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 tooth-discolouration-pedo
•     Tooth discolouration may be extrinsic or intrinsic
in nature.
•     Extrinsic stains are superficial & occur after tooth
eruption.
•          Intrinsic discolouration may result from
developmental defect of enamel or internal staining of
the tooth.
Causes of tooth discolouration



Extrinsic 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 enamel
defects or become attached to the enamel without
bringing 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 the
gingival contour or it may be apparent in a
more generalized pattern on the clinical
crown.


If it collects in pitted areas, it is difficult to
remove.


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-surface
decalcification
     with intact surface which has undergone
Intrinsic discolouration
     Factors causing these conditions
include blood-borne pigments, blood
decomposition within the pulp, and
drugs used in procedures such as root
canal 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 this
intrinsic staining are erythroblastosis
       fetalis and biliary atresia
Erythroblastosis Fetalis

            Leads to Rh-incompatibility

Causes 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      Turner's 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 Turner's
                                    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) TETRACYCLINES



Yellow             Yellow to        Orange to                     Grey to
                 bright yellow      Grey brown                  blue brown

Tetracycline      Oxytetracycline   Chlortetracycline        Dimethyl chlortetra
hydrochloride                                                    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 have
received
       tetracycline therapy during the period of
calcification of primary or permanent teeth.
     Tetracyclines chelate calcium salts & so, are
incorporated into bones & teeth during calcification.
     Tetracyclines administered during pregnancy can
be     transferred through the placenta, & cause
discolouration.
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 a
rubber 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- 5
2. McDonald RE, Avery DR, Dean JA.          Dentistry for the child and adolescent
8th edn, Mosby, 2004 :133-5, 447-8
3. Neville BW, Damm DD, Allen CM, Buoquot JE. Oral and maxillofacial
pathology, 2nd edn Saunders, 2005: 53-4, 59-66
4. Cameron AC, Widmer RP. Handbook of pediatric dentistry 2nd edn, Mosby,
2003: 209-12

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tooth-discolouration-pedo

  • 2. Tooth discolouration may be extrinsic or intrinsic in nature. • Extrinsic stains are superficial & occur after tooth eruption. • Intrinsic discolouration may result from developmental defect of enamel or internal staining of the tooth.
  • 3. Causes of tooth discolouration Extrinsic 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
  • 4. Extrinsic Staining Agents responsible are deposited in enamel defects or become attached to the enamel without bringing out a change in its surfaces. Aetiological agents causing extrinsic stains are : * Beverages / food * Smoking * Poor oral hygiene * Drugs - Iron Supplements - Minocycline - Chlorhexidine
  • 5. 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
  • 6. 2. Black stains Tobacco Drugs Iron supplements Minocycline chlohexidine
  • 7. The stain may be seen as a line following the gingival contour or it may be apparent in a more generalized pattern on the clinical crown. If it collects in pitted areas, it is difficult to remove. Black staining by iron supplements is caused
  • 8. 3. Yellow stains  Caused by beverages / foods  Due to bile pigments from gingival crevicular fluid (biliary atresia & jaundice)
  • 9. 4. Brown stains Arrested caries Chromogenic bacteria Discolouration is due to sub-surface decalcification with intact surface which has undergone
  • 10. Intrinsic discolouration Factors causing these conditions include blood-borne pigments, blood decomposition within the pulp, and drugs used in procedures such as root canal therapy.
  • 11. 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
  • 12. 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
  • 13. • Blue brown (Opalescent) Dentinogenesis Imperfecta  All teeth are uniformly affected  Often associated with osteogenesis imperfecta
  • 14. 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
  • 15. 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
  • 16. 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
  • 17. v. Green - blue Hyperbilirunaemia Seen in children with end stage liver disease and premature infants Common disorders that cause this intrinsic staining are erythroblastosis fetalis and biliary atresia
  • 18. Erythroblastosis Fetalis Leads to Rh-incompatibility Causes anaemia & Jaundice due to red cell destruction Which in turn leads to Hyperbilirunaemia Persistent Jaundice during the neonatal period, also can cause such discolouration
  • 19. 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
  • 20. 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
  • 21. iii) Yellow brown / White Developmental defects Subsurface decalcification Turner's 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 Turner's tooth .
  • 22. 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)
  • 23. c. Chronological staining of dentition i) TETRACYCLINES Yellow Yellow to Orange to Grey to bright yellow Grey brown blue brown Tetracycline Oxytetracycline Chlortetracycline Dimethyl chlortetra hydrochloride cycline unoxidized fluorophore seen erupted teeth, oxidized in newly erupted teeth fluorophore odour also depends on the type of tetracycline
  • 24. Discolouration is noticed in children who have received tetracycline therapy during the period of calcification of primary or permanent teeth.  Tetracyclines chelate calcium salts & so, are incorporated into bones & teeth during calcification.  Tetracyclines administered during pregnancy can be transferred through the placenta, & cause discolouration.
  • 25. ii) SYSTEMIC ILLNESS Yellow / brown Vitamin D deficiency Developmental defects of enamel affecting all teeth forming during illness Severe measles
  • 26. TREATMENT • Extrinsic stains : * Can be removed from the surface of the teeth by polishing with a rubber cup & an abrasive material ( flour pumice ) * Improving the oral hygiene will minimize the recurrence of the stains
  • 27. 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
  • 28. References: 1. Welbury RR. Paediatric dentistry 2 edn , Oxford university Press, 2001: 204- 5 2. McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent 8th edn, Mosby, 2004 :133-5, 447-8 3. Neville BW, Damm DD, Allen CM, Buoquot JE. Oral and maxillofacial pathology, 2nd edn Saunders, 2005: 53-4, 59-66 4. Cameron AC, Widmer RP. Handbook of pediatric dentistry 2nd edn, Mosby, 2003: 209-12