Colour alteration Flashcards
Extrinsic stains can be:
- primary
- seconary
What are primary stains?
Substances that enter that the oral cavity: tea, coffee, wine
Intrinsic stains can be:
- pre eruptive
- post eruptive
What are secondary stains?
- Mouthwashes or medicaments that deposit colored substances
- Denaturation of the plaque proteins
Define extrinsic stains:
Deposit of chromogenic materials in the tooth surface over the acquired pellicle
What are extrinsic staining?
Substances that stain the surface of the teeth.
What extrinsic factors do we have?
- chromogenic bacteria stains
- Tobacco
- Medicaments
- Foods and beverages
- Iron
Whats the characteristic of chromogenic bacteria stains?
Green, black brown and orange
Whats is the characteristic of tobacco stain?
black and brown
What is the characteristic of medicament stains?
- silver nitrate: grey black
- stannous fluoride: black brown
- chlorhexidine: black brown
What are the characteristics of foods and beverages?
coffe, tea, wine, berries etc. colour of food item
What are the characteristics of Iron?
Black cervical discolouration
What are the primary extrinsic pigmentation?
- Green
- Orange
- Black
- Metallic
- Tobacco
What are primary stains?
Tea, coffee, wine, nicotine, colorants…
Chromogens bind to proteins in the bacterial plaque by hydrogen bonds.
Treatment: Easy to remove at the beginning – brush and more abrasive pastes.
Aggravated if fissures on the tooth surface.
What are green pigmentation?
Due to the phenacetin pigment, produced by bacterias and oral yeasts + bad oral hygene.
• Some authors relate it with hemoglobine deposits derivated from the gingivitis.
• Variable thickness.
• Sometimes disappear in adolescence.
What are orange pigmentation?
Irregular stains in cervical and buccal surfaces of anterior teeth.
Easy to remove with the brush (low adherence).
Related with bacteria like mesenteric bacillus, sarcina roseus.
What are black pigmentation?
- Stains in the cervical surfaces .
- More in primary teeth.
- Related with ferric deposits from the diet, metabolized by the oral flora.
- Black line 1mm width. Small and frequently in the gingival margin ( B and P). The color intensity varies according to the patient , but they are not related to hygiene
What is metallic pigmentation?
- by inhalation of metal salts in the work environment, metals in the mouth, drugs
The metal powder attacks to the acquired pellicle and generates pigmentation
- green: lead, nickel
- brown- grey: iron
- black: silver or manganese
Trist brushing is important, otherwise they could penetrate into the tooth and could cause permanent staining
Tobacco pigmentation:
• Related with consumption of tobacco.
• Black or brown pigmentation.
• It affects palatal surface of upper molars (2/3 gingival) and plaque
of lower incisors.
• Not related to the amount of tobacco, but the type of tobacco
(Black=more pigmentation)
Secondary extrinsic pigmentation:
- Clorhexidine, tin fluoride, medicines containing iron, vitamin complexes! treatment: abrasive paste
- Substances initially not dyed. Due to chemical oxidation reactions become chromogen.
- A reverse oxidation reaction makes them disappear.
Whats intrinsic discolouration?
Intrinsic discoloration occurs following a change of the structural composition or thickness of the dental hard tissues. Chromogenic deposits inside the teeth (enamel or dentin). It is not possible to remove just brushing.
Characteristic of Detinogenesis imperfecta::
yellow or grey brown
Characteristic of Amelogenesis imperfecta:
yellow brown
characteristic of dental fluorosis:
opaque white to yellow brown patches
Characteristics of sulphur drugs:
Black staining
Tetracyclines:
- chlortetracycline
- oxytetracycline
- Tetracycline HCL
- Demetylchlortetracycline
- Minocycline
- Doxycycline
Different discolouration
colour of chlortetracycline:
grey brown hue
Colour of Ixytetracycline:
Brown. yellow to yellow
Colour of Tetracycline HCL:
Brown- yellow to yellow
Colour Minocycline:
Blue grey to grey
Colour Doxycycline:
no change
Colour trauma:
Transiently red through to black
Colour Hyperbilirubemia:
Yellow- green to blue brown and grey
Colour Eryythropoeietic porphyria:
red or brown
Colour Ochronosis:
brown
Alterations during teeth development (odontogenesis)
- Dentinogenesis and amelogenesis imperfecta
- Enamel hypoplasia
- Endemic fluorosis (environmental)
- Hemolytic disease of the newborn due to incompatibility in the Rh: green-brown stains
- Acute jaundice: green-blue or brown stains
- Tetracycline
What’s an acquired discolouration?
Pre- eruptive:
dental fluorosis
- By excessive Fluoride intake (> 3 ppm).
- Alters the enzymatic mechanism of the ameloblasts in the last stages of the formation of enamel.
- White or yellowish spots on the surface of the enamel.
- If the excess is very marked, defects in the tooth structure may appear.
Clinical classification of pre- eruptive fluorosis:
Feinman, 1987
- Fluorosi simple
- Fluorisier opaque
- Fluorosis veined
Discolouration of Fluorosis simple:
White or brown spots over the free enamel surfaces
Fluorosis opaque discolouration:
Chalk apparence spots
Fluorosis veined discolouration:
Massive coloration, defects and loss of substance
Hypoplasias
Aquired pre eruptive Tetracycline discolouration: Whats the risk?
Risk: During odontogenesis: calcification of deciduous teeth begins at approximately the end of the fourth month of gestation and ends at approximately 11–14 months of age.
Aquired pre eruptive Tetracycline discolouration: attachmenet
Attached to the tooth by its affinity for Ca.
Aquiered Pre eruptive Tetracycline discolouration: Administration
Administration of tetracycline to pregnant women : avoided during the second or third trimester of gestation and to children up to eight years of age.
Where is Tetracycline also excreted?
It should not be given to nursing mothers, as they are also excreted in human milk.
On what does Tetracycline relate to/ depend on?
Severity related to dose, frequency, length of therapy and critically the stage of odontogenesis.
Discoloration: depending on the dose or the type of the drug received in relation to body weight
Discolouration Clortetracicline (Aureomicina)
grey- brown
Discolouration
Dimetihylclortetracicline (Ledermycin) :
yellow
Discolouration
Doxycicline (Vibramicina)
does not stain
Discolouration
Oxytetracicline (Terramicina)
yellow
Discolouration
Tetracicline (Acromicina)
yellow
How does the Tetracyclinen discolouration work?
Tetracycline: incorporates as a fluorescent pigment into tissues that are calcifying at the time of administration (to form a tetracycline-calcium orthophosphate complex).
Light exposition induces photochemical chromogen reactions
Enamel and dentin are affected
Other characteristics of Tetracycline discolouration:
- Chance in the fluoresces in the presence of ultraviolet light, unlike normal teeth, these teeth acquire a bright yellow colour when illuminated with UV light
There are changes of color in the teeth after its eruption resulting from oxidation. As the sunlight falls on them, the antibiotic is oxidized acquiring a darker color (brown) and it loses its fluorescence.
This effect of oxidation can explain why there is some recurrence after bleaching treatments or why the anterior teeth are darker than posterior
Jordan and Boksman`s classification:
- 1st degree
- 2n dregree
- 3rd degree
- 4th degree
1st degree classification:
First Degree. Mild tetracycline staining. This staining is yellow to grey with no banding and is uniformly spread throughout the tooth.
2nd degree classification:
Second Degree. Moderate tetracycline staining. This is yellow brown to dark grey staining.
3rd degree classification:
Third degree. is accompanied by significant banding across the tooth (gingival 1/3). Dark grey-blue colour.
4th degree classification:
Fourth degree. Severe tetracycline staining in all the crown surface. This is blue grey or black.
Tetracycline staining treatment:
Depending on the grade:
1-2 grade
First and second grade treatment:
It has been proven that the grades I and II respond well to “at home” external bleaching when long-lasting (approximately six months)
More aggressive grade treatment of Tetracycline:
More aggressive grades will have to be treated with crowns or veneers with bleaching before the prosthetic treatment
Internal bleaching of the teeth with root canal treatment prior to external bleaching. This has fairly predictable short-term results.
When using at home technique, tetracycline-stained teeth can be
effectively lightened with the extended use of tooth bleaching. Cervical staining is the most difficult area to lighten.
What happened when administrated tetracycline in adults?
It has been proven that there are risks of pigmentation also in prolonged treatments.
Why we have risk of pigmentation by prolonged tetracycline stain?
- continuous remineralization processes of enamel.
- or by incorporation into the secondary dentin, which is subsequently oxidized by the action of light, producing permanent staining.
Whats an acquired post eruptive discolouration?
Post-eruptive:
- Trauma and bleeding pulp.
- Pulp tissue remains.
- Restoration materials: eg Amalgams (black/grey)
- RCT: metal or internal medication.
- Internal resorption.
- Minocycline.
- Dentin apposition, normal aging.
How is the post eruptive form clinical seen?
- Minocycline hydrochloride, a semi-synthetic derivative of tetracycline produces blue-grey darkening of the crowns of permanent teeth (3-6% cases).
- Deposit of the antibiotic in secondary dentin through the dental vascular network and due to external penetration from saliva.
