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Pace R, Giuliani V, Di Nasso L, Pagavino G, Franceschi D, Franchi L. Regenerative Endodontic Therapy using a New Antibacterial Root Canal Cleanser in necrotic immature permanent teeth: Report of two cases treated in a single appointment. Clin Case Rep 2021; 9:1870-1875. [PMID: 33936606 PMCID: PMC8077429 DOI: 10.1002/ccr3.3696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022] Open
Abstract
A case of regenerative endodontics: (a) before treatment; (b) post-treatment Xray; (c) follow-up at 6 months; (d) follow-up at 12 months.
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Affiliation(s)
- R Pace
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - V Giuliani
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - L Di Nasso
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - G Pagavino
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - D Franceschi
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - L Franchi
- Department of Experimental and Clinical Medicine University of Florence Italy
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2
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Abstract
AbstractThe current review assesses the literature concerning the etiology of primary teeth staining and discoloration. The appearance of the dentition is of concern to many children and their caregivers seeking dental treatment as the color of the teeth is of aesthetic importance. The correct diagnosis of the cause of the discoloration is important as, invariably, it has a profound effect on treatment outcomes. It would seem reasonable, therefore, that dental practitioners understand the etiology of tooth discoloration to make a diagnosis and enable appropriate treatment to be conducted. Knowledge of the etiology of tooth staining is of importance to the dental practitioner to explain the patient the exact nature of the condition. In some instances, the mechanism of staining affects the outcome of the treatment and influences the options the dentist will be able to offer. Many of these contributing factors are preventable if parents are educated, managed by professional interventions, or provide a multidisciplinary approach. In this review, we highlight the importance of children smiles and the difference between primary and permanent teeth. We discuss the different types of primary teeth staining and discoloration and whether it is intrinsic or extrinsic, as well as the different impacts of some conditions on primary teeth compared with permanent teeth.
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Affiliation(s)
- Abdulfatah Alazmah
- Pediatric Dentistry Division, Department of Preventive Dental Science, College of Dentistry, Prince Sattam University, Alkharj, Saudi Arabia
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3
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Haywood VB, Sword RJ. Tray bleaching status and insights. J ESTHET RESTOR DENT 2020; 33:27-38. [DOI: 10.1111/jerd.12688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Van B. Haywood
- Restorative Sciences Department Dental College of Georgia, Augusta University Augusta Georgia
| | - Rhoda J. Sword
- Restorative Sciences Department Dental College of Georgia, Augusta University Augusta Georgia
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Mandal SS, Margasahayam SV, Shenoy VU. A Comparative Evaluation of the Influence of Three Different Vehicles on the Antimicrobial Efficacy of Triple Antibiotic Paste against Enterococcus faecalis: An In vitro Study. Contemp Clin Dent 2020; 11:150-157. [PMID: 33110328 PMCID: PMC7583540 DOI: 10.4103/ccd.ccd_372_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/17/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: The root canal is a hub of numerous microorganisms. Routine endodontic procedures fail to remove the resistant microorganisms such as Enterococcus faecalis. Aim: The aim of the present study was to evaluate the influence of different vehicles on the antimicrobial efficacy of triple antibiotic paste (TAP) on E. faecalis infected root canals. Materials and Methods: Eighty single-rooted and freshly extracted human teeth were prepared in radicular portion, and pure culture of E. faecalis (ATCC® 29212™) inoculum was injected into canals of tooth blocks and incubated for 21 days. Tooth blocks were divided into five groups. Each experimental group was then medicated with 0.1 ml of TAP and no medication was added for control groups. After 21 days of incubation at 37°C, colony-forming units per milliliter (CFU/ml) were counted for each group. Results: Group II treated with TAP mixed with propylene glycol revealed a maximum reduction in CFU/ml, and that was followed by Group I and Group III, where TAP was mixed with 2% chlorhexidine (CHX) and 0.9% normal saline, respectively. Data were compared and analyzed using statistics software. The results were considered statistically significant for P < 0.05. There was a statistically significant difference in CFU/ml between propylene glycol and positive control group, between CHX and positive control group, between saline and positive control group. Conclusions: The propylene glycol group with TAP was the most effective vehicle for the elimination of E. faecalis from canals of tooth blocks, followed by 2% CHX solution as the second vehicle of choice over 0.9% normal saline.
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Affiliation(s)
- Shouvik S Mandal
- Department of Conservative Dentistry and Endodontics, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Sumanthini V Margasahayam
- Department of Conservative Dentistry and Endodontics, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Vanitha U Shenoy
- Department of Conservative Dentistry and Endodontics, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
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Fagogeni I, Metlerska J, Lipski M, Falgowski T, Maciej G, Nowicka A. Materials used in regenerative endodontic procedures and their impact on tooth discoloration. J Oral Sci 2019; 61:379-385. [PMID: 31378754 DOI: 10.2334/josnusd.18-0467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
There is some evidence of tooth discoloration after regenerative endodontic procedures. The aim of this review is to determine which materials used in regenerative procedures induce tooth discoloration. The authors searched six digital databases in February 2018: PubMed, Google Scholar, the Cochrane Library, Scopus, Web of Science, and Lilacs. As a result, 353 studies were found. Eleven studies that met the established criteria were selected. Analysis of the selected studies showed that most materials used in regenerative endodontic procedures have the potential to stain tooth tissues. To decrease tooth discoloration, sealing dentin with a dentin-bonding agent before the placement of a disinfectant paste and barrier materials should be considered. Only a small number of in vitro studies have been performed; therefore, further studies on this topic are warranted.
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Affiliation(s)
- Irini Fagogeni
- Faculty of Dentistry, Pomeranian Medical University in Szczecin
| | | | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics,Pomeranian Medical University in Szczecin
| | | | - Górski Maciej
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin
| | - Alicja Nowicka
- Department of Conservative Dentistry and Endodontics, Pomeranian Medical University in Szczecin
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Brezhnev A, Neelakantan P, Tanaka R, Brezhnev S, Fokas G, Matinlinna JP. Antibacterial Additives in Epoxy Resin-Based Root Canal Sealers: A Focused Review. Dent J (Basel) 2019; 7:E72. [PMID: 31266165 PMCID: PMC6784478 DOI: 10.3390/dj7030072] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 01/16/2023] Open
Abstract
Dental materials used in root canal treatment have undergone substantial improvements over the past decade. However, one area that still remains to be addressed is the ability of root canal fillings to effectively entomb, kill bacteria, and prevent the formation of a biofilm, all of which will prevent reinfection of the root canal system. Thus far, no published review has analysed the literature on antimicrobial additives to root canal sealers and their influence on physicochemical properties. The aim of this paper was to systematically review the current literature on antimicrobial additives in root canal sealers, their anti-fouling effects, and influence on physicochemical properties. A systematic search was performed in two databases (PubMed and Scopus) to identify studies that investigated the effect of antimicrobial additives in epoxy resin-based root canal sealers. The nature of additives, their antimicrobial effects, methods of antimicrobial testing are critically discussed. The effects on sealer properties have also been reviewed. A total of 31 research papers were reviewed in this work. A variety of antimicrobial agents have been evaluated as additives to epoxy resin-based sealers, including quaternary ammonium compounds, chlorhexidine, calcium hydroxide, iodoform, natural extracts, antibiotics, antifungal drugs, and antimicrobial agent-functionalised nanoparticles. Antimicrobial additives generally improved the antimicrobial effect of epoxy resin-based sealers mainly without deteriorating the physicochemical properties, which mostly remained in accordance with ISO and ANSI/ADA specifications.
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Affiliation(s)
- Alexander Brezhnev
- Applied Oral Sciences-Dental Materials Science, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Prasanna Neelakantan
- Discipline of Endodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Ray Tanaka
- Applied Oral Sciences-Oral and Maxillofacial Radiology, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Sergey Brezhnev
- Discipline of Endodontology, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - George Fokas
- Department of Prosthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Jukka P Matinlinna
- Applied Oral Sciences-Dental Materials Science, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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Evaluation of the antimicrobial efficacy of two combinations of drugs on bacteria taken from infected primary teeth (in vitro). Eur Arch Paediatr Dent 2019; 20:609-615. [PMID: 31124083 DOI: 10.1007/s40368-019-00446-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/12/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Using a combination of metronidazole, ciprofloxacin and minocycline (3Mix) for root canal disinfection of primary teeth is a well-known technique known as the lesion sterilisation and tissue repair therapy. Minocycline has the potential to cause discoloration in treated teeth and the permanent successors. This study aimed to assess the efficacy of a new combination of antibacterial drugs, in which minocycline is replaced with clindamycin. METHODS Thirty hopeless primary teeth according to our inclusion criteria were extracted and enrolled. The experiment was conducted in two parts: aerobic and anaerobic, and the efficacy of the two drug combinations, namely the 3Mix and the other mix (metronidazole, ciprofloxacin and clindamycin), for elimination of bacteria isolated from the primary teeth was evaluated and compared. Data were analysed using SPSS 21 via descriptive statistics and Friedman and Wilcoxon tests. Level of significance was considered at 0.05. RESULTS Except for minocycline, none of the other antibiotics in the studied concentrations (25, 50 and 100 μg/mL) were able to eliminate all the bacteria. Clindamycin alone was weaker than minocycline, but its combination with metronidazole and ciprofloxacin had the same potency with no significant difference. CONCLUSIONS Replacement of minocycline with clindamycin in the 3Mix composition is practical and can be generalised to clinical studies and ultimately to the clinical setting.
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8
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Regenerative Endodontic Procedures Using Contemporary Endodontic Materials. MATERIALS 2019; 12:ma12060908. [PMID: 30893790 PMCID: PMC6471897 DOI: 10.3390/ma12060908] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/28/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.
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10
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Botelho MG, Chan AWK, Newsome PRH, McGrath CP, Lam WYH. A randomized controlled trial of home bleaching of tetracycline-stained teeth. J Dent 2017; 67:29-35. [PMID: 28478214 DOI: 10.1016/j.jdent.2017.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/31/2017] [Accepted: 05/02/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the effectiveness of two home bleaching modalities on whitening of tetracycline-stained teeth (TST). METHODS A randomized controlled trial on the bleaching effect of 15% carbamide peroxide gel loaded in tray and 6.5% hydrogen peroxide strip in subjects with TST was performed. Eligible subjects were judged independently by two assessors, and randomly assigned into the tray or the strip group. Lightness (L*), redness (a*) and yellowness (b*) were measured with colorimeter at baseline, one, two and three months. Any adverse reaction associated with bleaching were also recorded. Overall colour changes (ΔE) were analysed by one-sample and independent t-test/Wilcoxon test at significance level α=0.05. RESULT Twelve and fourteen participants were allocated to the tray and the strip group respectively. Both groups experienced noticeable and significant L*a*b* improvement at the end of the trial in comparison to the baseline (p<0.05). Significant improvement was observed in the first month for the tray group (p<0.05) and in the first two months for the strip group (p<0.05). While greater lightness improvement was observed in the tray group over the strip group in the first month (p=0.02), the reverse was noticed in the second month (p=0.01). There was no difference between two groups at the end of this trial (p<0.05) and no significant adverse reactions were observed. CONCLUSION Over a three-month period, 6.0% hydrogen peroxide strip performed equally well as the 15% carbamide peroxide tray delivery system in TST. CLINICAL SIGNIFICANCE Home bleaching systems produce noticeable tooth whitening effect in subjects with tetracycline-stained teeth.
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Affiliation(s)
- Michael George Botelho
- Prosthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong.
| | | | | | - Colman Patrick McGrath
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong
| | - Walter Yu Hang Lam
- Prosthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong
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11
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Kohli MR, Yamaguchi M, Setzer FC, Karabucak B. Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Various Bioceramic Cements and Other Endodontic Materials. J Endod 2015; 41:1862-6. [PMID: 26386949 DOI: 10.1016/j.joen.2015.07.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/28/2015] [Accepted: 07/07/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Coronal tooth discoloration induced by various endodontic materials was evaluated in vitro. METHODS Eighty extracted human maxillary anterior teeth were accessed, instrumented, and sectioned to standardized root lengths of 10 mm below the cementoenamel junction. Pulp chambers were cleaned chemomechanically to ensure complete tissue removal. Specimens were filled with experimental materials in 8 random groups: RRM, EndoSequence RRM putty (Brasseler, Savannah, GA); RRMF, EndoSequence RRM fast set paste (Brasseler); BD, Biodentine (Septodont, Saint-Maur-des-Fossés, France); WMTA, white MTA (Dentsply, York, PA), GMTA, gray MTA (Dentsply); AH+, AH Plus sealer (Dentsply); TAP, triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline); and NF, no filling (negative control group). After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 7, 30, 60, and 180 after material placement (T0-T180). Data were transformed into Commission International de I'Eclairage's L*a*b color values, and corresponding ΔE values were calculated. Two-way analysis of variance and the Bonferroni method were performed. RESULTS Visual discoloration was observed in all specimens in the GMTA, WMTA, and TAP groups at T7, increasing with time. The ΔE value between the initial color at T0 and at T7, T30, T60, and T180 was significantly different for GMTA, WMTA, and TAP (P < .001). ΔE values for the BD, RRM, RRMF, AH+, and NF groups were not statistically significantly different between T0 and T7, T30, T60, and T180, respectively, except for 3 samples below the human perceptible threshold. Values of L* dropped significantly from T0 to T180 in the TAP, GMTA, and WMTA groups. CONCLUSIONS Significant coronal tooth discoloration was caused by TAP, GMTA, and WMTA but not by BD, RRM, and RRMF.
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Affiliation(s)
- Meetu R Kohli
- From the Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania.
| | - Maimi Yamaguchi
- From the Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Frank C Setzer
- From the Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
| | - Bekir Karabucak
- From the Department of Endodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
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Park HB, Lee BN, Hwang YC, Hwang IN, Oh WM, Chang HS. Treatment of non-vital immature teeth with amoxicillin-containing triple antibiotic paste resulting in apexification. Restor Dent Endod 2015; 40:322-7. [PMID: 26587419 PMCID: PMC4650529 DOI: 10.5395/rde.2015.40.4.322] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 07/11/2015] [Indexed: 11/11/2022] Open
Abstract
A recent treatment option for non-vital immature teeth in young patients is revascularization with triple antibiotic paste (TAP). However, tooth discoloration was reported with the use of conventional minocycline-containing TAP. In this case report, amoxicillin-containing TAP was used for revascularization of non-vital immature teeth to prevent tooth discoloration. At the 1 yr follow up, the teeth were asymptomatic on clinical examination and showed slight discoloration of the crown due to mineral trioxide aggregate (MTA) filling rather than amoxicillin-containing TAP. Radiographic examination revealed complete resolution of the periapical radiolucency, and closed apex with obvious periodontal ligament space. However, the root growth was limited, and the treatment outcome was more like apexification rather than revascularization. These results may be due to unstable blood clot formation which could not resist the condensation force of MTA filling, whether or not a collagen matrix was in place. These cases showed that although revascularization was not successful, apexification could be expected, resulting in the resolution of the periapical radiolucency and the closure of the apex. Therefore, it is worthwhile attempting revascularization of non-vital immature teeth in young patients.
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Affiliation(s)
- Hyon-Beom Park
- Department of Conservative Dentistry, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Bin-Na Lee
- Department of Conservative Dentistry, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Yun-Chan Hwang
- Department of Conservative Dentistry, Chonnam National University School of Dentistry, Gwangju, Korea
| | - In-Nam Hwang
- Department of Conservative Dentistry, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Won-Mann Oh
- Department of Conservative Dentistry, Chonnam National University School of Dentistry, Gwangju, Korea
| | - Hoon-Sang Chang
- Department of Conservative Dentistry, Chonnam National University School of Dentistry, Gwangju, Korea
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Hans MK, Nagpal A, Shetty S, Hans R. Can accidental local application of a drug cause discolouration of permanent teeth? J Clin Diagn Res 2014; 7:3081-2. [PMID: 24551734 DOI: 10.7860/jcdr/2013/6504.3875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 09/10/2013] [Indexed: 11/24/2022]
Abstract
Thorough knowledge on the aetiology of tooth staining is of importance to dental surgeons, in order to enable a correct diagnosis to be made when examining a discoloured dentition and it allows the dental practitioner to explain to the patient the exact nature of the condition. Tetracyclines are a group of drugs which can discolour teeth permanently. One such case of discolouration of adult teeth caused by administration of tetracycline(oxytetracycline) has been reported here and it has been discussed in detail.
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Affiliation(s)
- Manoj Kumar Hans
- Associate Professor, Department of Conservative Dentistry & Endodontics, Vyas Dental College & Hosptal , Jodhpur, Rajasthan, India
| | - Ajay Nagpal
- Associate Professor, Department of Conservative Dentistry & Endodontics, Kanti Devi Dental College and Hospital , India
| | - Shashit Shetty
- Professor & Head, Department of Conservative Dentistry & Endodontics, Kanti Devi Dental College and Hospital , Jodhpur, Rajasthan, India
| | - Rinki Hans
- Post Graduate Student, Department of Public Health Dentistry, Vyas Dental College & Hosptal , India
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14
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Yadlapati M, Souza LC, Dorn S, Garlet GP, Letra A, Silva RM. Deleterious effect of triple antibiotic paste on human periodontal ligament fibroblasts. Int Endod J 2013; 47:769-75. [DOI: 10.1111/iej.12216] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/14/2013] [Indexed: 10/26/2022]
Affiliation(s)
- M. Yadlapati
- Department of Endodontics; School of Dentistry; University of Texas Health Science Center at Houston; Houston TX USA
| | - L. C. Souza
- Department of Endodontics; School of Dentistry; University of Texas Health Science Center at Houston; Houston TX USA
| | - S. Dorn
- Department of Endodontics; School of Dentistry; University of Texas Health Science Center at Houston; Houston TX USA
| | - G. P. Garlet
- Osteoimmunology Lab; Department of Biological Sciences; Bauru School of Dentistry; University of Sao Paulo; Bauru Brazil
| | - A. Letra
- Department of Endodontics; School of Dentistry; University of Texas Health Science Center at Houston; Houston TX USA
| | - R. M. Silva
- Department of Endodontics; School of Dentistry; University of Texas Health Science Center at Houston; Houston TX USA
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15
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Zuckerman MD, Boyle KL, Rosenbaum CD. Minocycline toxicity: case files of the University of Massachusetts medical toxicology fellowship. J Med Toxicol 2012; 8:304-9. [PMID: 22777680 DOI: 10.1007/s13181-012-0247-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Matthew D Zuckerman
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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16
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Kumar A, Kumar V, Singh J, Hooda A, Dutta S. Drug-induced discoloration of teeth: an updated review. Clin Pediatr (Phila) 2012; 51:181-5. [PMID: 21917545 DOI: 10.1177/0009922811421000] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of tooth discoloration is emerging in our society because of the poor oral hygiene, physical agents, environmental chemicals, mouth rinses, some dental procedures, general systemic conditions, and drugs. Other common causes of tooth discoloration include excessive use of tea, coffee, tobacco smoking and chewing, chewing of betel morsel (piper betel, paan), and so on. Drug-induced tooth discoloration can be prevented by avoiding prescriptions of well-known offender drugs known to cause tooth discoloration during pregnancy and in young children. This review describes some important groups of drugs that cause tooth discoloration.
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Affiliation(s)
- Arun Kumar
- Department of Pedodontics & Preventive Dentistry, Government Dental College, Rohtak, Haryana, India.
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17
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Kim B, Song MJ, Shin SJ, Park JW. Prevention of tooth discoloration associated with triple antibiotics. Restor Dent Endod 2012. [DOI: 10.5395/rde.2012.37.2.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bona Kim
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentisty, Seoul, Korea
| | - Min-Ju Song
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentisty, Seoul, Korea
| | - Su-Jung Shin
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentisty, Seoul, Korea
| | - Jeong-Won Park
- Department of Conservative Dentistry, Gangnam Severance Dental Hospital, Yonsei University College of Dentisty, Seoul, Korea
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18
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Tay FR, Mazzoni A, Pashley DH, Day TE, Ngoh EC, Breschi L. Potential Iatrogenic Tetracycline Staining of Endodontically Treated Teeth via NaOCl/MTAD Irrigation: A Preliminary Report. J Endod 2006; 32:354-8. [PMID: 16554211 DOI: 10.1016/j.joen.2005.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Revised: 11/13/2005] [Accepted: 11/16/2005] [Indexed: 11/20/2022]
Abstract
This study reported red-purple staining of light-exposed, root-treated dentin when root canals were rinsed with 1.3% NaOCl as initial rinse followed by the use of BioPure MTAD as final rinse. This intrinsic dentin staining occurred irrespective of whether the root canals were filled, and could be observed even in crown dentin when the latter was sequentially immersed in NaOCl and MTAD. Bench-top reproductions of the phenomenon revealed that the exothermic reaction is not an acid-base reaction. Conversely, the reaction is of a redox nature that highly resembled the previously reported mechanism of tetracycline staining, in which photo-oxidation of tetracycline resulted in a red-purple tetracycline degradation product that has a high affinity for hydroxyapatite. This photo-oxidative degradation process is probably triggered by the use of NaOCl as an oxidizing agent, and may be prevented by rinsing the NaOCl-treated dentin with ascorbic acid, a reducing agent, before the application of MTAD.
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Affiliation(s)
- Franklin R Tay
- Department of Oral Biology and Maxillofacial Pathology, School of Dentistry, Medical College of Georgia, Augusta, GA 30912-1129, USA.
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Abstract
It is essential that every health care professional who is involved with the prescription or recommendation of drugs be fully aware of any resultant disorders that may arise as a side-effect. A range of drugs can affect the teeth. In this review article, drugs that have the potential to induce changes in teeth have been classified as those leading to tooth discoloration (intrinsic and extrinsic), physical damage to tooth structure (enamel, dentin, and cementum), and alteration in tooth sensitivity.
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Affiliation(s)
- C J Tredwin
- Units of Conservative Dentistry and Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK.
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LaPorta VN, Nikitakis NG, Sindler AJ, Reynolds MA. Minocycline-associated intra-oral soft-tissue pigmentation: clinicopathologic correlations and review. J Clin Periodontol 2005; 32:119-22. [PMID: 15691339 DOI: 10.1111/j.1600-051x.2005.00646.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intra-oral minocycline staining of alveolar bone and teeth is well-described in the literature. Minocycline-induced discoloration of oral soft tissues is less common and has been often attributed to staining of the underlying bone. AIM This report documents the clinical and histopathologic features of a case of actual oral soft tissue minocycline-induced pigmentation. The patient, a 45-year-old Caucasian female, presented with pigmentation of the gingiva, lips, and nail beds of recent onset. The past medical history revealed initiation of minocycline therapy 6 months earlier for dermatological concerns. Histopathologic examination of biopsy specimens from the gingiva and lip showed evidence of increased melanin/melanocytes in the epithelium and melanin/melanophages in the connective tissue. A working diagnosis of drug-associated pigmentation was determined and the patient discontinued immediately minocycline therapy. Nine months after cessation of minocycline the patient exhibited a marked reduction in pigmentation. CONCLUSION Systemic minocycline treatment has the potential to induce significant and esthetically objectionable discoloration of the gingiva and oral mucosa. A brief review of the literature is presented to help understand this uncommon finding that should be included in the differential diagnosis of spontaneous discoloration of intra-oral soft tissues.
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Affiliation(s)
- Vincent N LaPorta
- Department of Periodontics, Dental School, University of Maryland, 666 W. Baltimore Street, Baltimore, MD 21201, USA
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Sánchez AR, Rogers RS, Sheridan PJ. Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity. Int J Dermatol 2004; 43:709-15. [PMID: 15485524 DOI: 10.1111/j.1365-4632.2004.02108.x] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tetracyclines (TCN) were introduced in 1948 as broad-spectrum antibiotics that may be used in the treatment of many common infections in children and adults. One of the side-effects of tetracyclines is incorporation into tissues that are calcifying at the time of their administration. They have the ability to chelate calcium ions and to be incorporated into teeth, cartilage and bone, resulting in discoloration of both the primary and permanent dentitions. This permanent discoloration varies from yellow or gray to brown depending on the dose or the type of the drug received in relation to body weight. Minocycline hydrochloride, a semisynthetic derivative of tetracycline often used for the treatment of acne, has been shown to cause pigmentation of a variety of tissues including skin, thyroid, nails, sclera, teeth, conjunctiva and bone. Adult-onset tooth discoloration following long-term ingestion of tetracycline and minocycline has also been reported. The remarkable side-effect of minocycline on the oral cavity is the singular occurrence of "black bones", "black or green roots" and blue-gray to gray hue darkening of the crowns of permanent teeth. The prevalence of tetracycline and minocycline staining is 3-6%. The mechanism of minocycline staining is still unknown. Most of the reviewed literature consisted of case reports; longitudinal clinical trials are necessary to provide more information on the prevalence, severity, etiology and clinical presentation of tetracycline and TCN-derivative staining in the adult population.
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Affiliation(s)
- Andrés R Sánchez
- Division of Periodontics, Department of Dental Specialties, Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
BACKGROUND Minocycline is a tetracycline antibiotic that is commonly used in the treatment of moderate to severe acne vulgaris. Although it is more convenient for patients to take than first-generation tetracyclines, as it only needs to be taken once or twice a day and can be taken with food, it is more expensive. Concerns have also been expressed over its safety following the deaths of two patients taking the drug. There is a lack of consensus among dermatologists over the relative risks and benefits of minocycline. As most acne prescribing is undertaken by general practitioners, it is important that guidelines issued to them are based on the best available evidence rather than personal judgements. OBJECTIVES To collate and evaluate the evidence on the clinical efficacy of minocycline in the treatment of inflammatory acne vulgaris. Specific objectives were to compare the efficacy of minocycline with other drug treatments for acne and to collate information on the incidence of adverse drug reactions. SEARCH STRATEGY Randomised controlled trials (RCTs) of minocycline for acne vulgaris were identified by searching the following electronic databases; MEDLINE, EMBASE, Biosis, Biological Abstracts, International Pharmaceutical Abstracts, Cochrane Skin Group's Trial Register, Theses Online, BIDS ISI Science Citation Index, National Research Register, Current Controlled Trials and Bids Index to Scientific and Technical Proceedings. Other strategies used were scanning the references of articles retrieved, hand-searching of major dermatology journals and personal communication with trialists and drug companies. SELECTION CRITERIA To be eligible for the review, studies had to be RCTs comparing the efficacy of minocycline at any dose to active or placebo control, in subjects with inflammatory acne vulgaris. Diagnoses of papulo-pustular, polymorphic and nodular acne were also accepted. Trials were not excluded on the basis of language. DATA COLLECTION AND ANALYSIS 27 randomised controlled trials met the inclusion criteria and were included in this review. The comparators used were placebo (2 studies), oxytetracycline (1), tetracycline (6), doxycycline (7), lymecycline (2), topical clindamycin (3), topical erythromycin/zinc (1), cyproterone acetate/ ethinyloestradiol (1), oral isotretinoin (2), topical fusidic acid (1) and there was one dose response study. Two studies are ongoing and it remains to be clarified whether one further study is a RCT. Major outcome measures used in the trials included lesion counts, acne grades/severity scores, doctors' and patients' global assessments, adverse drug reactions and drop out rates. The quality of each study was assessed independently by two assessors and an effect size calculated where possible. An additional three RCTs and three safety studies were identified by searches conducted in November 2002; these will be reviewed for a major update in early 2003 when it is anticipated that the results of the two ongoing studies will be available. MAIN RESULTS The trials were generally small and of poor quality and in many cases the published reports were inadequate for our purpose. Pooling of the studies was not attempted due to the lack of common outcome measures and endpoints and the unavailability of some primary data. Although minocycline was shown to be an effective treatment for acne vulgaris, in only two studies was it found to be superior to other tetracyclines. Both of these were conducted under open conditions and had serious methodological problems. A third study showed it to be more effective than 2% fusidic acid, applied topically, against inflammatory lesions in mild to moderate acne. Differences in the way adverse drug reactions were identified could have accounted for the wide variation between studies in numbers of events reported. This meant that no overall evaluation could be made of incidence rates of adverse events associated with minocycline therapy. No RCT evidence was found to support the benefits of minocycline in acne resistant to other therapies and the dose response has only been evaluated up to eight weeks of therapy. REVIEWER'S CONCLUSIONS Minocycline is likely to be an effective treatment for moderate acne vulgaris, but this review found no reliable RCT evidence to justify its continued use first-line, especially given the price differential and the concerns that still remain about its safety. Its efficacy relative to other acne therapies could not be reliably determined due to the poor methodological quality of the trials and lack of consistent choice of outcome measures. Similarly the relative risk of adverse drug reactions could not be ascertained reliably and no recommendations can be made concerning the appropriate dose that should be used. It is hoped that this review will highlight the inadequacy of acne trials in general and encourage improvements in methodological quality and standards of reporting.
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Affiliation(s)
- S E Garner
- Department of Public Health, St George's Hospital Medical School, Cranmer Terrace, Tooting, London, UK, SW17 0RE.
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Abstract
Minocycline, a broad-spectrum antibiotic used in the treatment of acne and periodontal disease and to control inflammatory diseases such as rheumatoid arthritis, has recently been shown to induce a spectrum of adverse health effects. In the light of these contradictory data, this research was directed to provide basic information on the toxicology of minocycline, using in vitro cell culture models, and to evaluate its efficacy in periodontal therapies, particularly for wound healing. The human gingival epithelioid S-G cell line was used as the bioindicator. The greater toxicity of minocycline over doxycycline and tetracycline, related antimicrobial agents, probably correlated with its higher lipophilicity. The cytotoxicity of minocycline was unaffected by an S9 hepatic microsomal fraction, indicating that it is a direct-acting, rather than a metabolism-mediated, cytotoxicant. In comparative toxicity studies, much variation in the degree of sensitivity to minocycline was noted for different cell types. No correlation in the extent of sensitivity to minocycline and the physiologic state of the bioindicator cell (normal, transformed or malignant) was noted. The toxicity of minocycline to the S-G cells was dependent on its concentration and length of exposure. For a continuous 3-day exposure of the S-G cells to minocycline, the midpoint cytotoxicity (or, NR(50)) value, as quantified in the neutral red (NR) assay, was 204 microg/ml on day 1, 84 microg/ml on day 2, and 59 microg/ml on day 3. For a 1-h exposure of the S-G cells in phosphate buffered saline (PBS), the NR(50) value was 780 microg/ml minocycline. Although a 1-h exposure in PBS to 200 microg/ml minocycline exerted some toxicity, the S-G cells recovered on exposure to growth medium; irreversible, progressive damage occurred at 400 microg/ml minocycline and greater. Minocycline, at 50 microg/ml, enhanced attachment of the S-G cells to a gelatin-coated surface and cell migration towards an immobilized fibronectin gradient, both biologic parameters important in periodontal wound healing. Minocycline generally had little or no effect on production of the pro-inflammatory cytokines, interleukin-6 (IL-6) and interleukin-8 (IL-8), by non-activated S-G cells, the exception being stimulation of IL-6 at 48 h. IL-1beta, however, greatly stimulated IL-6 and IL-8 production, which was further increased by concurrent exposure to minocycline. This suggested that minocycline may enhance the ability of gingival epithelial cells to participate in the early, inflammatory phase of periodontal wound healing. The limitation of minocycline efficacy to a rather narrow window of concentration, centering about 50 microg/ml, and primarily for short-term exposures may possibly explain, in part, the contradictory clinical data on the health effects of this drug.
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Affiliation(s)
- H Babich
- Department of Biology, Stern College for Women, Yeshiva University, 245 Lexington Avenue, New York, NY 10016, USA.
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Larsson M, Kronvall G, Chuc NT, Karlsson I, Lager F, Hanh HD, Tomson G, Falkenberg T. Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community. Trop Med Int Health 2000; 5:711-21. [PMID: 11044266 DOI: 10.1046/j.1365-3156.2000.00630.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate antibiotic use and antibiotic susceptibility of respiratory tract pathogens in children aged 1-5 years in Bavi, Vietnam. METHOD Nasopharynx and throat specimens were collected from 200 children from randomly selected households in a demographically defined population. Respiratory isolates were tested for antibiotic susceptibility according to the standard disk diffusion method. A questionnaire survey of carers elicited information on type of antibiotic used, duration of treatment, where the antibiotics had been purchased, type of treatment information retained by carers and episodes of illness preceding the study. RESULTS 82% of the children had at least one symptom of acute respiratory tract infection (ARI) in the 4 weeks prior to the study, and of these 91% were treated with antibiotics. The most commonly used antibiotics were ampicillin (74%), penicillin (12%), amoxicillin (11%), erythromycin (5%), tetracycline (4%) and streptomycin (2%). Ampicillin was used for 3.3 days on average (SD:1.8) and penicillin for 2.6 days (SD:0.7). When deciding which antibiotic to use, 67% of the carers consulted the pharmacy seller, 11% decided themselves and 22% followed the doctor's prescription. The carrier rate of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis was 50%, 39% and 17%, respectively. Isolates from 145 children were susceptibility tested, and 74% were found to carry resistant pathogens. Of the tested isolates, 90% of S. pneumoniae, 68% of H. influenzae and 74% of M. catarrhalis were resistant to at least one antibiotic. The mean number of antibiotics (susceptible strains excluded) to which resistance was found was 2.0 (SD:1.2), 2.5 (SD:1.8) and 2.1 (SD:0.9), respectively. S. pneumoniae and H. influenzae showed high resistance to tetracycline (88% and 32%, respectively), trimethoprim/sulphonamide (32% and 44%), and chloramphenicol (25% and 24%). 23% of S. pneumoniae were erythromycin-resistant and 18% of H. influenzae isolates were resistant to ampicillin. There was a significant difference in ampicillin and penicillin resistance between the group of children previously treated with beta lactam antibiotics and the group of children who did not receive antibiotics. CONCLUSION As reported by the carers, children in Bavi are treated with antibiotics frequently. Most antibiotics were obtained without consulting a doctor. High levels of antibiotic resistance and high prevalence of multidrug-resistant strains were found among respiratory pathogens. The existence of a large reservoir of resistance genes among children in low-income countries represents a threat to the success of antibiotic therapy throughout the world. Multi-faceted programmes to improve rational use of antibiotics in Vietnam are urgently needed.
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Affiliation(s)
- M Larsson
- Department of Public Health, Karolinska Institutet, Stockholm, Sweden.
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Abstract
BACKGROUND The objective of esthetic dentistry is to treat diverse problems and achieve natural-appearing results. The author reviews the issues involved in the discoloration of human dentition and the concerns associated with current treatment for this problem. Understanding the proper use of materials in esthetic dentistry can result in a conservative, natural-appearing restoration. OVERVIEW Dentition discoloration due to intrinsic staining can be a severe esthetic problem. Current treatment using crowns and highly opaque porcelain veneers has inherent disadvantages in regard to the final restorations. The author explores a subopaquing technique that allows for progressive lightening of highly stained teeth to create natural color depth in a conservative porcelain veneer procedure. CLINICAL IMPLICATIONS In treating dental problems, the clinical practitioner looks for solutions that conserve tooth structure. To achieve natural-appearing esthetic results, it is important for the practitioner to be aware of technological advances in materials science as well as the proper use of esthetic dental techniques. Understanding the problems associated with dental discoloration and ways of correcting them will allow the practitioner to solve these moderate-to-severe esthetic problems on a consistent basis.
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Abstract
UNLABELLED Often the first evidence of variation from normal in human dentition is an observable difference in the color of the teeth. During the past decade, the demand for conservative esthetic dentistry has grown dramatically. 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. The intensity of stains may be worsened if there are enamel defects. Tooth discoloration presents two major challenges to the dental team. The first challenge is to ascertain the cause of the stain; the second is its management. CLINICAL SIGNIFICANCE This article reviews the etiology and clinical presentation of dental stains and outlines treatment options.
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Affiliation(s)
- F N Hattab
- Department of Restorative Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
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