Short Communication
Volume 2 Issue 2 - 2015
Tooth Discoloration: The Challenging Task
Nissaf Daouahi*, Dalenda Hadyaoui, Hassen Harzallah and Mounir Cherif
Department of fixed prosthodontics, Faculty of dentistry, Monastir University, Tunisia
*Corresponding Author: Nissaf Daouahi, Department of fixed prosthodontics, Faculty of dentistry, Monastir University, Tunisia.
Received: August 09, 2015; Published: August 29, 2015
Citation: Nissaf Daouahi., et al. “Tooth Discoloration: The Challenging Task”. EC Dental Science 2.2 (2015): 271-272.
Tooth discoloration is a frequent dental finding, associated with clinical and esthetic problems. It differs in etiology, appearance, composition, location, severity, and firmness in adherence to the tooth surface. Basically, there are two types of tooth discolorations: those caused by extrinsic factors and those caused by intrinsic congenital or systemic influence. Tooth staining presents two major challenges to the dental team. The first challenge is to determine the cause of the stain; the second is its treatment. In the management of patients with stained teeth it is very important to know and understand the mechanisms behind tooth discolorations as well as the clinical features of different types of tooth staining, in order to make a correct diagnosis. In this short communication, we focused on some aspects of tooth discoloration. Treatment options were, also, briefly discussed.
Keywords: Aesthetics; Tooth discoloration; Prosthetic approach; Dental fluorosis; Devitalized teeth
The appearance of the dentition is of concern to a large number of people seeking dental treatment. Recently, the color of the teeth is of particular cosmetic importance. For that, tooth discoloration remains a challenging task and a subject of concern regarding its modalities of treatment. In fact, it can be improved by a number of approaches including bleaching procedures, ceramic veneers and full coverage restorations [1,2].
In some instances, the mechanism of staining may have an effect on the outcome of treatment and influence the treatment options. Therefore, examining a discolored dentition requires knowledge of its etiology is of importance to dental surgeons in order to enable a correct diagnosis. It allows the dental practitioner to explain to the patient the exact nature of the condition and choose the correct modality of treatment. It should be based on the localization, the degree and the etiology of the discoloration which can be defined as being extrinsic or intrinsic [3,4]. Tetracycline-induced discolouration in developing deciduous teeth results from the formation of insoluble tetracycline-calcium orthophosphate complexes which are deposited in dentine and enamel and darken upon exposure to light [5].
Dental fluorosis is one of the most popular endemy involved in teeth discoloration compromising the beauty of the smile. Its clinical manifestations vary from enamel changes seen as white flecks to moderate and severe tooth surface changes seen as pitting and mottling areas, with or without brown to black staining. To evaluate its degree, establishing characterizing score, and other extensive carious lesions and endodontic treatment, are essential parameters to decide about the suitable treatment option. Depending on these factors, the clinician has to choose between a full crown, veneers or bleaching [6-8].
When discoloration comes from necrotic pulp tissue, it becomes difficult to achieve satisfactory esthetic improvement using non invasive techniques. In the same context, discoloration can be developed after applying a triple antibiotic mixture (ciprofloxacin, metronidazole, and minocycline) which is used as an intracanal medicament in an attempt to disinfect the root canal system during endodontic treatment [9-11].
In fact, it has been proved by authors that devitalized teeth have high fracture risk aggravated by endodontic procedures responsible for a loss of structure. For that, the treatment approach does not only aim for the imitation of natural teeth in terms of shade and translucency but also the improvement of its altered mechanical properties. In this situation, full coverage restorations are preferred since several studies showed that adequate coronal coverage following endodontic treatment resulted in decrease of tooth loss. Whereas, thin ceramic veneers, is not the suitable approach because they are made from translucent ceramics such as silica glass based all ceramics. In such cases, we need an opaque material that can mask this discoloration. This justifies the use of Zirconia single restorations which offers excellent results in terms of esthetics and biocompatibility. Recently, Zirconia based ceramics has been considered as the most suitable material to be used when covering devitalized teeth as it is white in color and more opaque than other dental ceramics because of its high refractive index [12-14].
An understanding of the mechanisms behind tooth staining is of relevance to the general dental practitioner. In the management of patients with tooth discoloration such information is valuable in the decision-making process when considering whether or not to treat a condition, or refer on to a specialist for an opinion or for treatment.
  1. Succaria F and Morgano SM. “Prescribing a dental ceramics material: Zirconia vs lithiuim - dissilicate”. The Saudi dental journal 23.4 (2011): 165-166.
  2. Luke S Kahng. “Material Selection and shade Matching for a single Central incisor”. The journal of cosmetic dentistry 22.1 (2006): 80-86.
  3. Anand kumar and G Vinay kumar Hiremath. “Bleaching of a non vital anterior tooth to remove the intrinsic discoloration”. Journal of Natural Science, Biology and medicine 5.2 (2014): 476-479.
  4. Mohammed Q Alqahtani. “Tooth bleaching procedures and their controversial effects: a literature review”. The Saudi dental journal 26.2 (2014): 33-46.
  5. E Ayaslioglu. “Doxycycline-induced staining of permanent adult dentition”. Australian DentalJournal 50.4 (2005): 273-275.
  6. Chetana S. Murthy., et al. “Combined Approach for Tooth Whitening: A case Report”. International Journal of Clinical Dental Science 2.4 (2011): 69-71.
  7. Jonathan Du Toit., et al. “Aesthetic treatment of severely fluorosed teeth with prefabricated composite veneers: a case report”. International Dentistry African dentistry 2.6 (2012): 44-50.
  8. Wafa El-Badrawy and Omar El-Mowafy. “Comparison of Porcelain Veneers and Crowns for Resolving Esthetic Problems: Two Case Reports”. Journal Canadian Dental Association 75.10 (2009): 701-709.
  9. Andrew Joiner. “The bleaching of teeth: A review of the literature”. Journal of dentistry 34.7 (2006): 412-419.
  10. Daniel Edelhoff and Olivier Brix. “Restoring several discoloured anterior teeth using minimally invasive procedures”. International Dentistry, African Edition 1.3 (2011): 42-48.
  11. Elie Daou and Maha Al Gotmeh. “Zirconia Ceramics: A versatile restorative Material”. Dentistry 4.4 (2014): 219.
  12. Isao Yamashita., et al. “Development of highly transparent Zirconia Ceramics. Tokyo Research Laboratory.
  13. Vogel RI. “Intrinsic and extrinsic discoloration of the dentition A review”. Journal of Oral Medicine 30.4 (1975): 99-104.
  14. Addy M and Moran J. “Mechanisms of stain formation on teeth, in particular associated with metal ions and antiseptics”. Advances in Dental Research 9.4 (1995): 450-456.
Copyright: © 2015 Nissaf Daouahi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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