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.
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.
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:
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Past medical history
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Concurrent systemic conditions
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Medications (ie, medications taken during pregnancy, early childhood, and at present): This includes prescription and nonprescription drugs, vitamins, nutraceuticals, and homeopathic preparations.
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History of an exposure to chemicals, trauma, or infection
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Exposure to fluoride
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History of dental treatment
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Daily hygiene
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Dietary habits (foods, beverages, candies, chewing gum, mints)
A complete oral examination is required to help determine the etiology of tooth discoloration.
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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.
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Caries are assessed by using a sharp explorer and intraoral radiographs.
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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.
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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).
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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Transverse section of a central incisor illustrates the different soft and hard tissue layers of the tooth and the supporting dental-alveolar apparatus.
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Dental calculus accumulations on the mandibular anterior teeth.
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Stained supragingival plaque and calculus deposits.
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Severe tobacco staining.
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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).
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Extrinsic dental staining caused by long-term topical use of 0.12% chlorhexidine mouthrinse.
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Image demonstrates dental attrition in a 75-year-old patient due to loss of occlusal enamel structure that reveals the underlying dentin.
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Severe dental abrasion and gingival recession due to long-term traumatic toothbrushing habit.
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Root surface caries, severe periodontitis, and amalgam restorations.
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Extensive dental caries.
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Severe root surface and occlusal caries that necessitated tooth extraction.
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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.
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Intrinsic dental discoloration caused by blunt trauma to the mandibular incisors that led to pulpal necrosis.
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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.
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Enamel hypoplasia of the incisal half of the maxillary and mandibular secondary incisors caused by rubella infection when the patient was aged 4 months.
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Tetracycline staining of mandibular teeth caused by the ingestion of tetracycline when the patient was aged 3 years.
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Mild dental fluorosis causing mottled white intrinsic discoloration of the teeth.
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Severe fluorosis of the teeth.
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Amelogenesis imperfecta (hypoplastic type 1 form) and associated enamel pitting and extrinsic dental discoloration.
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Amelogenesis imperfecta (hypomaturation type 2 form).
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Porcelain laminate veneers for the treatment of tetracycline staining.
Tables
|
Primary Teeth Calcification Begins (Weeks In Utero) |
Enamel Completed (Months after Birth) |
Eruption (Months after Birth) |
Maxilla |
|
|
|
Central incisor |
13-16 |
1.5 |
8-12 |
Lateral incisor |
14.5-16.5 |
2.5 |
8-13 |
Canine |
15-18 |
9 |
16-22 |
First molar |
14. 5-16.5 |
6 |
13-19 |
Second molar |
16-23.5 |
11 |
25-33 |
Mandible |
|
|
|
Central incisor |
13-16 |
2.5 |
6-10 |
Lateral incisor |
14.5-16.5 |
3 |
10-16 |
Canine |
16-18 |
9 |
17-23 |
First molar |
14.5-17 |
5.5 |
14-18 |
Second molar |
17-19.5 |
10 |
23-31 |
|
Permanent Teeth Calcification Begins (Months) |
Eruption (Years) |
Maxilla |
|
|
Central incisor |
3-4 |
7-8 |
Lateral incisor |
10-12 |
8-9 |
Canine |
4-5 |
11-12 |
First premolar |
8-21 |
10-11 |
Second premolar |
24-27 |
10-12 |
First molar |
0-1 |
5-6 |
Second molar |
30-36 |
12-13 |
Mandible |
|
|
Central incisor |
3-4 |
6-7 |
Lateral incisor |
3-4 |
7-8 |
Canine |
4-5 |
9-10 |
First premolar |
21-24 |
10-12 |
Second premolar |
27-30 |
11-12 |
First molar |
0-1 |
5-6 |
Second molar |
30-36 |
12-13 |
