Dentistry General Articles

Tooth Discoloration


Tooth Discoloration

COLOUR

  • Teeth made of many colours, with natural gradation from the darker cervical to the lighter incisal third
  • Variation affected by thickness of enamel and dentine, and reflectance of different colours
  • Blue, green and pink tints in enamel, yellow through to brown shades of dentine beneath
  • Canine teeth darker than lateral incisors
  • Teeth become darker with age (secondary/tertiary dentine, tooth wear/dentine exposure)
Tooth colour affected by:
  • individual interpretation
  • time of day
  • patient positioning/ angle tooth is viewed at
  • hydration of tooth (always take shade at start of appointment)
  • skin tone (make-up)
  • surrounding conditions (e.g. lighting in clinic)

CLASSIFICATION OF TOOTH DISCOLORATION

  1. Extrinsic discoloration
  2. Intrinsic discoloration

AETIOLOGY OF DISCOLORATIONExtrinsic Discoloration - tooth discoloration

Extrinsic Discoloration:
  • Stains (chromogens) that lies on/attach to the tooth surface or in the acquired pellicle, or
  • The incorporation of extrinsic stain within the tooth substance following dental development. It occurs in enamel defects and in the porous surface of exposed dentine (‘stain internalisation’).
  • Extrinsic Discoloration – E.g.Extrinsic Discoloration - tooth discoloration
    • Plaque, chromogenenic bacteria
    • Mouthwashes (chlorhexidine)
    • Smoking / chewing tobacco
    • Beverages (tea, coffee, red wine, cola)
    • Foods (curry, cooking oils and fried foods, foods with colorings, berries, beetroot)
    • Antibiotics (erythromycin, amoxicillin-clavulanic acid)
    • Iron supplements
Intrinsic Discoloration:Intrinsic Discoloration - tooth discoloration
  • Intrinsic Discoloration occurs following a change to the structural composition or thickness of the dental hard tissues.
  • Pre-eruptive:
  • Disease:
    • Haematological diseases
    • Liver diseases
    • Diseases of enamel and dentine (e.g. Amelogenesis/ Dentinogenesis imperfecta)
  • Medication:Intrinsic Discoloration - tooth discoloration
    • Tetracycline, other antibiotic s
  • Fluorosis stains (excess F)
  • Enamel hypoplasia (trauma or infection)
  • Post-eruptive:
  • Trauma (e.g. pulpal haemorrhagic products)
  • Primary and secondary caries
  • Tooth wear
  • Dental restorative materials
  • Ageing
  • Chemicals
  • Antibiotics
  • Minocycline (used to treat acne)
Types of Discoloration Colour Produced
Extrinsic (Direct stains)
Tea, coffee and other foods
Cigarettes/cigars
Plaque/poor oral hygiene
Brown to black
Yellow/brown to black
Yellow/brown
Extrinsic (Indirect stains)
Polyvalent metal salts and cationic antiseptics
e.g. Chlorhexidine
Black and brown
Intrinsic
(Metabolic causes)
e.g. Congenital erythropoietic porphyria
(Inherited causes)
e.g. Amelogenesis Imperfecta
e.g. Dentinogenesis Imperfecta
(Iatrogenic causes)
Tetracycline
Minocycline
Fluorosis
(Traumatic causes)
Enamel hypoplasia
Pulpal haemorrhage products
Root resorption
(Ageing causes)
Purple/brown
Brown or black
Blue-brown (opalescent)
Banding appearance:
classically yellow, brown, blue, black or grey
Grey
White, yellow, grey or black
Brown
Grey black
Pink spot
Yellow
Internalized
Caries
Restorations
Orange to brown
Brown, grey, black

MANAGEMENT OF DISCOLOURED TEETH

  • Treatment options:
  • No treatment
  • Removal of surface stain
  • Bleaching techniques
  • Operative techniques to mask underlying Discoloration
    1. Veneers
    2. Crowns
Treatment option Indications Advantages Disadvantages
No treatment Patient with poor oral hygiene/ caries/ PA pathology, large ant restorations/crowns Non invasive, no cost Will not address patients aesthetic concerns
Removal of surface stain-Scale and polish-Microabrasion -Extrinsic staining-Fluorosis, white spot demineralisation, enamel hypoplasia Non/minimally invasive May not improve aesthetics significantly, may require further RxMicroabrasion- soft tissue irritation/ excessive tooth prep (technique sensitive)
Bleaching-Home bleaching, Walking bleach -See later slides Non/minimally invasive Cost, limitation on shade improvement (a few shade lighter only), may fail/ need repeating, compliance (home bleaching)
Restorative treatment-Veneers, crowns Severely discoloured teeth, e.g. tetracycline staining (may bleach 1st)Unaesthetic tooth morphology (e.g. AI/DI)Heavily restored teeth May achieve a more aesthetic result Destructive, irreversible (tooth tissue removal), changes natural shape of teeth, cost, maintenance, oral hygiene compliance (interdental cleaning)

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