is called Turners tooth .
iv. Greyish brown Non-vitality Usually after trauma This discolouration is due to severe pulpal damage i.e. pulpal degeneration followed by necrosis (pulpal obliteration calcific metamorphosis)
c. Chronological staining of dentition i) TETRACYCLINESYellow Yellow to Orange to Grey to bright yellow Grey brown blue brownTetracycline Oxytetracycline Chlortetracycline Dimethyl chlortetrahydrochloride cycline unoxidized fluorophore seen erupted teeth, oxidized in newly erupted teeth fluorophore odour also depends on the type of tetracycline
Discolouration is noticed in children who havereceived tetracycline therapy during the period ofcalcification of primary or permanent teeth. Tetracyclines chelate calcium salts & so, areincorporated into bones & teeth during calcification. Tetracyclines administered during pregnancy canbe transferred through the placenta, & causediscolouration.
ii) SYSTEMIC ILLNESS Yellow / brown Vitamin D deficiency Developmental defects of enamel affecting all teeth forming during illness Severe measles
TREATMENT • Extrinsic stains : * Can be removed from the surface of the teeth by polishing with arubber cup & an abrasive material( flour pumice ) * Improving the oral hygiene will minimize the recurrence of the stains
b) Intrinsic stains:* Vital bleaching & laboratory laminate veneers must be considered state-of-the-art treatment for aesthetic dentistry* Bleaching & enamel microabrasion may be used in combination for certain types of discolouration* Direct resin veneers or laboratory laminate veneers are often the treatment of choice, especially in young patients, when bleaching fails to improve aesthetics
References:1. Welbury RR. Paediatric dentistry 2 edn , Oxford university Press, 2001: 204- 52. McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent8th edn, Mosby, 2004 :133-5, 447-83. Neville BW, Damm DD, Allen CM, Buoquot JE. Oral and maxillofacialpathology, 2nd edn Saunders, 2005: 53-4, 59-664. Cameron AC, Widmer RP. Handbook of pediatric dentistry 2nd edn, Mosby,2003: 209-12