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Dental Discoloration: An Overview

Authors:
  • Faculty of Dentistry, Karolinska Institute, Stockholm.

Abstract

Unlabelled: Often the first evidence of variation from normal in human dentition is an observable difference in the color of the teeth. During the past decade, the demand for conservative esthetic dentistry has grown dramatically. Tooth discoloration is a frequent dental finding, associated with clinical and esthetic problems. It differs in etiology, appearance, composition, location, severity, and firmness in adherence to the tooth surface. Basically, there are two types of tooth discolorations: those caused by extrinsic factors and those caused by intrinsic congenital or systemic influence. The intensity of stains may be worsened if there are enamel defects. Tooth discoloration presents two major challenges to the dental team. The first challenge is to ascertain the cause of the stain; the second is its management. Clinical significance: This article reviews the etiology and clinical presentation of dental stains and outlines treatment options.
... After excluding all the above contributors, our first approach was to address her complaint of xerostomia and hyposalivation, by reinforcing daily fluid intake, use of coconut oil to oral mucosa before meals and sugar-free gums and candies. At the same time, a reduction in the amount of caffeinated coffee was advocated, as studies have consistently identified dark beverages such as coffee, black tea and red wine, as possible etiologic factors [6,7,9,17,[27][28][29][30]. As no benefit was seen after reduction of caffeine intake, the patient was encouraged to discontinue her daily use of alcohol-free mouthwash, although the literature has pointed at chlorhexidine containing in these products as the most implicated in extrinsic stain of teeth and tongue [31][32][33]. ...
... However, the higher predisposition of such food in staining the tongue seems more implicated in the lack of tongue movement with consequent impairment of desquamation of the keratinized filiform papillae [10], rather than the soft food itself. One plausible explanation of walnuts as a precipitating factor for extrinsic stain is the presence of tannins, which are also present in coffee and tea [28]. Tannins only accounts for 0.01-0.88% of walnuts composition, although the proportion can vary according to the specific seed [35]. ...
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Extrinsic stain and black hairy tongue need to be considered in the differential diagnosis of discoloration of the tongue. Both are be- nign conditions, characterized by altered coloration of the dorsum of the tongue. However, they differ in the macro- and microscopic ap- pearance, with black hairy tongue presenting with hypertrophy and elongation of the filiform papillae. In the absence of such manifes- tation, extrinsic stain is a more likely diagnosis. Several factors have been associated with extrinsic stain including poor oral hygiene, dark beverage intake, smoking habit, yeast infections, topical or systemic medications. There are few reports of food substances contributing to extrinsic stain. In this report, a persistent black discoloration of the tongue completely resolved within 2 weeks after discontinuation of daily walnut consumption (15-20 per day). Clinicians should familiarize with this unusual side-effect of walnuts, especially when all the other etiological factors have been excluded.
... However, restorative procedures will always be a challenge due to the reproduction of the dental contour, texture and optical characteristics, especially in anterior teeth [6,7]. Thus, the chromatic harmony will be more challenging to achieve with the dentin pigmented with more intense colors due to the greater restorative procedure to correct the chromatic alteration, becoming an obstacle to the professional [8][9][10][11]. ...
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This study aims to evaluate in vitro the effect of violet LED when applied directly to dentin tissue pigmented by different substances. We analyzed the chromatic alteration, the bleaching effect and the temperature variation. Hence, 60 bovine dentin tissue discs were divided into five groups: N-Natural Pigmentation; T-Black Tea; C-Soluble Coffee; W-Red Wine; B-Equine Blood. Individualized pigmentation protocols were performed and all groups reached the same chromatic change value. Subsequently, we simultaneously performed a bleaching session and measured temperature variation using a K-type thermocouple device. Data on chromatic change (∆E, ∆E00, ∆a, ∆b and ∆L), whitening effect (WID) and temperature variation were subjected to one-way Anova and Tukey's post-test at a 5% significance level. The C group showed the most relevant chromatic change values, similar to the N group, responding positively to the treatment. However, the B group differed from the control group, which showed difficulty to respond to the treatment. Regarding the whitening index, only the W group showed lower results than the others. The B group showed the greatest temperature changes. Concluded that the violet LED offered chromatic change, which generated a bleaching effect, and the pigmentations with red wine and blood showed the greatest difficulty to respond to the treatment, besides promoting a higher temperature rise in teeth pigmented with blood.
... Accumulation of iron deposits also causes painful inflammation of salivary glands [9]. Breakdown of haemoglobin leads to accumulation of bilirubin in the dentinal tubules of these patients leading to characteristic yellow discoloration of their teeth [19] [ Fig. 1]. Neutrophils represent the principal leukocyte (>95%), which are recruited as the first line defence against the bacterial biofilm [20]. ...
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Background: Increased prevalence of gingival diseases in thalassemia patients has been consistently reported. In diseases with neutrophil dysfunctions, periodontal tissue is lost very rapidly. β-thalassemia major (TM-β) patients exhibit defective neutrophils and macrophages. Therefore, supplementary gingival inflammation is detrimental to periodontal tissues in these patients. This warrants attention to specialized oral health care intervention in these patients. This is Original Research Article Hanif et al.; JPRI, 34(42A): 19-27, 2022; Article no.JPRI.88384 20 the pioneer pre and post study that evaluates the effect of non-surgical periodontal therapy (NSPT) in β-thalassemia major (TM-β) patients with gingivitis. And also reports the prevalence and distribution of disease severity in TM-β patients. Methods: 31 patients (15 females, 16 males) fulfilling the inclusion criteria were provided with protocol guided NSPT including scaling, polishing and chemical mouthrinse (0.2% CHX). Gingival index (GI), plaque score, Papillary bleeding index (PI) and periodontal pocket depth (PPD) were recorded with a periodontal probe (UNC-15) at baseline and evaluated after 6 weeks of intervention. Paired T-test was applied for GI, PBI and plaque and Wilcoxon signed rank test for PPD at the P-value of <0.05 Results: 86% of the assessed individuals had gingivitis (6%-mild, 44%-moderate and 36%-severe). NSPT showed highly significant (P-<0.000) improvement from baseline to 6 weeks after intervention for all the clinical parameters, GI, PBI, plaque score and PPD. Conclusion: Within the limitations of the study, the results show that with proper protocol, multidisciplinary approach and careful screening of the patient's systemic status, TM-β patients with gingivitis respond positively to local measures of plaque control.
... It occurs due to the deposition of tannins on the tooth surface. The salivary proteins increase the binding of tannins to the hydroxyapatite resulting in tooth staining (32,33). As oolong tea contains tannins, which are intermediate between green and black teas, it may produce extrinsic staining. ...
Article
Introduction: Oolong tea, a functional food, has numerous therapeutic benefits owing to the presence of bioactive polyphenols, theasinensins (TS) and catechins. The present study aimed to evaluate the influence of systemic administration of oolong tea as an adjunct to nonsurgical periodontal therapy (NSPT) in the management of chronic periodontitis (CP).Methods: A total of 60 subjects with mild to moderate CP were randomly divided into two groups of tests (n = 30) and the controls (n = 30). They underwent NSPT with adjunctive oolong tea supplementation in the test group only. At baseline, 1, and 3 months, their gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment loss (CAL), percentage of sites with bleeding on probing (BOP), and lobene stain index (LSI) were recorded. Furthermore, the levels of glutathione peroxidase (GPx), total antioxidants (TAO), and malondialdehyde (MDA) were also estimated in gingival crevicular fluid (GCF), saliva and serum. Additionally, colony-forming units (CFUs) of selective supra and subgingival plaque bacteria were estimated in the plaque samples.Results: In both groups, at 1 month, the GI, PI, BOP, GPx, and TAO levels were improved with a reduction in the levels of MDA and CFU’s and no staining of teeth (P < 0.05). The results were maintained in the test group at 3-month recall visit.Conclusion: Adjunctive administration of oolong tea with NSPT reduced the local and systemic oxidative burden and rapidly resolved the inflammation in CP. This would be specifically beneficial in CP subjects with systemic conditions.
Chapter
Tooth discolouration caused by endodontic procedures can be an important aesthetic concern to the patient. The literature reveals a number of different approaches for the management of coronal discolouration. In this chapter, we discuss aetiological factors for coronal discolouration, its prevention, and management guidelines including patient preparation, intracoronal bleaching procedures, and their prognosis. The chapter also covers possible complications following bleaching, ways to prevent them, and current recommendations for restoration of teeth following bleaching. The potential for tooth discolouration following regenerative endodontic procedures together with a suggested management protocol is discussed.
Article
Salivary pellicle was modified with bioproducts and we assessed the change in tooth color and the protection of enamel to erosion. Human enamel specimens were assigned to one of three solutions: grape seed extract or black tea (bioproducts), or deionized water (negative control); after which one half the specimens underwent erosive challenges. The specimens underwent 15 cycles involving salivary pellicle formation (10 min, 37°C), incubation in solution (2 min, 25°C), subsequent pellicle formation (90 min, 37°C). Half of the specimens was kept in a humid chamber and the other half was submitted to erosion (2 min, 1% citric acid). After 15 such cycles, the pellicle was removed. Tooth color and the surface reflection intensity were assessed after every five cycles and after pellicle removal. For non‐eroded specimens, the exposure to bioproducts promoted significantly greater color change than the deionized water, with increases in yellow appearance. After pellicle removal, the color was similar in all non‐eroded specimens. The bioproducts increased the surface reflection intensity over cycles. For the erosion‐exposed specimens, erosion itself resulted in color change. Black tea and deionized water resulted in increased yellow appearance. Exposure to the bioproducts resulted in higher relative surface reflection intensity values over time, but only grape seed extract resulted in higher relative surface reflection intensity value at the time of pellicle removal. The bioproducts caused transient staining effect, which was reduced after pellicle removal. For enamel submitted to erosion, grape seed extract resulted in less color change and better protection of enamel against erosion than black tea or water.
Article
Whitening agents, such as hydrogen peroxide and carbamide peroxide, are currently used in clinical applications for dental esthetic and dental care. However, the free radicals generated by whitening agents cause pathological damage; therefore, their safety issues remain controversial. Furthermore, whitening agents are known to be unstable and short-lived. Since 2001, nanoparticles (NPs) have been researched for use in tooth whitening. Importantly, nanoparticles not only function as abrasives but also release reactive oxygen species and help remineralization. This review outlines the historical development of several NPs based on their whitening effects and side effects. NPs can be categorized into metals or metal oxides, ceramic particles, graphene oxide, and piezoelectric particles. Moreover, the status quo and future prospects are discussed, and recent progress in the development of NPs and their applications in various fields requiring tooth whitening is examined. This review promotes the research and development of next-generation NPs for use in tooth whitening.
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Differentiating between fluorotic and non-fluorotic defects of dental enamel is an important diagnostic decision in epidemiology and public health dentistry. The commonly accepted diagnostic criteria for fluorosis discriminate between non-discrete symmetrical and asymmetrical distributions of opacities of dental enamel. These criteria appear to identify most cases of dental fluorosis. However, it is not yet confirmed that the pattern and distribution of dental fluorosis are a unique phenomenon. Metabolic, physiological, other trace elements, and malnutrition have been reported to induce bilateral symmetrical developmental enamel opacities. Misdiagnosis of non-fluoride-induced opacities remains a possibility. Reports of unexpectedly high population prevalence and individual cases of fluorosis, where such diagnoses are incompatible with the known fluoride history, indicate the need for a more precise definition and diagnosis of dental fluorosis. A more discriminating diagnostic procedure is recommended. This calls for a positive identification of the levels of fluoride available to communities and individuals before a diagnosis of fluorosis is confirmed. We believe a more critical approach to the diagnosis of fluorosis will be helpful in the rational use and control of fluorides for dental health, and in the identification of factors associated with inducing developmental defects of enamel.
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The general objectives of this study were to examine the long term effects of daily chlorhexidine application on the development of dental plaque, calculus and periodontal pathology and to monitor changes in oral microbiology and any systemic or local side effects following prolonged use of chlorhexidine over a period of two years.An experimental group of 61 medical and dental students used 10 ml. of 0.2 per cent aqueous solution of chlorhexidine gluconate daily in addition to tooth brushing and interdental cleansing. A control group of 59 students used a placebo solution in addtion to tooth brushing and interdental cleansing. Assessment of selected oral and systemic parameters took place at regular intervals throughout the experiment.The results show that, when compared to the placebo solution, chlorhexidine treatment reduced plaque and gingivitis, but tended to stain teeth. Stains were readily removed by a conventional dental prophylaxis procedure. The chlorhexidine group tended to exhibit a greater amount of supragingival calculus. There were no other local side effects relative to the structure and function of the oral mucosa, tongue, salivary glands and pharyngeal complex, following the prolonged use of chlorhexidine.
Article
Fifty-eight bleached pulpless teeth were re-examined after periods of 1–8 years. Recall examination included recording of the esthetic results, clinical findings and radiographs. External root resorption was found in 4 of the cases (6.9%), and was progressive in 2 cases and arrested in 2 cases. There had not been any pre- or postoperative trauma in any of the 4 cases. The occurrence of resorption was not related to the bleaching technique used. Resorptive lesions were found to have been initiated apical to and not at the cemento-enamel junction. Esthetically, the bleaching was considered successful in only 50% of the cases, acceptable in 29% and failed in 21%. These results caution against indiscriminate use of bleaching with hydrogen peroxide, and emphasize the importance of preventive measures and postoperative follow-up of bleached pulpless teeth.
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A group of weanling rats was given, daily for 5 weeks, an intraperitoneal injection of pyrrolidinomethyl tetracycline nitrate (PMT), equivalent to twice the therapeutic dose. During this period, while receiving a normal laboratory diet, they increased in weight about six-fold, and their skeletons formed reservoirs of tetracyclinelabelled bone. At this point the dosages of PMT were stopped, the animals transferred to a low calcium diet and killed up to six weeks later. When dentine and bone, formed in the weeks after PMT administration had been terminated, were examined by fluorescent microscopy, a faint yellow fluorescence was seen. The results indicated that the tetracycline, mobilized from the skeleton where it had been deposited, was subsequently capable of again becoming incorporated in tissues undergoing calcification.
Article
Purpose: The purpose of this study was to evaluate the 2-year effectiveness of a carbamide peroxide at-home bleaching gel used to provide tooth lightening treatment. Material and Methods: Twenty-nine patients participated in the original study, during which they treated their maxillary teeth with a 10% carbamide peroxide gel nightly for 2 weeks. Shades were determined before and after treatment by comparison with a Vita shade guide. Twenty-four patients (a recall rate of 83%) were recalled for evaluation 2 years after the initial bleaching treatment. The shade of the maxillary incisors was evaluated and compared with shades before, immediately after, and at 6 months and 2 years after initial treatment. Data were analyzed using a repeated-measures analysis of variance. Results: At 2 years after bleaching with a 10% carbamide peroxide gel, the median shade was D2, a six-increment difference from the baseline median of D3. Twenty of 24 patients (83.3%) had a shade change of two or more units, which is the threshold value for bleaching efficacy using American Dental Association guidelines. The lightening result remained statistically significant (p <.0001) at 2 years.
Article
Abstract – Extrinsic discoloration of teeth following a large consumption of tannin-containing beverages or a prolonged use of chlorhexidine mouthrinses is a well known observation. Tannins as well as chlorhexidine are denaturing agents. Based on preliminary studies revealing the presence of iron in chlorhexidine discolored pellicle material, the ability of iron to stain the integument after pretreatmentwith the two denaturants was studied in a human model. The denaturing effect of an acidic environment was also included. Enamel slabs fixedto acrylie appliances were carried in the oral cavity and alternately exposed to the test solutions in different sequences in vitro. Pretreatment with chlorhexidine or tannic acid led to marked discolorations upon iron application during 5-d tests, whereas the compounds individually had no such effect. A large content of the metal was found in the stained material. Stannous fluoride appeared to reduce the formation of the pigments, and strong oxidation completely bleached the established color. Possible mechanisms underlying the phenomena observed are discussed.
Article
The purpose of this presentation is to describe a method used to remove or improve superficial stains in the enamel including mild decalcification present before and after orthodontic therapy. This procedure1,2 is only successful in the treatment of stains involving the outer enamel surface and is not effective for treating generalized pigmentation of the enamel and/or dentin. A step-by-step approach for the removal of the superficial enamel stains is presented.
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Since the introduction in 1989 of a home tooth-bleaching technique, the practice has become widespread in the USA. Safety concerns led the Food and Drug Administration (FDA) to temporarily ban sales in 1991 but the ban was later lifted, and the American Dental Association (ADA) now issues guidelines for safety and efficacy. Early information on safety of home bleaching products was often skewed because they were being compared out of context with those designed to be used only in the dental office. The early studies also failed to put the risks into perspective with the risks from other routine dental procedures. The risks are minimized with the systems supplied by dentists because he or she is able to diagnose any problems or special needs, to plan appropriate treatment and to fabricate, fit and adjust the prosthesis used to apply the material. A wide variety of disfigurements may now be treated successfully at home using preparations supplied by the dental practitioner.