Introduction

Defined as any change in the hue , colour or translucency of the tooth due to any
cause Discoloration of the tooth results from trauma, loss of vitality, endodontic
treatment, and restorative procedures The remnants of the blood stain consequent
to trauma or incomplete removal of pulp during endodontic treatment lead to
hemolysis. The chromogenic blood degradation products, such as hemosiderin,
hemin, hematin, and hematoidin, get deposited in the dentinal tubules The
accumulated breakdown products lead to grayish-yellow to brown discoloration of
the teeth. Other causes such as obturation materials, remnants of pulp tissue in the
pulp horns, intracanal medicaments, and coronal restorations may also cause
discoloration. The discolored anterior teeth can cause significant esthetic concerns.

Discoloration of the tooth can erode the sparkle from a smile. In the management
of patients with discolored tooth, knowledge of the mechanisms behind tooth
discoloration is of relevance as it can influence the treatment plan. In certain
instances it may even have an effect on the outcome of the treatment.

Classification of tooth discoloration

Intrinsic discoloration

The intrinsic discoloration occurs when the chromogens are deposited within the
bulk of the tooth, which maybe of local or systemic origin.

Extrinsic discoloration

Extrinsic discoloration is defined as discoloration located on the outer surface of

the tooth structure and is caused by topical or extrinsic agents.

Causes

Factors responsible for Example color

extrinsic discoloration
Diet Tea, coffee & other foods Brown to black
Oral hygiene Dental plaque, calculus & Food Yellow/brown/black/green/orange
particles Chromogenic bacteria
Medications Cationic antiseptics e.g.: Yellow brown
chorhexidine
Sysgtemic antibiotics e.g Green-gray
Minocycline
 Iron containing oral solutions Black
Copper salt in mouth rinse
Potassium permanganate in Black
mouth rinse Green
Stannous fluoride Violet to black
gray
Habits Tobacco smoking/chewing Dark brown/black
Pan chewing Red-black
Occupation and environment Exposure to iron, manganese, black
silver
Factors responsible for Example color
intrinsic discoloration
Disturbance of tooth Germ Localized Turner Tooth White to Yellow to Brownish
Generalized Infection (maternal
or childhood) Nutritional
deficiency Molar Incisor
Hypomineralization
Genetic Disorder Amelogenesis imperfecta Yellow to Brown
Amelogenesis imperfecta Blue to brown
dentin dysplasia Yellow
Systemic syndrome e.g.: Yellow
Epidermolysis bullosa
Pulpal causes Pulpal trauma with hemorrhage Gray-brown
Calcific metamorphosis Yellowish to yellowish brown
Internal resorption Pinkish
Dental materials Amalgam Blue-gray
Composite/GIC Yellowish brown
Intra canal medicaments e.g. Brownish gray
lodoform, Ledermix
Obturating materials & sealers Grayish
Environmental Tetracycline Yellow, brown, blue or grayish
Minocycline Blue – green
Ciprofloxacin Greenish
Fluoride supplements Chalky white to brown/ black

Diagnosis
History The patient's history of tooth discoloration provides useful information regarding the etiology .
The history should include the following:

 Dental history (previous dental treatment, oral hygiene practices, use of mouthwashes, amount
and scheduling of fluoride intake, history of dental trauma )
 Medical history (history of maternal or childhood diseases, use of medications)
 Family history (genetic disorders)
 Diet history (nutritional deficiencies, diet that can cause staining of the teeth)
  Social history (occupational exposure to metals, use of tobacco) Clinical Examination

Over the years, a number of bleaching and restorative techniques have been proposed for managing discolored
nonvital incisors.[3],[8] Walking bleach technique is based on the use of chemicals that release active oxygen such as
hydrogen peroxide (H2O2) or sodium perborate (SP). A combination of SP and water or H2O2 has been used in the
“walking bleach” technique.[9],[10] The outcome of the bleaching depends mainly on the concentration of the bleaching
agent, ability of the agent to reach the chromophore molecules, and duration and number of times the agent is in
contact with chromophore molecules.[11] Although H2O2 exhibited excellent esthetic outcome, the undesirable
consequences such as cervical resorption and irreversible damage to the dentin and surrounding tissues led the
clinicians to look for alternative methods.

SP has been widely used to bleach nonvital teeth with predictable results.[3] SP is an oxidizing agent containing 95%
perborate and is available in three forms: monohydrate, trihydrate, and tetrahydrate. In the presence of water,
perborate will break down to form sodium metaborate, H2O2, and oxygen. SP is also synergistically used with
H2O2 but when used with water released H2O2 in a controlled manner with remarkable esthetic outcome with little or
no side effects.[12] The SP releases active oxygen radicals inside the pulp chamber and diffuses to the dentinal
tubules.[13] It oxidizes and bleaches the iron sulfide and other pigments present in the dentinal tubules and the free
radicals induces oxidative effects to lipids, proteins, and nucleic acids.[7],[14] A case of successful bleaching of
discolored nonvital, endodontically treated tooth using walking bleach technique with SP and water was reported. The
case was followed up for 1 year with no relapse or side effects.

http://www.jioh.org/article.asp?issn=0976-
7428;year=2017;volume=9;issue=3;spage=133;epage=135;aulast=Almohareb

//////////////////////////

What Is It?
Your teeth can become discolored by stains on the surface or by changes in the tooth material.
Dentists divide discoloration into three main categories:

o Extrinsic discoloration — This occurs when the outer layer of the tooth (the enamel) is
stained by coffee, wine, cola or other drinks or foods. Smoking also causes extrinsic stains.
o Intrinsic discoloration — This is when the inner structure of the tooth (the dentin) darkens
or gets a yellow tint. Causes include excessive exposure to fluoride during early childhood,
the maternal use of tetracycline antibiotics during the second half of pregnancy and the use
of tetracycline antibiotics in children 8 years old or younger.
o Age-related discoloration — This is a combination of extrinsic and intrinsic factors. In
addition to stains caused by foods or smoking, the dentin naturally yellows over time. The
enamel that covers the teeth gets thinner with age, which allows the dentin to show through.
Chips or other injuries to a tooth can also cause discoloration, especially when the pulp has
been damaged.

In rare cases, children with a condition called dentinogenesis imperfecta are born with gray, amber
or purple discolorations.

Symptoms
Symptoms include stains on the enamel or a yellow tint in the dentin.

Diagnosis
No special tests are needed. A dentist can diagnose tooth discoloration by looking at the teeth.

Expected Duration
Some tooth discoloration can be removed with professional cleaning, but many stains are permanent
unless the teeth are treated (whitened) with a bleachin

gel.

Prevention
Brushing your teeth after every meal will help to prevent some stains. Dentists recommend that you
rinse your mouth with water after having wine, coffee or other drinks or foods that can stain your
teeth. Regular cleanings by a dental hygienist also will help to prevent surface stains.

Intrinsic stains that are caused by damage to a nerve or blood vessel in the inner part (the pulp) of a
tooth sometimes can be prevented by having root canal treatment, which removes organic material
before it has a chance to decay and darken. However, teeth that undergo root canal treatment may
darken anyway. To prevent intrinsic stains in children, avoid water that contains a high fluoride
concentration. You can check the concentration of fluoride in your drinking water supply by calling
the public health department. Then consult your dentist.

Discoloration often can be removed by applying a bleaching agent to the enamel of the teeth. With a
technique called "power bleaching," the dentist applies a light-activated bleaching gel that causes
the teeth to get significantly whiter in about 30 to 45 minutes. Several follow-up treatments may be
needed.

It's also possible to remove discoloration with an at-home bleaching gel and a mouth guard given to
you by your dentist. The bleaching gels designed for use at home aren't as strong as those applied
by your dentist, so the process takes longer — usually two to four weeks. Whitening toothpastes
may remove minor stains, but they aren't very effective in most cases.

If you've had a root canal and the tooth has darkened, your dentist may apply a bleaching material to
the inside of the tooth.

When a tooth has been chipped or badly damaged or when stains don't respond to bleaching, your
dentist may recommend covering the discolored areas. This can be done with a composite bonding
material that's color-matched to the surrounding tooth. Another option is to get veneers, which are
thin shells of ceramic that cover the outer surfaces of the teeth.
///////////////////////////////////////////////////////////////////////////////////////////////////

Causes of tooth discoloration

 Decomposition of pulp tissue- most common cause. Intensity of discoloration is directly related to the
duration of time the pulp has been necrotic.
 Trauma – traumatic injury of a tooth may cause the blood vessel in the pulp to rupture, with diffusion
of blood into the dentinal tubules.

 Pulpal hemorrhage during extirpation – discoloration may occur if hemorrhage is excessive during
pulp extirpation.

 Calcific metamorphosis - it is a condition characterized by rapid deposition of hard tissue within the
root canal. Usually seen in the anterior teeth following trauma.

 Traumatic injury transient disruption of blood supply cause destruction of odontoblast replaced by
cells of the indifferenciated mesenchymal cell lay down tertiary dentin tooth become opaque due to loss
of translucency.

 Filling material – Discoloration Depends on the kind of filling used. Silver amalgum– slate gray to
dark gray Copper amalgum– bluish black to black stain Stain from amalgum are likely to occur when
the dentinal wall is thin. Microleakage of old resin composite restoration might cause dark
discoloration of the margins and may stain the dentin overtime. Metal post can be seen through the
translucent enamel or may release metallic ions causing discoloration. Fewer than 5% of treated
pulpless teeth become noticeably discolored because of dehydration of tooth substance with
subsequent loss of translucency.

 Root canal medicaments– certain medicaments cause discoloration. Some stain the tooth diretly
Other stain only on decomposing or combining with other agents used in endodontic treatment.
Example- essential oils from resinous substance.

 Aging– during natural aging process, the physiological deposition of secondary dentin.  Iatrogenic
discoloration– caused by certain dental material or inappropriateoperating techniques.

file:///F:/Users/lenovo/Downloads/toothdiscoloration-180824032650.pdf

/////////////////////////

https://www.slideshare.net/SupritPawar/discoloration

////////////////

https://www.slideshare.net/AhmedAbbas45/teeth-discoloration-61520135?from_action=save

‫اهم مصدر‬

//////////////////////////////////////////////////////////////////////////////////////////////////////////////
///////////////////

conclusion

In the management of patients with discolored tooth, an understanding of the mechanism behind the
discoloration is of relevance to the dental practitioner as it can be valuable in the decision-making
process when considering how to treat the condition. An understanding of the pathological process
involved can assist in explaining the cause toanxious or concerned patients/ parents.

‫اهم مصدر‬

https://eprints.manipal.edu/1970/1/21._Nig_Dent_J._2010_etio_discolo.pdf

///////////////////////////////