[Green tooth discoloration in a two-year-old boy]. / Groene tandverkleuring bij een peuter.

Green tooth discoloration can have several causes. From the patient history of the two-year-old with green tooth discoloration clear causal relationships can be identified. The pathological cause is an increase in bilirubin levels for an extended period of time. Determining the extent of tooth development in combination with the increase in bilirubin levels makes it possible to estimate the degree and pattern of green tooth discoloration. If the increase in bilirubin levels is short-lived, it is possible the permanent dentition will not be affected.

[Transient pink tooth discoloration during orthodontic treatment]. / Voorbijgaande roze coronale verkleuring van een gebitselement tijdens orthodontische behandeling.

A healthy adult male patient presented himself, 11 days after a fixed orthodontic appliance was placed, with a sudden pink discoloration of the dental crown of tooth 21. The emergency dentist on call diagnosed the discoloration as non-painful peri-apical periodontitis, partly on the basis of a radiograph, and recommended endodontic treatment of tooth 21. Prior to endodontic treatment, the patient was first seen by the orthodontist who had initiated treatment. Tooth 21 was investigated and reacted normally to percussion and palpation but did not react to the cold test. The patient was referred to an endodontist who made the likely diagnosis: 'Transient apical breakdown'. No endodontic treatment was carried out and the orthodontic treatment was not interrupted. Six weeks after the discoloration appeared, visible recovery was evident.

Spectrophotometric Evaluation of Anterior Maxillary Tooth Color Distribution According to Age and Gender.

PURPOSE: To determine the effects of age and gender on the color distribution of the right maxillary central, lateral incisors, and canine teeth. MATERIALS AND METHODS: The tooth color was measured using the VITA Easyshade V spectrophotometer with a total of 202 volunteers (89 men, 113 women). The age distribution in this study was between 15 and 70 years old (average: 31). A grey background color was used to prevent background reflection while performing the color measurements. RESULTS: According to the VITAPAN Classical shade guide, the tooth color distribution of the central and lateral incisors showed a maximum of A2, with a maximum of B3 for the canine teeth. When comparing the International Commission on Illumination L* , a* , and b* values (CIELab color space coordinates) of the teeth with subject gender, statistically significant differences were not found between gender and the L* and b* values (p > 0.05); however, a statistically significant difference was observed between gender and the a* values (p < 0.05). CONCLUSION: When the distribution ratio of tooth color was examined, different ratios were determined based on gender and age and between the maxillary central, lateral incisors, and canine teeth. A uniform tooth color should not be chosen for anterior restorations, and factors such as gender and age should be considered when making a color selection for patients.

Replicating a discolored tooth preparation: A technique for effective laboratory communication.

Fabricating a ceramic restoration for a discolored anterior tooth presents a clinical challenge. The dental technician is often hampered by being unaware of the shade of the discolored tooth preparation, which influences the color of the overlying ceramic restoration. A definitive cast that replicates the shade of the prepared tooth helps the ceramist to fabricate a restoration that masks the discoloration appropriately and still achieves the desired optical properties. This report demonstrates the use of a technique of recording and communicating the shade of a prepared tooth to the dental laboratory technician.

The reproducibility of assessment of white spot lesions adjacent to orthodontic brackets, with a quantitative light induced fluorescence digital camera at different rotations of teeth - an in vitro study.

BACKGROUND: A quantitative light-induced fluorescence digital (QLF-D) camera is able to assess demineralizations adjacent to orthodontic brackets. Rotations of teeth during and the presence of the orthodontic appliances may influence the longitudinal follow-up of such lesions over time. METHODS: Brackets were bonded on extracted teeth: 54 incisors and 31 canines. Demineralizations were formed in vitro directly cervical of the bracket. Images were captured using a QLF-D camera mounted on an optical bench, equipped with a goniometer on a turntable. The teeth were placed in the goniometer simulating buccolingual rotation (0°, 10°, 20°), the turn-table was used for mesiodistal rotations (0°, 10°, 20°). Standardized QLF-D images were made before (with and without a wire) and after debonding at combinations of aforementioned angles of rotation. The image after debonding at 0° buccolingual and 0° mesiodistal rotation served as a control. RESULTS: The presence of a bracket resulted in a significantly higher fluorescence loss, yet a smaller lesion area (p < 0.05) in comparison to the control. A significant higher fluorescence loss was seen for rotations towards lingual relative to the 0° buccolingual and 0° mesiodistal rotation, while the effect was less explicit towards buccal. CONCLUSIONS: Fluorescence loss and lesion size are influenced by the angle of rotation under which the demineralization is photographed. The full extent of demineralizations is only apparent after debonding when photographed at rotations of 0° mesiodistal and up to 20° buccal. Precaution must be taken into account assessing demineralizations of patients undergoing treatment with fixed appliances when using a QLF-D camera.

Dental disorders in brown howler monkeys (Alouatta guariba clamitans) maintained in captivity.

BACKGROUND: The aim of this study was to investigate dental disorders of brown howler monkeys maintained in captivity. The hypothesis is that the identification and diagnosis of the lesions may contribute to control and prevention. METHODS: Sixteen intact brown howler monkeys (Alouatta guariba clamitans), eight females and eight males, weighing from 3.9 to 6.8 kg, were studied. Under general anesthesia, the teeth were evaluated by visual inspection, probing, palpation, and intra-oral radiographic exam. The findings were registered on a dental chart specific for primates. RESULT: Of the 16 monkeys evaluated in the present study, 94% (n = 15) had some type of dental disorder. The lesions observed were dental calculus (88%), dental wear (81%), missing teeth (38%), gingivitis (19%), gingival recession (6%), dental fracture (19%), pulp exposure (19%), and dental staining (25%). CONCLUSIONS: Alouatta guariba clamitans maintained in captivity have a high rate of dental problems.

A survey of oral and dental health in children on home parenteral nutrition.

AIM: To determine oral and dental problems in children who are receiving long term intravenous nutrition at home. DESIGN: Children who had been at home on parenteral nutrition (PN) for a period of at least 3 months were recruited from the intestinal failure clinic database of a large tertiary nutrition centre. The parents were contacted by email, face to face or telephone and asked to fill in a questionnaire. Information about the PN, enteral nutrition, type of feeding in infancy, weaning, dental and oral problems was collected. Results A total of 35 patients were identified, of which 28 participated in the study. The age of the children ranged from 1-18 years with a median age of 5.5 years. The average duration of PN administration was 4.3 years. Just over half were also orally fed and three quarters had a history of breast and/or bottle feeding in infancy. Around 60% of children reported oral problems including teeth staining (29%), gum infections (11%), teeth decay and delayed dentition (16%). 68% regularly visited the dentist at 2-12 monthly intervals. CONCLUSION: In comparison to the general UK paediatric population, oral and dental problems occurred less commonly in our study group of children on HPN, unlike adult patients on intravenous nutrition where poor oral health was much more prominent compared to the general public. However the overall prevalence was similar in the adult and paediatric age group receiving long-term HPN highlighting the need for specific health advice in this patient group.

Dental Treatment Needs among Children and Adolescents Residing in an Ugandan Orphanage.

BACKGROUND: Previous studies focused on the dental caries status of East African children and not on their overall dental needs. Urban children consume more sugar-rich foods. OBJECTIVES: To assess overall dental treatment needs of children living in an orphanage in Uganda. STUDY DESIGN: Teeth were diagnosed as needing treatment by obvious frank carious lesions (WHO criteria), temporary fillings, staining, or very deep pit and/or fissures possibly requiring sealants. Calculus or crowding in the mandibular anterior region and evidence of tooth fractures were recorded, as were signs of wear on the mandibular molars and canines and the maxillary incisors. RESULTS: Most of the primary teeth (64%) required no dental treatment, but almost all (98%) of the permanent teeth did. A mean (±standard deviation) of 4.81±1.92 permanent teeth required treatment. The mean number of missing teeth was 0.47. Thirty-one children (20.2%) had crowding, 52 (34%) had calculus, and 49 (32%) had signs of attrition on primary and permanent molar teeth (45 enamel only and 4 enamel and dentin). CONCLUSIONS: Most of the primary teeth required no dental treatment, while the vast majority of permanent teeth did, possibly in association with high sugar cane consumption and poor brushing habits among older children.

Characteristics, detection methods and treatment of questionable occlusal carious lesions: findings from the national dental practice-based research network.

Questionable occlusal carious lesions (QOC) can be defined as an occlusal tooth surface with no cavitation and no radiographic radiolucencies, but caries is suspected due to roughness, surface opacities or staining. An earlier analysis of data from this study indicates 1/3 of patients have a QOC. The objective of this report has been to quantify the characteristics of these common lesions, the diagnostic aids used and the treatment of QOC. A total of 82 dentist and hygienist practitioner-investigators from the USA and Denmark in the National Dental Practice-Based Research Network participated. When consenting patients presented with a QOC, information was recorded about the patient, tooth, lesion and treatments. A total of 2,603 QOC from 1,732 patients were analyzed. The lesions were usually associated with a fissure, on molars, and varied from yellow to black in color. Half presented with a chalky luster and had a rough surface when examined with an explorer. There was an association between color and luster: 10% were chalky-light, 47% were shiny-dark and 42% were mixtures. A higher proportion of chalky than of shiny lesions were light (22 vs. 9%; p < 0.001). Lesions light in color were less common in adults than in pediatric patients (9 vs. 32%; p < 0.001). Lesions that were chalky and light were more common among pediatric than among adult patients (22 vs. 6%; p < 0.001). This is the first study to investigate characteristics of QOC in routine clinical practice. Clinicians commonly face this diagnostic uncertainty. Determining the characteristics of these lesions is relevant when making diagnostic and treatment decisions.

Reproducibility and diagnostic outcomes of two visual-tactile criteria used by dentists to assess caries lesion activity: a cross-over study.

UNLABELLED: The aim of this study was to evaluate the reproducibility and differences in diagnostic outcomes by practicing dental clinicians previously inexperienced in using the Nyvad criteria and the ICDAS II criteria with the Lesion Activity Assessment system (ICDAS II + LAA). Four volunteer dentists were randomly allocated to one of two groups. Both groups of dentists examined the same voluntary sample (n = 140) of caries active young adults using Nyvad and ICDAS II + LAA criteria in different sequences. The first group used the Nyvad criteria during period 1, followed by ICDAS II + LAA during period 2; the second group did the examinations in the opposite sequence. Before the period 1 and 2 examinations, dentists from both groups were trained with the Nyvad or ICDAS II + LAA criteria, depending on the group to which they were assigned. Intra-examiner agreement for lesion severity was high for both diagnostic instruments (weighted kappa 0.62-0.80). For lesion activity the intra-examiner unweighted kappa values ranged from 0.31 to 0.61 for ICDAS II + LAA and from 0.36 to 0.51 for Nyvad. The mean number of active non-cavitated caries lesions was significantly higher for ICDAS II + LAA (6.14 ± 5.4) than for Nyvad (3.90 ± 3.9) (p < 0.001). Active cavitated/dentinal caries lesions were significantly higher for ICDAS II + LAA (4.14 ± 4.1) than for Nyvad (2.13 ± 3.1) (p < 0.001). Both the Nyvad and ICDAS II + LAA diagnostic criteria showed high reproducibility for lesion severity assessment. The mean number of active caries lesions among high caries risk subjects was significantly higher using the ICDAS II + LAA criteria, which may subsequently lead to more caries treatment. TRIAL REGISTRATION: ISRCTN65592532.

Should cavitation in proximal surfaces be reported in cone beam computed tomography examination?

AIM: A clinical study was done to assess the clinical diagnostic accuracy of cone beam computed tomography (CBCT) in detecting proximal cavitated carious lesions in order to determine whether cavitation should be reported when a CBCT examination is available. MATERIALS AND METHODS: 79 adjacent proximal surfaces without restorations in permanent teeth were examined. Patients suspected to have carious lesions after a visual clinical and a bitewing examination participated in a CBCT examination (Kodak 9000 3D, 5 × 3.7 cm field of view, voxel size 0.07 mm). Ethical approval and informed consent were obtained according to the Helsinki Declaration. Radiographic assessment recording lesions with or without cavitation was performed by two observers in bitewings and CBCT sections. Orthodontic separators were placed interdentally between two lesion-suspected surfaces. The separator was removed after 3 days and the surfaces recorded as cavitated (yes/no), i.e. validated clinically. Differences between the two radiographic modalities (sensitivity, specificity and overall accuracy) were estimated by analyzing the binary data in a generalized linear model. RESULTS: For both observers, sensitivity was significantly higher for CBCT than for bitewings (average difference 33%, p < 0.001) while specificity was not significantly different between the methods (p = 0.19). The overall accuracy was also significantly higher for CBCT (p < 0.001). CONCLUSION: CBCT was more accurate in detecting cavitation in proximal surfaces than bitewing radiographs; therefore a CBCT examination performed for other clinical applications should also be assessed for proximal surface cavities in teeth without restorations, and when detected, this pathology must be part of the dentist's report.

[Keep an eye on the side effects]. / Nebenwirkungen im Auge behalten.

A 52-year-old man presented with a progressive grey-black pigmentation of facial skin, sclera and teeth. The cause was long-term ingestion of minocycline, as confirmed by history and skin biopsy. Minocycline-induced hyperpigmentation can be divided into four main patterns based on clinical appearance, distribution, light- and electron microscopic characteristics. Some patterns can manifest within weeks of initiating therapy. One must be alert to the early signs and warn the patient about the often cosmetically disturbing and persistent minocycline-induced hyperpigmentation.

Distinguishing and diagnosing contemporary and conventional features of dental erosion.

The vast number and variety of erosion lesions encountered today require reconsideration of the traditional definition. Dental erosion associated with modern dietary habits can exhibit unique features that symbolize a departure from the decades-old conventional image known as tooth surface loss. The extent and diversity of contemporary erosion lesions often cause conflicting diagnoses. Specific examples of these features are presented in this article. The etiologies, genesis, course of development, and characteristics of these erosion lesions are discussed. Contemporary and conventional erosion lesions are distinguished from similar defects, such as mechanically induced wear, carious lesions, and dental fluorosis, which affect the human dentition.

Prevalence of black stain and associated risk factors in preschool Spanish children.

BACKGROUND: In pediatric clinical practice, it is common to be asked about the presence of black stains on teeth in children and teenagers. According to controversial etiology, it is known to be related to a low rate of caries. The aim of this study was to determine the prevalence of black stain and associated risk factors in Spanish preschool children. METHODS: A total of 3272 children aged 6 years old (3058 non-emigrant and 214 immigrant children) living in Oviedo (Spain), were enrolled in the present study. RESULTS: The prevalence of black stain was 3.1% in the whole group. The index of primary decayed, missing, and filled teeth (dmft index) associated with black stain was 0.35 ± 1.123. A statistical association between black stain and the consumption of iron supplements was noted. CONCLUSIONS: The regular consumption of foods rich in iron and the use of iron supplements during pregnancy and early childhood, could favor the development of chromogenic microbiota. The prevalence of black stain did not differ significantly between non-emigrant and immigrant children in Spain.

Caries diagnosis: agreement between WHO and ICDAS II criteria in epidemiological surveys.

OBJECTIVE: The aim of this study was to ascertain the equivalence between WHO caries diagnosis criteria and the ICDAS II caries classification scale for comparisons in epidemiological studies. MATERIALS AND METHODS: Two intraoral examinations, one using the ICDAS II caries codes and the other the WHO caries assessment method, were performed in a random sample of 101 children (29 aged 5-6 years, 32 aged 12 and 40 aged 15). Both examinations were performed not more than one month apart by two calibrated examiners (one for ICDAS II criteria, Kappa=0.86, and the other for WHO criteria, Kappa=0.91). The DMFT/dft, DMFS/dfs and caries prevalence (DMFT or dfs>0) indices were obtained in accordance with WHO assessment criteria and by applying 5 cut-off points on the ICDAS II scale. The differences between means were analysed with the Wilcoxon test and those between proportions with the McNemar test. Agreement was determined by the intraclass correlation index and the Kappa statistic. RESULTS: The least differences between the WHO and ICDAS 11 criteria were found at cut-off point 3 (ICDAS 11 codes 3 to 6). The greatest agreement was found at the same cut-off point. CONCLUSION: While the equivalence between both methods used in epidemiological studies does not appear to be clear, possible errors could be reduced by locating this equivalence at cut-off point 3 and not at cut-off point 4.

Dental fluorosis in the paediatric patient.

UNLABELLED: Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient. CLINICAL RELEVANCE: Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.

Performance of laser fluorescence for the detection of enamel caries in non-cavitated occlusal surfaces: clinical study with total validation of the sample.

PURPOSE: To evaluate the clinical performance of a laser fluorescence device in detecting enamel caries in non-cavitated occlusal surfaces. METHODS: The sample included 96 first and second permanent molars, selected according to the criteria of Ekstrand: 44 not suspected of having dentin caries (score: 0-2) and 52 under suspicion (score: 3-4). Once measured by laser fluorescence, all teeth were validated by fissurotomy (gold standard). To avoid ethical questions, the 44 teeth (score: 0-2) used were to serve as abutments for a fixed dental prostheses. Following fissurotomy, the 52 teeth with suspected caries were treated with resin composite restorations. Kruskall-Wallis statistical analysis (P<0.05) was used. RESULTS: Laser fluorescence showed an area under the Receiver Operating Characteristic (ROC) curve of Az = 0.803 for enamel caries. The cut-off point with the highest sensitivity and specificity was 15, with a sensitivity and specificity of 0.97 and 0.63, respectively. Values under 10 indicated healthy teeth.

[Research on the pathogeny of black tooth stain and association between black tooth stain and primary dentition caries in children].

PURPOSE: To investigate the related factors of black tooth stain in primary teeth of 3~5 years old children and caries status of primary dentition in these children. METHODS: From December 2019 to August 2020, 182 3~5 years old children with black tooth stain and 200 children without pigmentation were investigated by oral examination and questionnaire survey to their guardians, while caries status , distribution range of the pigment, factors associated with black tooth stain were evaluated. SPSS 20.0 software package was used for data analysis. RESULTS: Children with black tooth stain had fewer dental caries. The lingual surfaces of the mandibular anterior teeth were the most affected sites. Factors associated with black tooth stain were foods with soy sauce and brushing teeth with parents' help. CONCLUSIONS: There is a negative correlation between the occurrence of primary dentition caries and blacktooth stain, but there is no significant correlation between formation of black tooth stain and most environmental factors.

Black staining: an overview for the general dental practitioner.

'Black stain' is a form of extrinsic staining affecting the buccal and palatal surfaces of primary and permanent teeth. It presents as an incomplete line of dark dots formed at the cervical third of the tooth, typically following the gingival margin and not extending to the proximal areas. There is no consensus on its prevalence, though it appears to vary between 2-20%, with an equal male and female distribution. Although the aetiology is not completely understood, its microflora is dominated by chromogenic bacteria, such as actinomyces and prevotella melaninogenica, and there appears to be a low incidence of caries in the presence of the stain. The cause of the dark pigmentation seems to be from iron deposits such as ferric sulphate, present due to a reaction with the products of bacterial metabolism. This paper aims to provide information on the diagnosis, aetiology and treatment considerations for black stain. A patient case report is also explored.

[Oral cavity features in patients suffering from osteogenesis imperfecta].

Osteogenesis Imperfecta (OI) is a rare hereditary connective tissue disorder. This pathology is characterized by disruption of biosynthesis of Type I collagen, and production of limited amount of defective and imperfect collagens. This causes decrease in bone mass of human body, bones become fragile and brittle, resulting in unreasonable multiple fractures. Reportedly, number of patients with OI ranges between 32-38 in Georgia. However, exact number of patients, including children and their parents, is unknown. Dentinogenesis Imperfecta (DI; DGI) and skeletal malocclusion occupy special place in varied spectrum of OI clinical symptoms. We studied 14 patients: 9 women (64.3%), 5 men (35.7%) and divided them in three age groups: I - 2.5-6 years - period of primary dentition (28.6%), II - 6-14 years - period of changing teeth dentition (35.7%) and III - above 14 years - period of permanent dentition (35.7%). 28.5% of screened patients had one of the symptoms of DI, such as tooth discoloration. Discoloration of primary teeth was revealed in 4 patients (primary dentition). Another symptom of DI, such as early abrasion, was detected in 5 patients i.e. 35.71%. This was divided in the following manner: I age group - 3 cases, II and III age groups - 1-1 cases. It was also observed that early abrasion of primary teeth prevails over permanent. One of DI's radiographic symptoms, such as peculiar form of teeth crown and root, was revealed in 21.4% or in 3 patients, 2 of whom had bulbous crown, and the third one deformed (curved) root. Peculiar characteristics of DI, such as increased constriction of the coronal-radicular junction, obliterated pulp chamber, short and narrow roots, were not observed in the patients examined. Interesting characteristic of DI, such as periapical destruction of intact tooth root, was revealed in the form of bone defect in 7.1% of those examined (1 patient). Therefore, out of examined 14 patients with OI - DI had 6 patients or 42.85% of cases. Also, interesting observation was revealed - DI is more common in primary teeth (66.66%) than in permanent (33.33%). Radiographic examination - orthopantomography - revealed secondary osteoporosis of jaw bones in 100% of cases. Mucous tissue of examined patients is within normal range. Among examined patients, 1 case of adenty, 1 case of retention and 1 case of overcomplex tooth were revealed. According to current literature, it is unknown whether there is a lgical relationship between adenty, retention, overcomplex teeth and OI. This will be defined by future research.