This document discusses bilirubin, which is a yellow-orange waste product from the breakdown of hemoglobin. It explains the 5 step process of how bilirubin is made water soluble and excreted from the body, involving formation from heme in macrophages, transport via albumin, uptake by liver cells, conjugation with glucoronic acid, and excretion in bile. It also discusses the diagnostic importance of bilirubin levels, noting that jaundice can be detected over 2.0-2.5 mg/dl and high bilirubin in neonates can cross the blood brain barrier and cause nervous system issues. The document then presents a case study of a 2 year old patient with green

1. Prepared by:
Noor Othman muhammed

2. is an orange-yellow substance, it’s a by-
product of the breakdown of hemoglobin
2noor

3. noor 3
• The breakdown of haeme produces bilirubin (an insoluble
waste product) and other bile pigments. Bilirubin must be
made water soluble to be excreted. This transformation
occurs in 5 steps
• 1. Formation… Macrophages converts heme to Biliverdin
• 2. Plasma transport… via albumin
• 3. Liver uptake… bilirubin (indirect) is taken by hepatocytes
• 4. Conjugation (direct)… to glucoronic acid via UDP-glucoranyle
transferase
• 5. Biliary excretion… in bile to intestine
As full explained in diagram

4. Conjugated bilirubin(direct)
conjugated with glucoronic
acid is water soluble and
found in bile and can be
excreted by kidney.
Unconjugated
bilirubin(indirect): is fat
soluble, found in plasma, and
cant be excreted by kidney.
Total bilirubin: sum of indirect
and direct bilirubin.
4noor

5. Diagnostic
Importance of
Bilirubin
noor 5
1. Clinically hyperbilirubinemia appears as jaundice or
icterus
2. Jaundice can usually be detected when the serum
bilirubin level exceeds 2.0 to 2.5 mg/dl
3. In neonates, unconjugated bilirubin can cross
BBB(blood brain barrier) and thus lead to accumulation in
Brain of neonates. This interfere with nervous system
development and permanent Nervous impairment.

6. noor 6
indirect directindirect

7. noor 7

8. noor 8

9. I am a dentist,
so why I need
to know about
bilirubin?
noor 9

10. neonatal
hyperbilirubinemia
noor 10
• Severe neonatal
hyperbilirubinemia carries a potential
for permanent neurological
impairment, Furthermore,
hyperbilirubinemia is associated with
the development of changes in color
of the teeth, known as green teeth.
These teeth do not show changes in
their morphology. However, the
green coloration considerably affects
the esthetics of the affected tooth

11. A patient of 2 years was brought for consultation by the
mother due to the presence of green teeth in the mouth.
The intraoral examination showed the presence of
anterior primary teeth with a green aspect. All deciduous
teeth were affected. No other changes involving the oral
soft tissues were observed. According to the story told by
the mother, the teeth were erupting in the mouth with a
discoloration and The child presented
with hyperbilirubinemia for about 2 months
noor 11

12. noor 12
Table I. Values of globular volume and levels of bilirubin of
the patient

13. noor 13
High serum bilirubin levels favor the
deposition of the product of hemoglobin
degradation in many tissues, including soft
tissue and mineralized tissues. When
hyperbilirubinemia occurs during dental
development in this patient, the teeth
developed a green color due to the bilirubin
deposition. This intrinsic pigment keeps
teeth permanently pigmented.

14. noor 14

15. PREPARED BY:
NOOR Othman Muhammed
HMU- dentistry
Group-A
April-2020