Tooth Discoloration Workup

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

Laboratory Studies

A comprehensive head, neck, and oral examination is required. Neck lymphadenopathy may be indicative of infection, an asymmetric mandible may be a sign of previous trauma, and ecchymoses may be suggestive of a bleeding disorder.

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Imaging Studies

Dental radiographs can reveal defects in both tooth structure and alveolar bone. This information is critical for the identification of a potential cause of intrinsic discoloration.

Intraoral radiographs are required to determine whether a dental-alveolar infection is present.

Panographic radiographs may be required if intraoral radiographs do not visualize the apices of the teeth.

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Procedures

The evaluation of a patient with dental discoloration requires a review of the systemic and oral conditions in the patient's history. This review includes the following:

  • Past medical history
  • Concurrent systemic conditions
  • Medications (ie, medications taken during pregnancy, early childhood, and at present): This includes prescription and nonprescription drugs, vitamins, nutraceuticals, and homeopathic preparations.
  • History of an exposure to chemicals, trauma, or infection
  • Exposure to fluoride
  • History of dental treatment
  • Daily hygiene
  • Dietary habits (foods, beverages, candies, chewing gum, mints)

A complete oral examination is required to help determine the etiology of tooth discoloration.

  • To exclude periodontal and gingival disorders, a thorough examination of the periodontium, including an examination of the gingival sulcus by using a periodontal probe, is required.
  • Caries are assessed by using a sharp explorer and intraoral radiographs.
  • To assess the vitality of the affected teeth, cold testing with ice, tetrafluoroethane, or ethyl chloride spray or vitalometer testing with an electric pulp tester is necessary.
  • A visual examination of the oral mucosal surfaces is helpful for identifying systemic conditions that affect soft and hard tissues (eg, bleeding disorders, minocycline staining).
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Histologic Findings

The histologic examination of a discolored tooth is primarily a research endeavor, and it is not performed in daily clinical practice. The likelihood for successful reimplantation is poor once a tooth is extracted.

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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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