A Delphi consensus on the nomenclature and diagnosis of lichen planus pigmentosus and related entities

Background: Although well known in clinical practice, research in lichen planus pigmentosus and related dermal pigmentary diseases is restricted due to lack of consensus on nomenclature and disease definition. Aims and Objectives: Delphi exercise to define and categorise acquired dermal pigmentary diseases. Methods: Core areas were identified including disease definition, etiopathogenesis, risk factors, clinical features, diagnostic methods, treatment modalities and outcome measures. The Delphi exercise was conducted in three rounds. Results: Sixteen researchers representing 12 different universities across India and Australia agreed to be part of this Delphi exercise. At the end of three rounds, a consensus of >80% was reached on usage of the umbrella term ‘acquired dermal macular hyperpigmentation’. It was agreed that there were minimal differences, if any, among the disorders previously defined as ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis and pigmented contact dermatitis. It was also agreed that lichen planus pigmentosus, erythema dyschromicum perstans and ashy dermatosis did not differ significantly apart from the sites of involvement, as historically described in the literature. Exposure to hair colours, sunlight and cosmetics was associated with these disorders in a significant proportion of patients. Participants agreed that both histopathology and dermatoscopy could diagnose dermal pigmentation characteristic of acquired dermal macular hyperpigmentation but could not differentiate the individual entities of ashy dermatosis, erythema dyschromicum perstans, Riehl’s melanosis, lichen planus pigmentosus and pigmented contact dermatitis. Limitations: A wider consensus involving representatives from East Asian, European and Latin American countries is required. Conclusion: Acquired dermal macular hyperpigmentation could be an appropriate conglomerate terminology for acquired dermatoses characterised by idiopathic or multifactorial non-inflammatory macular dermal hyperpigmentation

Caracterización clínico epidemiológica de pacientes con discromía dental / Clinical epidemiological characterization of patients with dental dyschromia

Introducción: La odontología conservadora ha afrontado un problema conocido como discromía, la cual ocurre cuando el diente sufre un cambio de color. No es grave en cuanto a la repercusión para la salud, pero es una condición desagradable que afecta la estética del paciente y su estado psíquico. Algunos estudios evidencian un aumento en cuanto a la discromía dental, como motivo de consulta de los pacientes, quienes en ocasiones solicitan la avulsión dentaria. Objetivo: Describir las características clínicas y epidemiológicas de pacientes con discromía. Método: Se realizó una investigación observacional, descriptiva transversal, en pacientes que acudieron a consulta en la clínica estomatológica docente del Hospital Militar Central Dr. Carlos J. Finlay, en el período comprendido entre febrero de 2016 a octubre de 2019, con un universo de 349 pacientes. Resultados: Los pacientes menos afectados fueron los menores de 19 años con un 4,3 por ciento, el sexo masculino representó un 65,9 por ciento. Predominaron las tinciones por bacterias cromógenas tanto para el sexo masculino como el femenino, con un 27,3 por ciento y 15,9 por ciento respectivamente, el grupo de edad de 35-59 años fue el más afectado con un 44,1 por ciento; las tinciones por descomposición aparecieron en el 48,4 por ciento de los pacientes. Conclusiones: Los pacientes más afectados por discromía dental fueron del sexo masculino, del rango de edad entre 35-59 años y causas extrínsecas(AU)

Introduction: Conservative dentistry has faced a problem known as dyschromia, which occurs when the tooth undergoes a color change. It is not serious in terms of consequences for health, but it is an unpleasant condition that affects the aesthetics of the patient and her psychic state. Some studies show an increase in terms of dental dyschromia, as a reason for consulting patients, who sometimes request dental avulsion. Objective: To describe the clinical and epidemiological characteristics of patients with dyschromia. Method: An observational, descriptive cross-sectional investigation was carried out in patients who came to the clinic at the teaching dental clinic of the Central Military Hospital Dr. Carlos J. Finlay, in the period from February 2016 to October 2019, with a universe of 349 patients. Results: The least affected patients were under 19 years old with 4.3 percent, the male sex represented 65.9 percent. Staining by chromogenic bacteria predominated for both the male and female sex, with 27.3 percent and 15.9 percent respectively, the age group of 35-59 years was the most affected with 44.1 percent; decomposition stains appeared in 48.4 percent of patients. Conclusions: The patients most affected by dental dyschromia were male, with an age range between 35-59 years and extrinsic causes(AU)

Recromía en un diente del maxilar superior / Tooth bleaching in the maxilla

Se describe el caso clínico de una paciente de 28 años de edad, quien acudió a la consulta de atención integral de la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba por presentar cambio de color en un diente anterosuperior izquierdo. Se indicó radiografía periapical que mostró tratamiento pulpo radicular en ese diente. Se decidió realizar la técnica de blanqueamiento para discromía de origen orgánico en 3 o 4 sesiones. Se obtuvo el resultado esperado y la paciente quedó satisfecha.

The case report of a 28 year-old patient who went to the comprehensive care service of Mártires del Moncada Provincial Teaching Stomatological Clinic in Santiago de Cuba for presenting a change of color in the anterosuperior left tooth is described. Periapical X-ray was indicated that showed pulpar radicular treatment in that tooth. It was decided to carry out the blenching technique for dyschromia of organic origin for 3 or 4 sessions. The expected result was obtained and the patient was satisfied.

Color comparison between non-vital and vital teeth

PURPOSE: The aim of this study was to define a color space of non-vital teeth and to compare it with the color space of matched vital teeth, recorded in the same patients. MATERIALS AND METHODS: In a group of 218 patients, with the age range from 17 to 70, the middle third of the buccal surface of 359 devitalized teeth was measured using a clinical spectrophotometer (Vita Easyshade Advance). Lightness (L*), chromatic parameters (a*, b*), chroma (C*), hue angle (h) and the closest Vita shade in Classical and 3D Master codifications were recorded. For each patient, the same data were recorded in a vital reference tooth. The measurements were performed by the same operator with the same spectrophotometer, using a standardized protocol for color evaluation. RESULTS: The color coordinates of non-vital teeth varied as follows: lightness L*: 52.83–92.93, C*: 8.23–58.90, h: 51.20–101.53, a*: −2.53–24.80, b*: 8.10–53.43. For the reference vital teeth, the ranges of color parameters were: L*: 60.90–97.16, C*: 8.43–39.23, h: 75.30–101.13, a*: −2.36–9.60, b*: 8.36–39.23. The color differences between vital and non-vital teeth depended on tooth group, but not on patient age. CONCLUSION: Non-vital teeth had a wider color space than vital ones. Non-vital teeth were darker (decreased lightness), more saturated (increased chroma), and with an increased range of the hue interval. An increased tendency towards positive values on the a* and b* axes suggested redder and yellower non-vital teeth compared to vital ones.

Blanqueamiento dental intrínseco utilizando técnica termo-catalítica: Presentación de un caso clínico / Intrinsic tooth whitening using thermo-catalytic technique: Clinical case report

Paciente femenino de 20 años de edad, quien acudió al Servicio de Odontología del Hospital Militar Regional de Guadalajara, Jalisco, por cambio de color en sus dientes. A la exploración, se observó discromía en el incisivo central superior derecho, las pruebas de sensibilidad negativas, radiográficamente ausencia de zona radio-lúcida, diagnosticándose necrosis pulpar, lo cual condujo al tratamiento de conductos en sesión única, para posteriormente realizar blanqueamiento intracoronario con técnica termocatalítica. Se llevó a cabo control clínico-radiográfico a uno, tres, seis y 12 meses, observándose en estos periodos, una adecuada evolución clínica, ausencia de sintomatología, zona radiolúcida y coloración adecuada de los tejidos dentales.

A 20 year old female patient attended the dental hospital of the Regional Military Hospital, Guadalajara, Jalisco. The patient's complaint was tooth discoloration. Exploration revealed dyschromia in the upper central right incisor. Sensitivity tests elicited negative results, radiographic examination revealed lack of radio-lucid areas. Emitted diagnosis was pulp necrosis. Root canal treatment was conducted in one single visit. Intra-coronary whitening with thermo-catalytic technique was achieved at a later date. Clinical and radiographic follow-up were conducted 3, 6 and 12 months after procedure. At these sessions the following traits were observed: suitable clinical evolution, absence of symptomatology, radio-lucid area and suitable coloring of dental tissues.

Nail dyschromias.

Nail dyschromias have a wide variety of presentation. There are numerous causes of discoloration of the nail affecting the nail plate, nail attachments, or the substance of the nail. The chromonychia may also be caused due to the exogenous deposition of pigments over the nail plate. Careful examination of the nail and few bed side tests may help in identifying the root cause of the nail dyschromia and many a times unravels some underlying systemic disorder too.