Topic, classification, Management

2. CASE PRESENTATION
Dr. M.Arsalan Zubair
MDS Trainee (Semester II)
Operative Dentistry Department
Dow Dental College
DUHS

3. PATIENT’S PERSONAL DATA
• Age: 43 years
• Sex: Female
• Address: Nazimabad

4. PRESENTING COMPLAINT
Patient presented with the complaint of dark yellow staining of
her teeth
HISTORY OF PRESENTING
COMPLAINT
Discolored teeth were present since her school age.
With more discussion with patient she revealed that her school
water was not good.

5. MEDICAL HISTORY
Non significant
FAMILY HISTORY
Non significant
DENTAL HISTORY
Extraction Root Canal treatment
6,8
7,8 6

9. CLINICAL EXAMINATION
• Teeth present:
• Teeth Missing:
• Carious Teeth:
7,5,4,3,2,1 1,2,3,4,5 6,7,8
8,7,6,5,4,3,2,1 1,2,3,4,5,6
8,7,6
7,8
5 ,7
INTRA ORAL EXAMINATION

10. SITE AND SIZE CLASSIFICATION
1 2
4 3
5(class 1) 7 (Class 1)

11. Periodontal Examination
Pocket Depths
11 0.5 0.5 0.5 0.5 0.5 0.5
12 0.5 0.5 0.5 0.5 0.5 0.5
13 0.5 0.5 0.5 0.5 0.5 0.5
14 2 0.5 1 2 0.5 1
15 2 0.5 0.5 2 0.5 0.5
17 2 0.5 0.5 2 0.5 0.5
No: F(Mes) Mid Distal P(Mes) Mid Distal
21 0.5 0.5 0.5 0.5 0.5 0.5
22 0.5 0.5 0.5 0.5 0.5 0.5
23 0.5 0.5 3 0.5 0.5 3
24 2 0.5 3 2 0.5 3
25 2 2 2 2 2 2
26 2 0.5 3 2 0.5 3
27 5 3 5 5 3 5
28 3 3 3 3 3 3

12. 31 0.5 0.5 0.5 0.5 0.5 0.5
32 0.5 0.5 0.5 0.5 0.5 0.5
33 0.5 0.5 3 0.5 0.5 3
34 0.5 0.5 0.5 0.5 0.5 0.5
35 1 0.5 3 0.5 0.5 3
36 0.5 0.5 0.5 0.5 0.5 0.5
41 1 0.5 0.5 1 0.5 0.5
42 0.5 0.5 0.5 0.5 0.5 0.5
43 3 0.5 2 3 0.5 2
44 1 0.5 0.5 1 0.5 0.5
45 0.5 0.5 3 0.5 0.5 3
46 1 0.5 1 1 0.5 1
47 3 0.5 3 3 0.5 3
48 3 2 2 3 2 2

13. Examination of Occlusion
• Group Function on left
side
• Group Function on Right
side

14. Plaque and Gingival index
A film of plaque adhering to the free gingival margin and
adjacent area of the tooth, which can not be seen with
the naked eye. But only by using disclosing solution or by
using probe
No plaque
Moderate accumulation of deposits within the gingival
pocket, on the gingival margin and/ or adjacent tooth
surface, which can be seen with the naked eye
Abundance of soft matter within the gingival pocket
and/or on the tooth and gingival margin.
No inflammation
Mild inflammation, slight change in color, slight
edema, no bleeding on probing.
Moderate inflammation, moderate glazing, redness,
bleeding on probing
Severe inflammation, marked redness and
hypertrophy, ulceration, tendency to spontaneous
bleeding
0
1.
3
2
1.
3
2
0

15. • On the basis of above criteria the plaque status was
“2” because plaque was observed with the naked eye
and gingival status was given score 1 because mild
inflammation was seen and also bleeding on probing
was there but not on all teeth it was only observed in
27
• No mobility of tooth was observed

16. • After reviewing the periodontal status it is observed that
there are dark yellow or brownish stains just like circular lines
on the facial surfaces of upper anterior teeth
• Stains are also observed on buccal surfaces of posterior tooth
as well, directed gingivally
• Stains are also observed on the lower anteriors as well
• Stains are more towards the gingival third and interdentally on
the facial surface of both sides.

17. • When the inner surfaces of upper and lower arches are
observed these stains are also present
• Clinically there is no surface loss of the enamel or pitting of
the surface.
• Attrition is seen in posterior teeth
• During further discussion with patient which revealed that
these stains were present since her school life. Her school was
in Punjab and the water was not good
• After brushing many times these stains were not cleaned

18. Investigation

19. DIFFERENTIAL DIAGNOSIS
• Fluorosis
• Amelogenesis Imperfecta
• Molar incisor hypomineralization
• Enamel Hypoplasia
• Early decalcification due to caries

20. Comparison
Enamel Hypoplasia
• Enamel hypoplasia stain
relatively clear, and are
parallel to the ridge line
enamel.
• Enamel hypoplasia can
occur in a single tooth or a
set of teeth
Dental Fluorosis
• Dental fluorosis as a long-
term damage, so the
patches were scattered in a
cloudy pattern, and not in a
well defined pattern
• Dental fluorosis occurs in
most teeth, particularly in
the maxillary anterior teeth
.
J Clin Exp Dent. 2009. Dental fluorosis: Exposure, prevention and
management

21. • Tooth Colour generalized Yellow
• Tooth size Small
• Tooth Shape is also changed
• Enamel leads to attrition which leads
to loss of enamel
• Patient Complain of Sensitivity due
loss of enamel
• high risk of caries
• Dark brown bands on gingival part of crown
• Tooth Size normal
• Tooth Shape normal
• No Such thing can be noticed
• No complain of sensitivity
• Low risk of caries
Comparison B/w Amelogenesis
Imperfecta and Fluorosis (clinical)

22. • Normal enamel thickness
• Normal Size pulp
Chambers
• No Tauro-donts are seen
• Root size normal
• Enamel and dentine
thickness is similar or
decrease enamel
thickness
• Enlarge pulp Chambers
• Taurodonts are also
there
• Roots size short

23. Evidences for ruling out
Amelogenesis Imperfecta and
Enamel hypoplasia and making a
Diagnosis that this condition is
Fluorosis

24. Fluorosis
• What is Fluorosis???
• Is It dangerous???
• What is threshold
dose???
• What are the
causes????

25. Classifying Fluorosis A/c to index
• Chronological Fluorosis Assessment Index
Ref:School of Dental Science, University of Melbourne, Victoria, Australia. Journal of
Dental Research 2003

26. •Cervical and little bit middle area is
involved
•So cervical is given score: 2
•Middle: 1

27. Dean’s flurosis

28. • In my case according to dean’s fluorosis index
the score is 3(moderate) because generalize
discolouration is there
• No pitting is there
• sign of attrition are there on posterior teeth

29. TREATMENT PLAN (initial)
• Oral hygiene instructions
• Diet modification
• Scaling was done
• Restoration of Class 1 cavities which is done with
amalgam

31. Final treatment plan was done
according to Score
Conservative measures:
• microabrasion
• vital bleaching,
Destructive measures:
• porcelain veneers

32. Severity Conservative Measures Destructive Measures
Mild Fluorosis
Score : 1,2
Vital bleaching+
Microabrasion
Separate areas can be
treated by localized
composite restorations
Moderate Fluorosis
Score: 3
Microabrasion Composite veneer
Severe Fluorosis
Score: 4
Composite veneers only
for adult but not in paeds
why????
Fix prosthesis is also
considered when there is
severe enamel loss

33. • In my case score is 3 that is moderate fluorosis
is present so we have both approaches ie
Micro-abrasion and Porcelain veneers
• Vital bleaching

34. THANK YOU