Stains Flashcards
What types of discoloration can we remove through a prophy, scaling and polishing?
Stains that have adhered directly to the tooth surface
Stains contained within calculus and soft deposits
What is the significance of thick stain deposits?
Can provide a rough surface for dental biofilm to collect and irritate the gingiva
Helps is evaluate oral cleanliness (home care)
What are the location based stain types?
Intrinsic
Extrinsic
What are the source based stain types?
Exogenous
Endogenous
Exogenous stains
Comes from an outside source
Happens after eruption
Can become intrinsic
Endogenous stains
Develops within the tooth
Most are dentin
Always intrinsic
Intrinsic stains
Cannot be mechanically removed
Exogenous or endogenous
Can only be improved with whitening treatments
Extrinsic stains
May be remived by mechanical means
Exogenous source
How do we recognize and identify stains?
Take a medical and dental history: more than one type may be present
Food diary: ethnic practices/food
Oral hygiene habits
Direct extrinsic stains
Attached to the pellicle
Indirect extrinsic stains
A chemical interaction that creates the stain
Different types of extrinsic stains
Yellow Green Black-line Tobacco Brown stain Orange/red Metallic
Yellow stain
Dull yellow, resembles biofilm
Generalized or local
More prevalent in poor Hc
Mechanical removal, like biofilm
Green stain
Light yellowish green to very dark green
Embedded in biofilm. Small curved lines following facial margin- irregular
May cover entire surface or follow grooves or lines in enamel
Frequently superimposed by aoft yellownor gray debris
Darker green may become embedded
Clinical considerations of green stain
Ename under stain= demineralized= result of cariogenic bacteria
Rpugh demineralized surface emcourages biofilm retention, demineralization and recurrence
Distribution and composition of green stain
Primary facials, may extend into proximal and lingual. Ging 3rd more common
Chromogenoc bacteria and fungi
Decomposed hemoglobin
Inorganic elements- calcium, potassium, sodim, silicon, magnesium, phosphorus
Clinical approach to green stain
Do not scale unless we know there is not demineralozation
Brush biofilm away
Stress daily biofilm control and fluoride
Other types of green stain
Marijuana typocally on linguals
Etiology: chlorophyll preparations, metallic dust, marijuana
Appearance of black-line stain
Continuous or interrupted 1mm line
Follows contour of ging margin
Thin clear line of instained atea btw black line and margin
Appears balck at basenof pits and fissures
Can feel like calc when heavy
Teeth frequently clean, low to no bleeding, low incidence of caries
Distribution of black-line stain
Facial and lingual following the gingival crest
Rarely on facials of max anteriors
Most frequent on lingual and prox of max posteriors
Composition of black-line stain
Microorganisms embedded in an inter-microbial substance
Primarily gram + and rods with other bacteria but rods predominate
Actinomyces
Attachment by pellicle-like structure
Mineralization is similar to formation of calculus
Rxn btw hudrogen sulfide produced by bacteria and iron in saliva
Occurence of black-line stain
All ages/ more common in childhood
Females more common
Frequently found in clean mouths
No predisposing factors
Recurrence of black-line stain
Will recur despite regular biofilm control
Very meticulous home are will reduce occurence
Appearance of tobacco stain
Light brown to leathery brown/black
Diffise staining of biofilm, natrow band following contour of ging crest. Wide, form, tar-like band covering cervical 3rd
Can incorporate into calculus
Heavy deposits may become wxogenous intrinsic
Distribution of tobacco stain
Promarily cervical 3rd
Any surface, pits snd fissures
Most frequently on linguals
Predisposing factors for tobacco stain
Natural tendency
Quantiyybof stain mot necessarily proportional to the amt of tobacco used
Neglected biofilm will cause more deposits- the more plaque, the easier it is to stain
Brown pellicle
Can take on stains of various colors that results from chemical alterations of pellicle
Brown stain from stannous fluoride
Light brown, sometimes yellowish, in pellicle after repeated topical use
Results from formation of stannous sulfide or brown tin oxide from rxn of tin ion
Food sources of brown stain
Tea Coffee Soy sauce Red wine Soda
Briwn stain from betel leaf
All ages, eastern countries Dark brown to almost black Reaukts from chewing leave of betel bush Thick, hard, partly smooth, partly rough Composed of microorganisms and mineralozed mayerial removed by scaling Caries inhibiting effect
Orange and red stains
May be seen with very thick biofilm
On anterior, facial and lingual, cervical 3rd, more frequent than posterior
Rare
Chromogenic bacteria in the biofilm
Metallic stains
Copper or brass (blue/green), iron (brown-green/brown), nickel (green), cadmium (yellow)
Primarily on anteriors but can be on any surface. More common on cervical 3rd
Workers inhaling dust- can become exogenous intrinsic
Metallic stains from drugs
Iron black (iron sulfide) or brown; manganese black (from potassium permanganate)
Generalized
Drug wnters biofilm substance, imparts color to calculus, pogment can attach directly to tooth surface
Use straws, tablet or capsule form for meds
Endogenous intrinsic stains
Pulpless or traumatized teeth (not all pulpless teeth oresent with color change)
Yellow brown, deep gray, reddish brown, dark brown, bluish black, orange or greenish
From blood and other elements available for breakdown as a resultbof hemorrhahe in pulp or neveosis and decomp of tissue
Tetracycline endogenous intrinsic stain
Broad spectrum antibiotic
Affinity for mineralized tissue- absorbed by bone/teeth
Can pass through placenta- administration of drig during last trimester, infancy and early childhood
Appearance of tetracycline stain
Depends on dosage and length of exposure. Light green to dark yellow. Ultraviolet light can cause teeth to fluoresce
May be generalized. In a banded line. In a series of administration separated by time
Hereditary/Genetic endogenous intrinsic stains
Amelogenesis imperfecta- disturbance of ameloblasts. Enamel partially to completely missing. Yellow brown to grey brown
Dentinogenesis imperfecta- distirbance in odontoblastic layer during development. Translucent or opalescent gray to bluish brown
DO NOT SCALE: enamel may fracture from dentin
Enamel hypoplasia- endogenous intrinsic stains
Systemic hypoplasia- chronologic hypoplasia- ameloblastic distrubance of a short duration
Teeth wrupt with white spotsbornpots. White spots more prone to discoloration from other stains. Location corresponds to the stage of development
Local hypoplasia affects a single tooth
Flurosis endogenous Intrinsic stains
Colorado brown stain, brown stain, mottled enamel
White spots to severe brown discoloration and cracks and pitting of enamel surface
Enamel hypomineralization from excessive ingestion of fluoride during tooth development
Excess of 2ppm in water
Jaundice endogenous intrinsic stains
Prolonged in early life, yellow to green discoloration
Erythroblastosis Fetalis endogenous intrinsic stains
Rh incompatibility, green brown or blue hue
Exogenous intrinsic stains
When intrinsic stains come from an outside source, not from within the tooth
Restorative materials
Endodontic therapy
Drugs
Restorative material stains
Silver amalgam- gray to black. Metallic ions migrate into enamel and dentin
Copper amalgam- bluish green color
Endodontic therapy
Silver nitrate: bluish black Volatile oils- yellowish brown Strong iodine- brown Aureomycin- yellow Ailver containing root canal sealer- black
Drug stains
Topical stannous fluoride- not the same as endogenous form
Light to dark brown
From tin sulfide on decal areas, pits/fissures, restoration margins
What to document
Which stains Location Color Type Extent
Factors to teach the patient
Where they come from- etiology
Personal care procedures
Smokinh cessation programs
Effective or abrasive dentifrice
Aboid tonacco, coffee, tea etc
Difficulty of removing certain extrinsic stains
Effect of tetracyclines on developing teeht
