Teeth Discoloration etiology and diagnosis Alaa Sabrah BDS, MSD, PhD

Discoloration: the process of changing to a different, less attractive color. Intrinsic extrinsic located within the tooth accessible only by bleaching. located on the surface of the tooth most easily removed by external cleaning.

extrinsic Discoloration Discoloration: the process of changing to a different, less attractive color. extrinsic Discoloration Poor oral hygiene

intrinsic Discoloration Discoloration: the process of changing to a different, less attractive color. intrinsic Discoloration Aging, Microcracks in the enamel, Tetracycline medication, Excessive fluoride ingestion, Severe jaundice in infancy. Porphyria. Dental caries. Restorations Thinning of the enamel layer Ingestion of chromogenic foods and drinks. Tobacco use. medical situations and conditions.

Tetracycline Discoloration intrinsic Discoloration Drug consumption Local application

Tetracycline Discoloration Discoloration from drug ingestion may occur either before or after the tooth is fully formed. Tetracycline is incorporated into the dentin sometime during tooth calcification probably through chelation with calcium, forming tetracycline orthophosphate. When the teeth are exposed to sunlight, they become darker, with a distinct gray/blue-gray tinge. The teeth not exposed to the sunlight (ie, molars) do not darken to the same degree but remain more yellow in color. The primary route of Tetracycline discoloration of fully formed teeth is thought to be in the secondary dentin.

Fluoride Discoloration (Fluorosis) Excessive fluoride in drinking water (>1 to 2 ppm) Metabolic alteration in the ameloblasts, resulting in a defective matrix and improper calcification of teeth. An affected tooth shows a hypomineralized, porous subsurface enamel and a well-mineralized surface layer. These teeth have a glazed surface and may be very white except for areas of yellow, brown, or even black shading. extrinsic Discoloration

Systematic conditions Severe jaundice leads to staining by bilirubin. Bilirubin is the yellow breakdown product caused by the body's clearance of aged red blood cells which contain hemoglobin. Intrinsic staining of teeth may vary in color from yellow to dark green.

Systematic conditions Erythroblastosis fetalis may also stain the teeth because of the destruction of red blood cells. Erythroblastosis fetalis: a blood disorder of the neonate due to Rh incompatibility of the fetal and maternal blood supplies. Affected teeth can range in color from brown to greenish-blue.

Systematic conditions Porphyria, a rare condition, manifests with purplishbrown teeth. Porphyria: a disorder of porphyrin metabolism which results in increased formation and excretion of porphyrins. Porphyrins help form many important substances in the body. One of these is hemoglobin.

Dental caries Produces varying stains depending on its stage of progression. An opaque white, grayish, or a brown to black stain. These stains arise from the bacterial degradation of food debris.

Trauma dark teeth could be a result of trauma to the tooth at an early age, and the tooth pulp may eventually become necrotic or abscess. It may take 1 to 20 years before this condition occurs. The tooth may remain vital but can discolor, either from iron containing hemoglobin in blood seeping into the dentinal tubules or from calcific metamorphosis. Calcific metamorphosis is the process by which the tooth deposits darker yellow secondary dentin in the pulp chamber, which may partially or completely obliterate the pulp chamber.

Pulp necrosis A necrotic pulp that has resulted in a periapical radiolucency or a tooth that is undergoing internal or external resorption can be discolored. Often there is no symptoms other than the onset of tooth darkening. A radiograph should always be taken of a single dark tooth, and pulp testing may also be indicated.

Diagnosis A proper examination is essential to diagnosing the cause of discoloration as well as to determine if there are other contributing factors or concerns to address. Discoloration or staining may be an indication of dental conditions such as a necrotic pulp, decay, resorption, or faulty restorations.

examination considerations • Intraoral soft and hard tissue examination (to rule out cancer, periodontal problems, recession, etc) • Radiographs (to assess periapical pathology, resorption, and single dark teeth) • Diagnosis of cause and location of tooth discoloration • Identification of esthetic restorations • Assessment of exposed roots, visible white spots, cracks, tooth or gingival architecture defects; overall esthetic/facial analysis; other appliances; and lifestyle issues • Complete sensitivity history and examination • Occlusal and TMD screening examinations

Diagnosis of tooth discoloration Generalized tooth discoloration • Genetic color of the teeth • Tetracycline staining • Coffee, tea, nicotine use • Multiple caries • Multiple discolored restorations • Multiple leaking restorations Single-tooth discoloration • Endodontic therapy • Necrotic pulp with periapical radiolucency • Internal or external resorption • Calcific metamorphosis • Silver point endodontic obturation or restorative material discoloration • Caries • Discolored restorations • Leaking restorations

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