1. Dental non-caries disease

2. Discoloration of teeth Anomalous formation of teeth
Chapter 5
Discoloration of teeth
Anomalous formation of teeth

3. Discoloration of teeth
Intrinsic discoloration
Extrinsic discoloration

4. Intrinsic discoloration of teeth
pigmentation of internal structure
anomalous development of teeth
Extrinsic discoloration of teeth
drug、food、drinks、tobacco
surface staining of teeth or denture

5. Extrinsic staining
chlorhexidine staining tobacco and coffee stains

6. Intrinsic discoloration dental bleaching
Treatment of dental discoloration
Intrinsic discoloration
dental bleaching
resin repair
crown repair
Extrinsic discoloration
ultrasonic scaling

7. Dental fluorosis
tetracycline pigmentation teeth
Dental bleaching technique

8. Dental Fluorosis
Dental fluorosis occurs as a result of long-term intake of fluoride during the period of tooth formation
Characterized by an increasing porosity of the surface and subsurface enamel causing the enamel to appear opaque

9. Etiological factors of dental fluorosis
Fluorides in drinking water
Fluorides in foods and drinks
Fluoride ingestion period

10. The optimum level of fluoride in drinking water supplies
1ppm（1mg/L)：maximum caries protection
while causing minimal dental fluorosis

11. The level depends on the mean annual maximum air temperature
USA: 0.7~ 1.2 ppm
China：0.5~1 ppm

12. Fluorides in foods and drinks
Fish, tea, etc
Fluoride solubility
Calcium and magnesium

13. The period of risk of developing dental fluorosis
For many years it was believed that only during certain stages of tooth formation can fluoride exert its toxic effect on enamel:
the stage during which enamel is laid down by the ameloblasts

14. So long as a tooth has not yet erupted
into the mouth,it may be sensitive to
exposure to fluoride
The later in the pre-eruptive life of
a tooth that it is exposed to fluoride
the less severe will be the resulting
degree of dental fluorosis

15. The pathogenesis and pathology of dental fluorosis
ALP (Alkaline phosphatase) inhibitor
hypo-mineralization of interrod substance
super-mineralization of enamel rod

16. Clinical features of dental fluorosis
Permanent dentition:
symmetrically distributed in the mouth, but not all teeth are equally affected
The least affected teeth are the incisors and first permanent molars
The premolars and other molars are most severely affected

17. Primary dentition
Similar clinical features
Less severely affected than their
permanent successors

18. Changes from fine white opaque lines
running across the tooth on all parts of
the enamel, to features where parts of
the chalky white and porous outer
enamel become detached and discolored

19. The loss of surface enamel in the severest cases results in a loss of anatomical form of the teeth

20. Indices for measuring dental fluorosis (the Dean index)
“Normal” (score: 0)
The enamel represents the usual translucent
semi-vitriform type of structure
The surface is smooth, glossy, and usually of
a pale, creamy white colour

21. Questionable (score: 0.5)
The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a
few white flecks to occasional white spots
This classification is utilized in those instance where a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of “normal” not justified

22. Very mild (score: 1.0)
Small, opaque, paper white areas scattered irregularly over the tooth but not involving as much as approximately 25% of the tooth surface
Frequently included in the classification are teeth showing no more than about 1-2mm of white opacity at the tip of the summit of the cusps of
the bicuspids of second molars

23. Very mild (score: 1.0)

24. Mild (score: 2.0) The white opaque areas in the enamel of the teeth are more extensive but not involve as much as 50% of the tooth

25. Moderate (score: 3.0)
All enamel surfaces of the teeth are affected, and surfaces subject to attrition show marked wear
Brown stain is frequently a disfiguring feature

26. Severe (score: 4.0)
All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be affected

27. The major diagnosis sign of this classification is the discrete or confluent pitting
Brown stains are widespread and teeth often present a corroded-like appearance

28. The TF index
--originally proposed by Thylstrup and Fejerskov
--score 0-9
--the TF index is a logical improvement and
extension of Dean’s index
--It is more precise and sensitive in its
characterization of various degrees of severity
of dental fluorosis, especially in its capacity to
distinguish between the spectrum of changes
associated with the early signs and with the
more severe forms of dental fluorosis

29. The prevention of the dental fluorosis
Defluoridation of drinking water
Lime softening
Alum, alum and lime
Activated alumina
Activated carbon
Electrodialysis
Reverse osmosis
Natural bone, bone char and charcoal ……

30. The shortcomings of several the above-mentioned methods
-high initial cost of defluoridation plant
-high operation and maintenance costs
-low fluoride removal capacities
-undesirable effects on water quality
-generation of sludge
-complicated procedures

31. The treatment of dental fluorosis
For very mild dental fluorosis:
Physically grinding away the outer porous fluorotic
enamel until the underlying almost sound and
better mineralized enamel is exposed

32. Pronounced opacities and stains can be removed by alternatively applying phosphoric acid to enamel surface and polishing with an abrasive, finished by applying a mineralizing solution and topical fluorides to the treated enamel

33. In the cases of severe dental fluorosis:
-Restoration with composite resins
cosmetically unsatisfactory in the long run
-Repair with crowns

34. Tetracycline Stained Teeth
background
pathogenesis
classification
clinical features
prevention and treatment

35. Background 1940s, clinical initial usage of Tetracycline
1950s, Tetracycline Stained Teeth reported
1970s, brought to attention

36. Onset time of the illness
Calcification stage of tooth formation
4 months afterwards during gestational period
placenta
Pigmentation of primary dentition
children below
7-year-old
tetracycline
Stained teeth or
enamel hypoplasia

37. Pathogenesis Discoloration of dentine and enamel
tetracycline +Ca compound of tetracycline-Ca+
mineralization inhibition
enamel hypoplasia

38. The classification of the illness
mild：yellow or gray staining
no enamel defect
moderate：brown-gray staining
severe：brown-gray or black band-like staining
accompanying enamel hypoplasia

40. Prophylaxis and treatment
Prevention of Tetracycline Stained Teeth
No tetracycline for---
pregnant women
breast-feeding women
children below 8-year-old

41. Treatment of Tetracycline Stained Teeth
Bleaching technique
Composite resin repair
Crown repair

42. Bleaching Technique Indication: discoloration teeth
Mild to moderate mottled enamel
Tetracycline Stained Teeth
Non-vital discolored teeth

43. Bleaching Technique Non-vital bleaching technique
In-office vital bleaching technique
In-home vital bleaching technique

44. Non-vital bleaching technique
Pulpectomy, root canal therapy
removal 2~3mm root canal filling material
30%H2O2 in pulp chamber every 3 days
4~6 times in all
coronal restoration

45. Non-vital bleaching technique
Walking bleach technique
Clinically effective
Shortcomings:
non-vital tooth
external absorption of tooth cervix

46. In-office vital bleaching technique
30%H2O2
enamel demineralization
enamel pellucidit
enamel remineralization

47. In-home bleaching technique
Matrix bleaching technique
Nightguard vital bleaching technique
10%-15% carbamide peroxide

48. In-office bleaching technique

49. Bleaching technique

50. Dental structural anomalies
Enamel Hypoplasia
Hereditary dentinogenesis imperfecta
Congenital syphilitic teeth

51. Enamel Hypoplasia
Developmental disturbance of enamel, which appears as a surface defect, during the period of tooth formation
enamel dysplasia
enamel hypocalcification

52. Enamel Hypoplasia
Etiology
Clinical feature
Prevention and cure

53. Etiology of Enamel Hypoplasia
Nutrient: VitA、C、D，Ca、P
Endocrine factor: parathyroid gland
Mother and baby related disease:
chickenpox, scarlatina, gravida rubella
Local factor:
periapical periodontitis of primary teeth (Turner teeth)

54. Clinical feature of Enamel Hypoplasia
Systemic hypoplasia affect homologous teeth
Several groups of teeth are
involved frequently

55. The classic clinical features vary from a grooved line across the tooth surfaces to
a wider band of faulty deformed enamel
Always characterized by having smooth rounded and well-demarcated borders

56. Enamel hypoplasia

57. Mild : Hypomineralization No alteration in enamel integrity
Color and pellucidit change
Chalk-like enamel

58. Severe: Band- or groove-like enamel defect
Pit or honeycomb appearance enamel
Thinned Incisal edge
defected cusp

59. Enamel hypoplasia associated
with dental fluorosis

60. Symmetry lesion of Enamel hypoplasia
1yr after birth to 2yr after birth yr after birth

61. Prophylaxis of enamel hypoplasia
related disease prevention during the
period of dental development

62. Treatment of enamel hypoplasia
anti-caries treat
cover with resin
ceramic restoration

63. Differential diagnosis
Enamel hypoplasia
well-demarcated borders
along incremental line
one or one group tooth/teeth
Dental fluorosis
long-term lesion
frog-like, no borders
high fluoride region

64. Dental fluorosis Enamel hypoplasia

65. Hereditary dentinogenesis imperfecta
Hereditary opalescent dentin
Autosomal dominant inheritance disease
Developmental disturbance of unknown
origin of the pulpo-dentinal organ

66. The discoloration is due to the fact that the
pathologically disturbed pulpo-dentinal organ
can be seen through the translucent enamel
Enamel loss and severe dental attrition

67. Less, enlarged irregular dentinal tubule
Narrowed, blocked pulp chamber and root canal

68. Treatment
Primary dentition: protection incisal edge and occlusal surface with plastic splint
Permanent dentition：crown and overdenture

69. Congenital syphilitic teeth
Hutchinson teeth
Mulberry molars
Pfluger teeth
Moon teeth

70. Dental morphologic abnormality
Microdontia、macrodontia, conic shaped teeth
Fused teeth, geminated teeth,
concrescence of teeth
Abnormal central cusp
Dens invaginatus
Enamel pearl

71. Microdontia

72. Macrodontia and conic shaped teeth

73. Fused teeth two dental germ

74. Geminated teeth one tooth germ

75. Concrescence of teeth

76. Abnormal central cusp

77. Dens evaginates

78. The treatment of abnormal central cusp
Pulp capping
Grinding
Apexification
Root canal therapy

79. Dens invaginatus
Dens–in-dente is the result of invagination of the coronal aspect of the enamel organ down into the dental papilla

80. Clinically, giving the appearance of a tooth within a tooth
Maxillary lateral incisors are most commonly involved

81. Classification of Dens invaginatus
Invaginated lingual fossa
Invaginated root groove
Talon cusp
Dens-in-dente

82. Invaginated lingual fossa Invaginated root groove

83. Dens-in-dente

84. The treatment of Dens invaginatus
Indirect pulp capping
GIC restoration
Endodontic treatment
Periodontic treatment
Tooth extraction

85. Enamel pearl

86. Abnormal number of teeth
Supernumerary tooth Partial anodontia Congenital anodontia

87. Supernumerary teeth
Teeth that develop from accessory tooth buds The mesiodens is most commonly, a small cone-shaped tooth located between the maxillary central incisors Also, distomolars and premolars Treatment: None, unless for esthetic or occlusal interference

88. Supernumerary teeth
Supernumerary teeth in cleidocranial dysplasia

89. Anodontia Congenitally missing teeth Complete(anodontia ) or
partial missing (oligodontia)
Third molars, lateral incisors,
second premolars

90. Anodontia Hereditary ectodermal dysplasia and head-
and-neck radiation therapy are associated
with anodontia or oligodontia

91. Partial anodontia

92. Congenital anodontia

93. Anodontia of ectodermal dysplasia

94. Dental eruptive disorder
Early eruption of tooth
deciduous or permanent teeth
natal tooth and neonatal tooth
Delayed eruption of tooth
Ectopic eruption of tooth