week twelve - intrinsic/extrinsic staining

Question 2

describe THREE characteristics of normal tooth colour

Answer 2

1. usually gradient from gingival margin to incisal edge [margin has darker appearance bcos of clos approximation to dentin]
2. in most people, canines are darker than incisors
3. younger people characteristically have darker teeth
   - teeth become darker w age partly due to depo of secondary dentin, staining, gradual enamel wear - allowing dentin to influence tooth colour

Question 3

distinguish between:
1. intrinsic staining
2. extrinsic staining
3. endogenous straining
4. exogenous staining

Answer 3

1. intrinsic staining
   - incorporated within tooth - cannot be removed w scale/polish
   - can be related to tooth devel
2. extrinsic staining
   - occ on external surface - can be removed w brushing/scaling/polishing
   - may be assoc w occupational exposure to metallic salts/meds w metal salts
3. endogenous straining
   - originate within tooth –> always intrinsic
4. exogenous staining
   - originate from sources outside tooth
   - can stay on outside or become intrinsic

Question 4

describe the characteristics of yellow extrinsic staining

Answer 4

• common
• occ from suboptimal OH

Question 5

describe the characteristics of green extrinsic staining

Answer 5

• chromogenic bacteria/fungi decomp Hb and inorg elements
• seen smeared across teeth/following facial gingival creases
• frequently superimposed by soft yellow/grey debris [food]
• enamel under stain is sometimes demin = remove w toothbrush - do not scale
• round demin surfaces encourage cycle of retention-demin = recurrence of green stain

Question 6

describe the characteristics of black line extrinsic staining

Answer 6

• highly retentive black/brown calc like stain
• forms along gingival 1/3 of tooth [can occ on prim/perm teeth]
• reported more frequently in healthy mouths and found mostly on lingual/proximal areas of max post. teeth
• also assoc. w soy food products

Question 7

describe the characteristics of black metallic extrinsic staining

Answer 7

• industrial workers inhale dust bringing metallic substances [eg iron, nickel] into contact w teeth
• stain may penetrate surface –> become exogenous intrinsic stain
• seen mostly on ANT. teeth

metallic staining can also occ from meds
- iron, manganese

Question 8

describe the characteristics of brown extrinsic staining

Answer 8

possible causes
- smoking, food/bev pigment [tea/coffee], meds, chlorhexidine [> 2 wk use], stannous fluoride extended use.

Question 9

describe the characteristics of orange extrinsic staining

Answer 9

chromogenic bacteria

Question 10

describe the characteristics of white extrinsic staining

Answer 10

possible causes
- hypoplasia
- fluorosis
- amelogenesis imperfecta
- hypomineralisation
- demineralisation

^ can all range from white –> yellow/brown

Question 11

describe endogenous intrinsic staining : hypoplasia/hypomineralisation

Answer 11

hypoplasia
- insufficient enamel deposition during development
- thin enamel structure - pits/grooves [can also be stained brown]

hypomineralisation
- failure/imcomplete mineralisation of enamel = weak/porous structure
- enamel discoloured - appearing more white than usual w white to creamy yellow brown abberations

Question 12

describe endogenous intrinsic staining : fluorosis

Answer 12

• excessive F- intake during dentition devel
• diffuse white opacities due to hypomin

mild forms
- scattered white flecks, spots, frosty edges,

moderate - severe forms
- larger white spots
- severe/rare = rough pitted surfaces

Question 13

describe endogenous intrinsic staining : amelogenesis imperfecta

Answer 13

• developmental - often inherited - affecting enamel

predominant clinical manifestations
- hypoplasia
- hypomin
- combined phenotype

Question 14

describe intrinsic staining : pulp necrosis

Answer 14

grey/brown staining
- not all non vital teeth discolour
- occ when pigments from decomp Hb and pulp tx penetrate dentin tubules

Question 15

describe intrinsic staining : green/yellow/brown

Answer 15

• tetracycline staining in band appearance on tooth
• drugs cross placenta and enter fetal circ
• discolours the child teeth if mother uses AB during 3rd trimester + adult teeth if drug was administered during infancy

green intrinsic staining can also be from bile pigments from bilirubin depos in hard tx

Question 16

describe intrinsic staining : dentinogenesis imperfecta

Answer 16

• hereditary
• discolouration = most often blue-gray, yellow-brown or translucent
• hypoplastic/hypocalc enamel defects in ~ 1/3 of pts = enamel breaks awar from underlying defective dentin and exposd dentin may undergo severe and rapid attrition
• radiographically = teeth have bulbous crowns w/ short roots

Question 17

describe exogenous intrinsic staining + possible tx options for discoloured teeth

Answer 17

• tobacco/green stains can become intrinsic
• resto materials can also stain

possible tx
- selective prophylaxis
- air/acid/pumice abrasion
- vital bleaching
- non vital bleaching
- indirect/direct resto

Question 18

list EIGHT factors in determining prognosis of periodontal disease

Answer 18

1. disease severity
2. age
3. systemic disease/ condition
4. genetics
5. mobility
6. furcation
7. smoking
8. pt compliance
9. root resorption

Question 19

describe the Stefanac Guide to Treatment Planning

Answer 19

1. systemic phase
   - eg stress/fear managment, any necessary tx considerations for systemic disease
2. acute phase
   - resolve acute problems
3. disease control phase
   eg
   - address aetilogical factors in disease processes
   - caries removal
   - extraction of hopeless/problematic teeth
   - ideal time for re-evaluation during periodontal tx = 8 weeks
4. definitive tx phase
   eg
   - adv perio therapy
   - consider periodontist referral [5mm pocket or greater at re-evaluation appt]
   - occlusal adjustments
5. maintenance phase
   continuing care provided by the dental team at selected intervals to assist the periodontal patient in maintaining oral health following the completion of non surgical/surgical therapy eg
   - updating hx
   - E/O I/O exams
   - radiographs
   - scale/polish