Tooth Discoloration Follow-up

  • Author: A Ross Kerr, DDS; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Nov 22, 2011
 

Further Outpatient Care

Patients who undergo dental procedures (eg, bleaching, restorations) for tooth discoloration should be monitored periodically.

In addition to routine dental and periodontal evaluation, some patients may require additional bleaching treatments to maintain aesthetic results.

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Deterrence/Prevention

Clinicians can help in preventing fluorosis by teaching parents about fluoride use and good toothbrushing habits for children.

Changes in dietary and toothbrushing habits and professional cleaning and treatment may help in preventing tooth discoloration (see Medical Care).

See Pathophysiology and Causes.

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Complications

All irreversible dental treatments have the potential to cause complications.

Bleaching (eg, home bleaching) and restorative procedures are safe if performed by or under the supervision of a dentist with appropriate training and experience.

  • Vital bleaching causes short-term tooth sensitivity (1-4 d) in two thirds of patients (see Medical Care).
  • Patients with preexisting restorations, cervical erosions, enamel cracks, large pulp chambers, or sensitive teeth before treatment are at higher risk for postbleaching sensitivity.
  • The use of a mild bleaching agent, shortened application time and frequency, and topical fluoride therapy can reverse this sensitivity.[31]
  • Allergic reactions to bleaching agents are rare.

Restorative procedures, including bonding and the use of laminate veneers and fixed prostheses (eg, crowns and bridges), can result in pulpal or periodontal complications; however, careful treatment planning and therapy can minimize these complications.

Depending on the anatomic site, the proximity to vascular and neurologic vessels, and the oral and systemic condition of the host, oral surgical procedures infrequently can cause sequelae such as hemorrhage; pain; swelling; infection; and motor, nerve, or sensory deficits.

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Prognosis

The prognosis is excellent if an etiology is identified and if the appropriate dental and medical care providers are involved in the comprehensive diagnosis and treatment of the condition.

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Patient Education

Educate patients about the necessity of daily oral hygiene and about the medications implicated in dental discoloration.

Educate patients who are treated for medical disorders associated with dental discoloration about the risks of tooth-related disorders.

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Contributor Information and Disclosures
Author

A Ross Kerr, DDS  Clinical Associate Professor, Department of Oral & Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry

Disclosure: Nothing to disclose.

Specialty Editor Board

Donald Belsito, MD  Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, and previous author, Jonathan Ship, DMD † , to the development and writing of this article.

References

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Transverse section of a central incisor illustrates the different soft and hard tissue layers of the tooth and the supporting dental-alveolar apparatus.
Dental calculus accumulations on the mandibular anterior teeth.
Stained supragingival plaque and calculus deposits.
Severe tobacco staining.
Image demonstrates a red extrinsic stain at the gingival margins and interproximal and incisal regions of the teeth in a patient with a habit of chewing pan (a combination of betel nut of the areca palm, betel leaf, and lime).
Extrinsic dental staining caused by long-term topical use of 0.12% chlorhexidine mouthrinse.
Image demonstrates dental attrition in a 75-year-old patient due to loss of occlusal enamel structure that reveals the underlying dentin.
Severe dental abrasion and gingival recession due to long-term traumatic toothbrushing habit.
Root surface caries, severe periodontitis, and amalgam restorations.
Extensive dental caries.
Severe root surface and occlusal caries that necessitated tooth extraction.
Severe enamel hypoplasia (ie, Turner tooth) on a secondary (permanent) maxillary central incisor. The patient had an intrusion injury of the primary central incisor during childhood that interrupted the development of the secondary central incisor.
Intrinsic dental discoloration caused by blunt trauma to the mandibular incisors that led to pulpal necrosis.
Dental radiograph demonstrates external resorption and periapical bone loss in a patient with intrinsic dental discoloration caused by blunt trauma to the mandibular incisors that led to pulpal necrosis. Image was obtained in the same patient as in Image 15.
Enamel hypoplasia of the incisal half of the maxillary and mandibular secondary incisors caused by rubella infection when the patient was aged 4 months.
Tetracycline staining of mandibular teeth caused by the ingestion of tetracycline when the patient was aged 3 years.
Mild dental fluorosis causing mottled white intrinsic discoloration of the teeth.
Severe fluorosis of the teeth.
Amelogenesis imperfecta (hypoplastic type 1 form) and associated enamel pitting and extrinsic dental discoloration.
Amelogenesis imperfecta (hypomaturation type 2 form).
Porcelain laminate veneers for the treatment of tetracycline staining.
Table 1. Calcification and Eruption Sequence of Primary Dentition
Primary Teeth Calcification Begins (Weeks In Utero)Enamel Completed (Months after Birth)Eruption (Months after Birth)
Maxilla
Central incisor13-161.58-12
Lateral incisor14.5-16.52.58-13
Canine15-18916-22
First molar14. 5-16.5613-19
Second molar16-23.51125-33
Mandible
Central incisor13-162.56-10
Lateral incisor14.5-16.5310-16
Canine16-18917-23
First molar14.5-175.514-18
Second molar17-19.51023-31
Table 2. Calcification and Eruption Sequence of Secondary Dentition
Permanent Teeth Calcification Begins (Months)Eruption (Years)
Maxilla
Central incisor3-47-8
Lateral incisor10-128-9
Canine4-511-12
First premolar8-2110-11
Second premolar24-2710-12
First molar0-15-6
Second molar30-3612-13
Mandible
Central incisor3-46-7
Lateral incisor3-47-8
Canine4-59-10
First premolar21-2410-12
Second premolar27-3011-12
First molar0-15-6
Second molar30-3612-13
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