Tooth Discoloration

The dentist is faced with a daunting task in application of clinical skills to achieve maximum cosmetic results when it comes to the management of discoloured and/or hypoplastic dentition. In this paper, an overview is made of the diagnosis and the management of these broadly termed conditions and the cost-effectiveness of the various modalities discussed.

Pi 'i-iodoniol 1995'i-iodoniol : 22: 923-928. © Munksgaard. 1995 Ahsrraci. Staining ofleelh and mucous membranes is a well-known side-effect with chiorhexidine mouthrinses in which dietary chrotnogcns play an important role. The purpose of (his study was to detertnine whether a co-polymer antiadhcsivc agent would prevent staining by a low concentration chiorhexidine solution. Additionally, the possibility thai an essential oil/phenolic rinse product may cause staining was investigated. The rinses studied were the anti-adhesive alone and combined with 0.02'-'^. chiorhexidine and the essential oil/phenolie rinse. These were positioned against a positive control rinse, 0.2"/u chiorhexidine. and a negative control rinse, water. Tlie study was a single blind 5-trealment. randomised Latin square cross-over design, incorporating balance for carry-over effects. 15 volunteers participated and on Day 1 of each study period were rendered stain free by scaling and polishing of the teelh. Oral hygiene was suspended and 8x per day subjects rinsed under stipervision. firstly with the allocated formulation and then with 10 ml of warm black tea. On Day 4. tooth and tongue staining was scored by area and intensity (colour). A washout period of at least 3'/2 days was permitted between treatment periods when oral hygiene was resumed. Before ihe study and during washouts, volunteers practised tongue brushing. Tooth and tongue staining was significantly increased with 0.2% chiorhexidine compared to the essential oil/phenolic rinse which in turn was significantly increased compared to the other 3 rinses. The antiadhesive,'chlorhexidine rinse produced no more staining than the anti-adhesive or water rinse. However, the parallel plaque regrowth study suggests this inhibition of staining resulted from the vitiation of the chiorhexidine activity by the antiadhcsive. The methodology would appear a simple and quick way of assessing the propensity of mouthrinses to cause extrinsic staining.

This article reviews the efficacy of a new 6.5% hydrogen peroxide tooth-whitening gel strip for bleaching teeth that have been intrinsically stained from tetracycline. Given the severity of staining in the cases presented during a recently conducted clinical trial, the resulting efficacy is dramatic. Additionally, the continuous use of these strips for 30 minutes per day, twice daily for 2 months with no meaningful adverse effects is noteworthy.

Rapid innovation in vital bleaching continues to expand the number of treatment options available to patients, particularly in the area of at-home whitening. The development of bleaching strips represented a new paradigm in the delivery of peroxide. The efficacy and safety of bleaching strip systems delivering up to 6.5% hydrogen peroxide has been established in numerous randomized clinical trials. In 2003, a novel bleaching strip with 14% hydrogen peroxide (Crest Whitestrips Supreme) was introduced. This advanced system carries a thinner but more concentrated gel on each strip, resulting in a relatively similar total amount of peroxide as compared to other strip systems. This 2-variable change, higher concentration gel with lowered gel volume translates to improved whitening without adversely affecting oral soft tissue tolerability and irritation. This paper provides an integrated review of 9 comparative clinical trials evaluating the whitening response (six trials) and safety (nine trials) of this novel vital bleaching system. Efficacy results for the 14% hydrogen peroxide strips were significantly (p<0.05) better than the placebo or pooled positive controls evaluated in the clinical trials assessing tooth color or shade. Adverse events were similar in type to the other vital bleaching systems. Overall, the research of 408 patients showed generally better efficacy and similar to or better tolerability for the 14% hydrogen peroxide strips compared to a selected group of marketed positive bleaching controls.

This clinical trial tested the efficacy and safety of a professional strip-based whitening system (Crest Whitestrips Supreme) using the manufacturer&#39;s recommended 3-week treatment regimen. These strips have a higher concentration, but a similar amount of hydrogen peroxide relative to Crest Professional Whitestrips, because the thickness of the gel on strips is reduced. Tooth whitening was measured using the value-oriented VITA Classic Shade Guide before and after treatment. Twenty-nine subjects were treated with either Crest Whitestrips Supreme or placebo strips that did not contain hydrogen peroxide. Participants in the experimental group achieved a mean lightening of nearly eight VITA shades relative to placebo, with minimal side effects.

Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques. (J Endod 2008; 34:394 -407)

To evaluate, using conventional in vitro procedures, the abrasivity, enamel polishing properties, and stain removal effectiveness of various commercial dentifrices that have a variety of compositions and are marketed for cleaning, whitening, and/or polishing capabilities, and to examine their relationships between stain removal and abrasivity. The Relative Dentin Abrasivity (RDA) method was used to measure abrasivity, and the Pellicle Cleaning Ratio (PCR) procedure was used to evaluate stain removal performance. A Cleaning Efficiency Index (CEI) was calculated using the RDA and PCR values. Enamel polish was determined on bovine enamel specimens using a reflectometer. All treatments were performed on a V-8 cross-brushing machine using aqueous dentifrice slurries and standard nylon-bristle toothbrushes. A total of 26 dentifrices, purchased at retail, were tested against the American Dental Association (ADA) calcium pyrophosphate reference standard. All dentifrices removed extrinsic st...

alcilic metamorphosis (CM) is seen commonly in the dental pulp after traumatic tooth injuries and is recognized clinically as early as 3 months atter injury Calcitic metamorphosis is characterized by deposition ot hard tissue within the root canai space and yellow discoloration of the clinical crown Opinion differs among practitioners as to whether to treat these cases upon early detection ot CM or to observe them until symptoms or radiographie signs of pulpal necrosis are detected. In this review, the clinical, radiographic, and histopathologic appearance ot CM is described; a review ot the iiterature is presented to address these issues in an attempt to establish a sound rationale for treatment. Approximately 3,8% to 24% of traumatized teeth develop varying degrees ot CM, Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis. Most ot the literature does not support endodontic intervention unless periradioular pathosis is detected or the involved tooth becomes symptomatfc. It may be advisable to manage cases demonstrating CM through observation and periodic examination, (Quintessence int 200132-447-455)

The purpose of this article is to identify the incidence of complications and the most common complications associated with single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores. A Medline and an extensive hand search were performed on English-language publications covering the last 50 years. The searches focused on publications that contained clinical data regarding success/failure/complications. Within each type of prosthesis, raw data were combined from multiple studies and mean values calculated to determine what trends were noted in the studies. The lowest incidence of clinical complications was associated with all-ceramic crowns (8%). Posts and cores (10%) and conventional single crowns (11%) had comparable clinical complications incidences. Resin-bonded prostheses (26%) and conventional fixed partial dentures (27%) were found to have comparable clinical complications incidences. The 3 most common complications encountered with all-ceramic crowns were crown fracture (7%), loss of retention (2%), and need for endodontic treatment (1%). The 3 most common complications associated with posts and cores were post loosening (5%), root fracture (3%), and caries (2%). With single crowns, the 3 most common complications were need for endodontic treatment (3%), porcelain veneer fracture (3%), and loss of retention (2%). When fixed partial denture studies were reviewed, the 3 most commonly reported complications were caries (18% of abutments), need for endodontic treatment (11% of abutments), and loss of retention (7% of prostheses). The 3 most common complications associated with resin-bonded prostheses were prosthesis debonding (21%), tooth discoloration (18%), and caries (7%). (J Prosthet Dent 2003;90:31-41.)

Several statistical methods have been proposed for estimation of age from teeth in human adults. Due to the smallness of the material or statistical shortcomings in previous reports, improvements of the methods were desirable and seemed possible. As a contribution to such improvement various age-related changes have been studied in a material of 1000 teeth. For each type of change the kind of measurement most strongly related to age was chosen, and a multiple regression analysis was run with age as the dependent variable, using SPSS/PC+ statistical program. Statistically significant formulae were calculated for each type of tooth excluding molars. Because the sex of a deceased body may be unknown and the tooth colour influenced by changes after death, separate formulae excluding these factors were calculated. For the calculated formulae the Pearson correlation (r) varied from 0.76 in mandibular second premolars (SEX and COLOUR excluded), to 0.91 for maxillary central incisors; a rather promising result compared with other methods. In addition, the intercorrelations between the age-related factors were calculated after control for the effect of age. In some types of teeth, but not in all, some of the factors displayed significant intercorrelation. To compare these formulae with previous methods an unbiased test in another independent material is needed.

The studies described in this paper aimed to assess the stain removal efficacy, fluoride efficacy and abrasivity to enamel and dentine of a new whitening toothpaste containing calcium carbonate and perlite, using appropriate in vitro models. Stain removal efficacy was assessed using the pellicle cleaning ratio (PCR) method. Fluoride efficacy was assessed using remineralisation, demineralisation and fluoride-uptake methods. Abrasivity was assessed using an enamel and dentine wear method. The results showed that the new whitening toothpaste was able to remove extrinsic tooth stain more effectively than three commercially available toothpaste formulations. The fluoride efficacy was superior to a non-fluoridated control and was not significantly different to a clinically tested fluoride-containing toothpaste. The abrasivity data showed that the calcium carbonate/perlite toothpaste is no more abrasive to enamel or dentine than two other commercially available whitening toothpastes. The s...

Several tooth whiteners are available on the market, and the ideal choice should be determined by efficacy and optimal clinical results. The purpose of this study was to compare the reported clinical success rates of different tooth whitening products. The relevant literature (1998 - 2011) was studied, using as sources the databases: Google Scholar, Science Direct, Medline and Pubmed. Selection criteria: The material was clearly identified, the manufacturers&#39; instructions were respected and the sample size stated. This descriptive report on 49 papers focuses on the total colour change, measured with a calibrated shade guide and also numerically (colourimeter, chromameter or spectrophotometer), the relapse of the colour change and tooth sensitivity. In general, the dentist-supervised at-home bleaching and the in-office treatment gave approximately the same initial percentage improvement of tooth whitening. However, the relapse after a four week or longer period was significantly ...

Introduction: True regeneration of the dental pulpdentin complex in immature teeth with necrotic pulps has not been shown histologically. It is not known to what extent this true tissue regeneration is necessary to achieve clinically acceptable outcomes. Methods: This case report describes the treatment of a patient with an immature maxillary right central incisor with a history of impact trauma and enamel-dentin crown fracture. A diagnosis of pulp necrosis with acute apical abscess was established. A regenerative endodontic protocol that used a paste containing Augmentin for 5 weeks as an intracanal medicament was used. Results: Follow-ups at 9, 12, 17, and 31 months revealed complete osseous healing of the periapical lesion and formation of the root apex, but without increase in root length. Clinically, the tooth was functional, asymptomatic, and nonresponsive to pulp vitality tests. The crown discolored over time. On reentering the root canal, no tissues were observed under magnification inside the root canal space. The root canal treatment was completed with mineral trioxide aggregate obturation. Conclusions: Augmentin might be an acceptable choice for root canal disinfection in regenerative endodontic procedures. The protocol for regenerative endodontic treatment is not predictable for pulp-dentin regeneration. Formation of the root apex is possible without pulp regeneration. (J Endod 2013;39:1291-1295

The esthetic treatment of darkened anterior teeth represents a great challenge to dentists, because dental materials ideally should match the natural teeth. The optical behavior of the final restoration is determined by the color of the underlying tooth structure, the color of the luting agent, and the thickness and opacity of the ceramic material used. This article reports a case in which veneers and full crowns made of heat-pressed, lithium disilicate glass-ceramic were used for the esthetic rehabilitation of anterior discolored teeth. The patient was referred for treatment with defective anterior composite resin restorations, provisional acrylic resin crowns, darkening of the gingival margins, and uneven gingival contours. The multidisciplinary treatment plan included dental bleaching, periodontal plastic surgery to create gingival symmetry, and indirect all-ceramic restorations using high-opacity lithium disilicate glass-ceramic ingots. The treatment was successful and an excell...

A wide spectrum of drugs can sometimes give rise to numerous adverse orofacial manifestations, particularly dry mouth, taste disturbances, oral mucosal ulceration, and/or gingival swelling. There are few relevant randomized double-blind controlled studies in this field, and therefore this paper reviews the data from case reports, small series, and non-peer-reviewed reports of adverse drug reactions affecting the orofacial region (available from a MEDLINE search to April, 2003). The more common and significant adverse orofacial consequences of drug therapy are discussed.

Ahmed HMA, Abbott PV. Discolouration potential of endodontic procedures and materials: a review. International Journal, 45, 883-897, 2012. Advances in endodontic materials and techniques are at the forefront of endodontic research. Despite continuous improvements, tooth discolouration, especially in anterior teeth, is considered an undesirable consequence following endodontic treatment as it creates a range of aesthetic problems. This article aims to discuss the intrinsic and internalized tooth discolouration caused by endodontic procedures, and to address the discolouration potential of materials used during root canal treatment, including root canal irrigants, intracanal medicaments, endodontic and post-endodontic filling materials. In addition, the discolouration patterns caused by combined endodontic and nonendodontic aetiological factors are discussed. The recommended guidelines that should be followed by dental practitioners to prevent and manage tooth discolouration are also outlined.

Invasive cervical resorption (ICR) is a relatively uncommon form of external resorption, which may occur in any tooth in the permanent dentition. Characterized by its cervical location and invasive nature, this resorptive process leads to progressive and usually destructive loss of the tooth structure, the clinical features of which often resemble internal resorption (&quot;pink tooth&quot;). This article describes a case report of ICR and its management. The salient features were a large resorptive defect and localized fibrous in-growth located almost wholly on the cervicolabial aspect of the maxillary incisor crown involving the enamel and dentin.

Background: Adhesive systems, resin composites, and light curing systems underwent continuous improvement in the past decade. The number of patients asking for ultraconservative treatments is increasing; clinicians are starting to reevaluate the dogma of traditional restorative dentistry and look for alternative methods to build up severely destroyed teeth.

Parents increasingly request esthetic restorations for their children&#39;s teeth. This split mouth, randomized controlled trial compared primary molars treated with white MTA pulpotomies and restored with either multi-surface composites (MSC) or stainless steel crowns (SSC). Forty matched, contra-lateral pairs of molars received MTA pulpotomies and were randomly assigned to MSC or SSC restorations and evaluated clinically and radiographically at 6 and 12 months. Two calibrated, blinded examiners evaluated and scored radiographs. Thirty-seven matched pairs were evaluated at 6 months, and 31 were available at 12 months. All teeth in both groups were radiographically and clinically successful at 6 and 12 months. Dentin bridge formation was noted in 20% of the primary molars by 12 months. Although not significant, the composite group exhibited fewer intact clinical margins than the SSC group. The vast majority (94%) of teeth restored with composite displayed gray discoloration at follo...

Dental fluorosis manifests itself as white stains on the enamel of teeth exposed to excessive doses of fluoride during their formation. Fluorosis usually occurs as a result of the ingestion of dentifrices, gels and fluoridated solutions. It may be diagnosed as mild, moderate or severe, and in some cases, it may cause the loss of the surface structure of dental enamel. The aim of this study was to report the clinical case of a female patient of 18 years with moderate fluorosis, whose smile was reestablished by the use of an enamel microabrasion technique, followed by in-office bleaching. A microabrasion technique with 6% hydrochloric acid associated with silica carbide showed to be a safe and efficient method for removing white fluorosis stains, while dental bleaching was useful for obtaining a uniform tooth shade. The association of these techniques presented excellent results and the patient was satisfied. Both techniques are painless, fast and easy to perform, in addition to prese...

Systemic disorders in pediatric patients, such as congenital biliary atresia, acute liver failure, and biliary hypoplasia, may be the indications for a need of liver transplantation. One of the manifestations of these disorders is the elevated serum levels of bilirubin (hyperbiliru-binemia), a product of hemoglobin degradation, which is deposited in different tissues, including mineralized and soft tissues. When hyperbilirubinemia occurs during the period of dental development, these teeth can develop a green coloration, which remains permanently, because, after maturation, these tissues loose their metabolic activity. This case report describes a 9-year-old girl who required a liver transplant due to biliary atresia when she was three years old. Some of her pigmented teeth needed extraction and afterwards were submitted for histological analysis and compared with sound teeth.

This clinical report describes the oral rehabilitation of a 19-year-old woman diagnosed with hypoplastic-type amelogenesis imperfecta (AI). She presented with discolored and mutilated teeth, missing teeth, anterior open bite, and posterior short crowns. She was classified as an American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class III patient. The aim of treatment was to restore esthetics and improve masticatory function. The patient's esthetic and functional expectations were successfully attained with porcelain laminate veneers and all-ceramic and metalceramic restorations after extensive crown lengthening. The patient was regularly recalled during the postoperative period. Loss of retention of one all-ceramic crown and minimal recession of the gingiva of one laminate veneer were noted at 4-year recall.

Tetracyclines (TCN) were introduced in 1948 as broad-spectrum antibiotics that may be used in the treatment of many common infections in children and adults. One of the side-effects of tetracyclines is incorporation into tissues that are calcifying at the time of their administration.

This study assessed the efficacy of a 0.12% chlorhexidine gluconate (CHX) rinse on the enhancement and maintenance of gingival health in patients receiving fixed prosthodontic treatment. Thirty patient participants in this examiner blind study were randomly assigned into two groups, one control and another group using CHX 15 ml b.i.d. in addition to normal oral hygiene. The medication was used for 2 weeks prior to crown preparation, 3 weeks during provisional crown placement, and 2 weeks after definitive crown cementation. Plaque and gingivitis indices were measured initially and at the three aforementioned points during the ?-week period. The plaque index for the control group decreased by 0.26 units; CHX decreased by 0.63 units at 7 weeks. The gingival index of the control group decreased by 0.37 units; CHX decreased by 0.87 units. Adjunctive use of chlorhexidine with fixed prosthodontic procedures significantly reduced plaque levels and significantly improved gingival health compared with the control patients. Fixed prosthodontic procedures alone decreased plaque levels and increased gingival health. (J PROSTHET DENT 1991;65:100-7.)

The most common esthetic challenge associated with endodontics is the discoloration of natural tooth structure. Also in fixed prosthesis, discolorations represent an esthetic limit, particularly in the case of all-ceramic restorations. In fact, the final esthetic result can be compromised by the grey radiated through the coping and soft tissue. The aim of the study was to evaluate the masking ability of Procera alumina restorations. Clinical evaluation was investigated by using tests of discolored teeth. Each abutment, classified with Natural Die Material (Ivoclar Vivadent), were manufactured three alumina copings with thickness of 0.4, 0.6, and 0.8 mm, respectively. Masking ability for each coping was evaluated in relation to the degree of discoloration. On the basis of the results obtained, seventeen discolored teeth, treated with Procera alumina restorations, were evaluated. Color match, porcelain surface, marginal discoloration, and marginal integrity were clinically examined fo...

Purpose: To evaluate the tooth whitening benefit through stain removal delivered by a marketed whitening dentifrice (Crest Vivid White) used twice a day or a combination regimen of two marketed dentifrices (Crest Vivid White Night used at night and Crest Cavity Protection used in the morning) relative to a positive control over a 2-week period. Methods: Both studies were randomized, two treatment, parallel group, examiner-blind, 2-week clinical trials involving 22 and 30 healthy adults with longstanding visible extrinsic stain on the facial surfaces of at least six anterior teeth. In each study, subjects were randomized to one of two treatments: a sodium fluoride/sodium hexametaphosphate whitening dentifrice used alone (Study 1) or in combination with a cavity protection dentifrice (Study 2) with an ADA reference manual toothbrush versus a control power toothbrush with a cavity protection dentifrice (both studies). Results: In both studies, all treatment groups statistically significantly (P < 0.001) reduced baseline stain scores following 1 and 2 weeks of brushing. After 2 weeks, the whitening dentifrice used twice daily had a median percent stain removal of 90% and the night-time whitening dentifrice (used once a day) in combination with the cavity protection dentifrice had a median percent stain removal of 85% while powered toothbrush groups showed median percent stain removal of 88-89% in both studies. Stain removal scores after 1 and 2 weeks of brushing did not differ significantly between the two treatment groups in either study.

available to reconstruct nonvital abutment teeth. The traditionally used metal posts exhibit excellent material stability and have rendered good clinical long-term results. 1 Because of their color and inadequate light transmission, however, metal posts and metallic post-and-core buildups may compromise the esthetic result of the final reconstruction. 2 On the one hand, gray metal posts are assumed to be one possible reason for the discoloration of the root, leading to a grayish shadowing of the gingiva in the cervical area. 2,3 This speculation, however, has not been proved to date. On the other hand, clinical reports demonstrated that dark posts and cores may lead to a discoloration of the reconstruction in the marginal region. 4-9 This may occur particularly when gray metal posts are combined with translucent allceramic reconstructions. 5 Hence, to achieve esthetically pleasing results, the dark, gray Objective: To evaluate whether post materials affect the color of roots, composite cores, and all-ceramic crowns. Method and Materials: Forty extracted human incisors were divided into four groups. White posts made of zirconia (Zi) or glass fiber (Gf) and gray posts made of titanium (Ti) or carbon fiber (Cf) were randomly assigned to the roots. Composite cores and glass-ceramic crowns were made. The color of the roots, cores, and crowns was captured (Spectroshade). The mean color difference (m⌬E) among the groups was calculated for the following comparisons: A-root: empty root versus post and core; B-root: post and core with and without cement; C-core: white versus gray posts and cores; D-lower third of crown versus original ceramic ingot; E-center of crown versus ingot. Statistical analysis was performed by ANOVA, Kruskal-Wallis, and Sheffé tests. Results: White, as well as gray posts, induced little changes of the root color (A, B). Gray

The survey had a response rate of 70%. Most practitioners (93%) routinely recommended dental prophylaxis for their recall patients. The proportion of practitioners who considered the following indications for recommending dental prophylaxis was: plaque, stain, and/or calculus removal -99%; caries prevention -75%; prior to topical fluoride application -82%; prior to sealant application -58%; and for behavioral modification -68%. Almost two thirds of the practitioners (62%) defined dental prophylaxis as referring to both rubber cup pumice prophylaxis as well as to toothbrush prophylaxis. However, only one in four practitioners (26%) had modified her/his clinical practice to substitute toothbrush prophylaxis in lieu of rubber cup pumice prophylaxis.

To date, no continuous scale exists for measuring the severity of dental fluorosis (DF). Objectives. The authors developed and validated a visual analog scale (VAS) for DF. They tested the scale in clinical (DFendemic area) and laboratory settings. Methods. Dentists and nondentists (23 per group) were asked to grade the DF severity in photographs of 23 anterior teeth with different DF levels (using a 100millimeter VAS) to create a VAS for DF. Statistical analysis was performed to validate the new scale. The authors used clinical and laboratory (unerupted third molars) analyses to assess the usefulness of the VAS. Results. The authors used an intraclass correlation coefficient (ICC) to assess the interexaminer (ICC = .79: good agreement) and intraexaminer (.88 < ICC < .97: excellent agreement) reliability during creation of the scale. They used the Spearman rank correlation (r s ) to validate the VAS against the gold standards (that is, the Thylstrup-Fejerskov index [TFI] and Dean's index [DI]) (the results showed excellent or good correlation for 45 examiners). Two dentist examiners clinically tested the new VAS, and the results showed excellent (r s = .922, P < .001) correlation and excellent ICC between the examiners (ICC = .96), as well as good ICC between the TFI and the VAS for DF (ICC = .6). The laboratory study showed better correlation between fluoride concentration and the VAS for DF than between fluoride concentration and the TFI. Conclusion. Because of its simplicity, precision and utility in statistical applications, the VAS for DF can be useful in DF studies.