Stains

Question 1

What types of discoloration can we remove through a prophy, scaling and polishing?

Answer 1

Stains that have adhered directly to the tooth surface

Stains contained within calculus and soft deposits

Question 2

What is the significance of thick stain deposits?

Answer 2

Can provide a rough surface for dental biofilm to collect and irritate the gingiva

Helps is evaluate oral cleanliness (home care)

Question 3

What are the location based stain types?

Answer 3

Intrinsic

Extrinsic

Question 4

What are the source based stain types?

Answer 4

Exogenous

Endogenous

Question 5

Exogenous stains

Answer 5

Comes from an outside source

Happens after eruption

Can become intrinsic

Question 6

Endogenous stains

Answer 6

Develops within the tooth

Most are dentin

Always intrinsic

Question 7

Intrinsic stains

Answer 7

Cannot be mechanically removed

Exogenous or endogenous

Can only be improved with whitening treatments

Question 8

Extrinsic stains

Answer 8

May be remived by mechanical means

Exogenous source

Question 9

How do we recognize and identify stains?

Answer 9

Take a medical and dental history: more than one type may be present

Food diary: ethnic practices/food

Oral hygiene habits

Question 10

Direct extrinsic stains

Answer 10

Attached to the pellicle

Question 11

Indirect extrinsic stains

Answer 11

A chemical interaction that creates the stain

Question 12

Different types of extrinsic stains

Answer 12

Yellow
Green
Black-line
Tobacco
Brown stain
Orange/red
Metallic

Question 13

Yellow stain

Answer 13

Dull yellow, resembles biofilm

Generalized or local

More prevalent in poor Hc

Mechanical removal, like biofilm

Question 14

Green stain

Answer 14

Light yellowish green to very dark green

Embedded in biofilm. Small curved lines following facial margin- irregular

May cover entire surface or follow grooves or lines in enamel

Frequently superimposed by aoft yellownor gray debris

Darker green may become embedded

Question 15

Clinical considerations of green stain

Answer 15

Ename under stain= demineralized= result of cariogenic bacteria

Rpugh demineralized surface emcourages biofilm retention, demineralization and recurrence

Question 16

Distribution and composition of green stain

Answer 16

Primary facials, may extend into proximal and lingual. Ging 3rd more common

Chromogenoc bacteria and fungi
Decomposed hemoglobin
Inorganic elements- calcium, potassium, sodim, silicon, magnesium, phosphorus

Question 17

Clinical approach to green stain

Answer 17

Do not scale unless we know there is not demineralozation

Brush biofilm away

Stress daily biofilm control and fluoride

Question 18

Other types of green stain

Answer 18

Marijuana typocally on linguals

Etiology: chlorophyll preparations, metallic dust, marijuana

Question 19

Appearance of black-line stain

Answer 19

Continuous or interrupted 1mm line

Follows contour of ging margin

Thin clear line of instained atea btw black line and margin

Appears balck at basenof pits and fissures

Can feel like calc when heavy

Teeth frequently clean, low to no bleeding, low incidence of caries

Question 20

Distribution of black-line stain

Answer 20

Facial and lingual following the gingival crest

Rarely on facials of max anteriors

Most frequent on lingual and prox of max posteriors

Question 21

Composition of black-line stain

Answer 21

Microorganisms embedded in an inter-microbial substance

Primarily gram + and rods with other bacteria but rods predominate
Actinomyces

Attachment by pellicle-like structure

Mineralization is similar to formation of calculus

Rxn btw hudrogen sulfide produced by bacteria and iron in saliva

Question 22

Occurence of black-line stain

Answer 22

All ages/ more common in childhood

Females more common

Frequently found in clean mouths

No predisposing factors

Question 23

Recurrence of black-line stain

Answer 23

Will recur despite regular biofilm control

Very meticulous home are will reduce occurence

Question 24

Appearance of tobacco stain

Answer 24

Light brown to leathery brown/black

Diffise staining of biofilm, natrow band following contour of ging crest. Wide, form, tar-like band covering cervical 3rd

Can incorporate into calculus
Heavy deposits may become wxogenous intrinsic

Question 25

Distribution of tobacco stain

Answer 25

Promarily cervical 3rd Any surface, pits snd fissures Most frequently on linguals

Question 26

Predisposing factors for tobacco stain

Answer 26

Natural tendency Quantiyybof stain mot necessarily proportional to the amt of tobacco used Neglected biofilm will cause more deposits- the more plaque, the easier it is to stain

Question 27

Brown pellicle

Answer 27

Can take on stains of various colors that results from chemical alterations of pellicle

Question 28

Brown stain from stannous fluoride

Answer 28

Light brown, sometimes yellowish, in pellicle after repeated topical use Results from formation of stannous sulfide or brown tin oxide from rxn of tin ion

Question 29

Food sources of brown stain

Answer 29

``` Tea Coffee Soy sauce Red wine Soda ```

Question 30

Briwn stain from betel leaf

Answer 30

``` All ages, eastern countries Dark brown to almost black Reaukts from chewing leave of betel bush Thick, hard, partly smooth, partly rough Composed of microorganisms and mineralozed mayerial removed by scaling Caries inhibiting effect ```

Question 31

Orange and red stains

Answer 31

May be seen with very thick biofilm On anterior, facial and lingual, cervical 3rd, more frequent than posterior Rare Chromogenic bacteria in the biofilm

Question 32

Metallic stains

Answer 32

Copper or brass (blue/green), iron (brown-green/brown), nickel (green), cadmium (yellow) Primarily on anteriors but can be on any surface. More common on cervical 3rd Workers inhaling dust- can become exogenous intrinsic

Question 33

Metallic stains from drugs

Answer 33

Iron black (iron sulfide) or brown; manganese black (from potassium permanganate) Generalized Drug wnters biofilm substance, imparts color to calculus, pogment can attach directly to tooth surface Use straws, tablet or capsule form for meds

Question 34

Endogenous intrinsic stains

Answer 34

Pulpless or traumatized teeth (not all pulpless teeth oresent with color change) Yellow brown, deep gray, reddish brown, dark brown, bluish black, orange or greenish From blood and other elements available for breakdown as a resultbof hemorrhahe in pulp or neveosis and decomp of tissue

Question 35

Tetracycline endogenous intrinsic stain

Answer 35

Broad spectrum antibiotic Affinity for mineralized tissue- absorbed by bone/teeth Can pass through placenta- administration of drig during last trimester, infancy and early childhood

Question 36

Appearance of tetracycline stain

Answer 36

Depends on dosage and length of exposure. Light green to dark yellow. Ultraviolet light can cause teeth to fluoresce May be generalized. In a banded line. In a series of administration separated by time

Question 37

Hereditary/Genetic endogenous intrinsic stains

Answer 37

Amelogenesis imperfecta- disturbance of ameloblasts. Enamel partially to completely missing. Yellow brown to grey brown Dentinogenesis imperfecta- distirbance in odontoblastic layer during development. Translucent or opalescent gray to bluish brown DO NOT SCALE: enamel may fracture from dentin

Question 38

Enamel hypoplasia- endogenous intrinsic stains

Answer 38

Systemic hypoplasia- chronologic hypoplasia- ameloblastic distrubance of a short duration Teeth wrupt with white spotsbornpots. White spots more prone to discoloration from other stains. Location corresponds to the stage of development Local hypoplasia affects a single tooth

Question 39

Flurosis endogenous Intrinsic stains

Answer 39

Colorado brown stain, brown stain, mottled enamel White spots to severe brown discoloration and cracks and pitting of enamel surface Enamel hypomineralization from excessive ingestion of fluoride during tooth development Excess of 2ppm in water

Question 40

Jaundice endogenous intrinsic stains

Answer 40

Prolonged in early life, yellow to green discoloration

Question 41

Erythroblastosis Fetalis endogenous intrinsic stains

Answer 41

Rh incompatibility, green brown or blue hue

Question 42

Exogenous intrinsic stains

Answer 42

When intrinsic stains come from an outside source, not from within the tooth Restorative materials Endodontic therapy Drugs

Question 43

Restorative material stains

Answer 43

Silver amalgam- gray to black. Metallic ions migrate into enamel and dentin Copper amalgam- bluish green color

Question 44

Endodontic therapy

Answer 44

``` Silver nitrate: bluish black Volatile oils- yellowish brown Strong iodine- brown Aureomycin- yellow Ailver containing root canal sealer- black ```

Question 45

Drug stains

Answer 45

Topical stannous fluoride- not the same as endogenous form Light to dark brown From tin sulfide on decal areas, pits/fissures, restoration margins

Question 46

What to document

Answer 46

``` Which stains Location Color Type Extent ```

Question 47

Factors to teach the patient

Answer 47

Where they come from- etiology Personal care procedures Smokinh cessation programs Effective or abrasive dentifrice Aboid tonacco, coffee, tea etc Difficulty of removing certain extrinsic stains Effect of tetracyclines on developing teeht