"Investigations of tooth discoloration"

1. "Investigations of
tooth discoloration"

2. Tooth discolouration :
Defined as any change in the hue, colour, or translucency of a
tooth due to any cause.

3. Laboratory Studies:

4. Laboratory Studies:
A comprehensive head, neck, and oral examination is required. Neck lymphadenopathy may be indicative of
infection, an asymmetric mandible may be a sign of previous trauma, and ecchymoses may be suggestive of a
bleeding disorder.
• renal ultrasound scan: patient with amelogenesis imperfecta should consider referral to a nephrologist for a
renal ultrasound scan.Follow-up may be indicated since blood chemistry analyses are typically normal, and the
nephrocalcinosis may not appear on renal ultrasound until later in life.
• Urine: Most laboratory testing for alkaptonuria detects the alterations in the urine. Increased urinary levels
of homogentisic acid (HGA) are characteristic of this metabolic disorder.
• CBC: Erythropoietic porphyria characterize by elevated in red blood cells, plasma, bile, and feces. The
diagnosis is usually made by finding the abnormal levels in erythrocytes and plasma by doing CBC.

5. Radiographic studies:

6. Radiographic studies:
Dental radiographs can reveal defects in both tooth structure and alveolar bone. This information is critical for the
identification of a potential cause of intrinsic discoloration.
- Intraoral radiographs are required to determine whether a dental-alveolar infection is present.
- Panographic radiographs may be required if intraoral radiographs do not visualize the apices of the teeth.

7. Radiographic features :
Thickness & radiodensity of enamel varies greatly
Hypomaturation of enamel and dentin.
Amelogenesis imperfecta:

8. Radiographically, the teeth may take on the appearance of ‘shell teeth’
as dentine production ceases after the mantle layer has formed.
Dentinogenesis imperfecta :

9. Radiographically the teeth have short roots with conical apical
constrictions.
Dentinal dysplasias:

10. Root resorption is often clinically asymptomatic
OUTLINE OF LESION: Sharply outlined appearance (than in external resorption).
OUTLINE OF ROOT CANAL: lost.
Root resorption:

11. Slight thickening of the PDL space
Radiolocent area at the apex of the roots
Pulpal haemorrhagic products

12. Histologic Findings:
The histologic examination of a discolored tooth is primarily a research endeavor,
and it is not performed in daily clinical practice.

13. REFERENCES :
1. Watts A, Addy M. Tooth discolouration and staining: a review of the literature. British Dental Journal. 2001;190(6):309-316.
2- McDonald R, Avery D, Dean J. Dentistry for the child and adolescent. St. Louis, Mo.: Mosby; 2010.
3.Wright J, Robinson C, Shoe R. Characterisation of the enamel ultrastructure and mineral content in hypoplastic amelogenesis
imperfecta. Oral Surg Oral Med Oral Pathol 1991; 72: 594-601.
4.Shields E D, Bixler D, El-Kafrawy A M. A proposed classification for heritable dentine defects with description of a new
entity. Arch Oral Biol 1973; 18: 543-553
5.Watanabe K, Shibata T, Kurosawa T, Morisaki I, Kinehara M, Igarashi S,Arisue M. Bilirubin pigmentation of human teeth
caused by hyperbilirubinaemia. J Oral Pathol Med 1999; 28: 128-30
6.de la Dure-Molla M, Philippe Fournier B, and Berdel A. Isolated dentinogenesis imperfecta and dentin dysplasia: revision of
the classification. European Journal of Human Genetics. April 2015; 23(4):445-451.
7. A. Watts,1 and M. Addy,2 Tooth discolouration and staining: a review of the literature, BRITISH DENTAL JOURNAL
VOLUME 190 NO.6 MARCH 24 2001

14. Thank you