Tetracycline staining of the dentition: a review of the literature and report of a clinical case.

The present article reviews the literature regarding tetracycline staining of the dentition and its esthetic management. A total of 49 articles were identified in the initial search, and 22 articles met the eligibility criteria of this narrative literature review. Tetracycline staining results from its use in children between the ages of 6 months and 6 years, when tooth crowns are formed; the effects are dependent on the dosage, duration of treatment, stage of tooth mineralization, and activity of the mineralization process. Tooth bleaching is always the first treatment option for low-grade cases of tetracycline staining. Restorative procedures are indicated for severe staining. The article also describes the treatment of severe staining affecting the maxillary anterior dentition of a 48-year-old man who reported the systemic administration of tetracycline during childhood. Direct composite resin laminate veneers were proposed to achieve immediate, highly esthetic restorations. A combination of different resinous materials in different shades was applied to meet the needs of the patient. The use of direct composite resin laminate veneers satisfied the functional and esthetic demands of the patient at a lower cost than ceramic materials.

Dental Bleaching with Phthalocyanine Photosensitizers: Effects on Dentin Color and Collagen Content.

With the increasing demand for tooth bleaching in esthetic dentistry, its safety has been the focus of a comprehensive body of literature. In this context, the aim of the present study was to evaluate the application effects of pentalysine ß-carbonylphthalocyanine zinc (ZnPc(Lys)5)-mediated photodynamic therapy in dentin bleaching and its effects on dentin collagen. We first established a new and reproducible tooth staining model using dentin blocks stained by Orange II and then bleached with ZnPc(Lys)5 (25 µM) and hydrogen peroxide (10% or 30%). Data were analyzed with one- and two-way ANOVA and a significance level of p < 0.05. ZnPc(Lys)5 effectively bleached the dentin samples to an extent comparable to hydrogen peroxide at either 10% or 30% concentrations. Further studies on the dentin morphology, chemical element distribution, and protein constituents, using an electron microscope, energy dispersive spectroscopy, X-ray photoelectron spectroscopy, and SDS-PAGE, demonstrated that treatment with the photosensitizer preserved the dentin structure and, at the same time, the major organic component, collagen type I. For comparison, hydrogen peroxide (10% or 30%) treatment significantly degraded the collagen protein. This work indicated that the photosensitizer exerts potent bleaching effects on dentin staining; importantly, does not damage dentin and its collagen content; and opens up a new strategy to further explore various photosensitizers for the bleaching of both tooth enamel and dentin.

Approaches to minimize tooth staining associated with silver diamine fluoride: A systematic review.

OBJECTIVE: To the effectiveness of different strategies to overcome silver diamine fluoride (SDF)-mediated tooth staining. MATERIALS AND METHODS: Four online databases (PubMed, ScienceDirect, Scopus, and Web of Science) were searched using different MeSH terms and Boolean Operators to retrieve the articles (until June 2021), followed by a hand-search of the reference list of the included articles. All full-text, original studies in English that evaluated SDF staining and at least one SDF modification/alternative were included. RESULTS: Among the assessed studies, nine studies explored the stain-minimization effect of potassium iodide (KI) post-application following SDF treatment. Among these, eight concluded that KI application after SDF treatment significantly reduced tooth staining, while one showed marginal staining following glass ionomer restoration of the SDF-treated dentine. Additionally, one study applied potassium fluoride (KF) and silver nitrate (AgNO3 ) concurrently to mitigate SDF-mediated staining. One study compared SDF staining with polyethylene glycol (PEG)-coated nanoparticles containing sodium fluoride (NaF), and another used nanosilver fluoride (NSF) for staining comparison with SDF. CONCLUSIONS: Within the limitations of this study, the addition of different materials to SDF has proven to be a beneficial strategy for overcoming tooth staining associated with SDF. Future studies are warranted, particularly clinical trials, to validate these findings. CLINICAL SIGNIFICANCE: SDF-mediated tooth staining is a serious concern that limits its clinical use. A review of various strategies to overcome this problem will help clinicians enhance its clinical use and patient acceptance.

Tinción dental por cloro / Chlorine`s dental stain

Las manchas dentales son motivo frecuente de preocupación por parte de las familias. Aunque en general se trata de patologías estéticas, algunos casos precisan tratamiento adecuado y eficaz. Por este motivo, es importante conocer las posibles etiologías con el fin de poder prevenirlas y tratarlas si es necesario. Las manchas dentales más frecuentes son las manchas cromógenas, manchas postraumáticas y las secundarias a caries dentales. Sin embargo, existen también otros motivos menos comunes a tener en cuenta, como la afectación dental por cloro. Esta patología es de especial interés, ya que puede pasar desapercibida si no realizamos una buena historia clínica (AU)

Dental stains are a common cause of concern for families. Although in general it is about aesthetic pathologies, it is important to know the possible causes that can lead to an adequate and effective treatment, as well as future prevention.The most frequent stains are black stains, post-trauma stains and dental caries. However, there are also other less common reasons to take into account, such as dental damage caused by chlorine. This pathology is of special interest, since it can go unnoticed if we do not take a good clinical history. (AU)

Incorporation of Green Capping Agents to Reduce Silver-Mediated Dentine Staining.

Silver diammine fluoride (SDF) is known as a noninvasive, cost-effective, safe, and simple method of dental caries treatment. However, staining and discoloration seem inseparable with SDF and continue as a cosmetic concern. Research is ongoing to overcome these issues, for example, by using glutathione (G) or potassium iodide among others. Therefore, the study aimed to investigate the effects of incorporating different concentrations of capping agents on SDF chemistry and SDF-mediated tooth staining at different time points. Tannic acid (TA), gallic acid (GA), carboxymethyl chitosan (CM), and G at different concentrations (5, 10, and 15% w/v) were incorporated in 30% SDF. FTIR and UV-Vis spectroscopies of the prepared solutions was performed to evaluate chemical changes. Time-dependent color changes (ΔE) in bovine dentine specimens (6 × 6 × 1 ± 0.25 mm3) were measured spectrophotometrically at application/washup, 1 and 3 h, after 1, 2, 4, 7, and 14 days. Results showed suppression of FTIR peaks at 3,358 cm-1 and 1,215 cm-1 in capping agent-modified SDF indicative of a successful capping effect of the silver ions, which was corroborated by UV-Vis blueshift of ∼∆32 nm. The capping effect on SDF increased proportionally with the concentrations of TA, GA, CM, and G used. A more pronounced tooth staining reduction however was shown more in TA- and G- rather than in GA- and CM-modified SDF. At day 14, SDF showed the highest mean ΔE(50.14 ± 2.14), while 15% TA showed the lowest ΔE(30.14 ± 0.81). In conclusion, capping agent incorporation significantly reduced SDF-mediated tooth staining. This reduction in staining is more dependent on the respective capping agent functional groups than concentrations per se. The potential of capping agents to minimize tooth staining of SDF was TA>G>CM>GA.

Comparison of staining potential of silver diamine fluoride versus silver diamine fluoride and potassium iodide under tooth-colored restorations: An in vitro study.

BACKGROUND: Silver diamine fluoride (SDF) is one of the effectual cariostatic agents widely used in minimal intervention dentistry. However, the major drawback of SDF is dark staining after its application. AIM: In the present study, the staining of 38% SDF alone and 38% SDF and potassium iodide (KI) was compared after restoration with glass-ionomer cement (GIC) and resin composite using ImageJ software. METHODS AND MATERIAL: Forty extracted carious primary teeth were sorted into four groups. In Group I and II, SDF was applied and restored with GIC and composite restorations, respectively. In Group III and IV, SDF application was followed by KI and restored with GIC and composite restorations, respectively. Images were captured after initial applications on day 1 and day 14 after restoration. The captured images were imported to ImageJ software and mean gray values were calculated. STATISTICAL ANALYSIS: The mean gray values obtained were subjected to statistical analysis using paired t-test and independent sample t-test. There was statistically significant if P < 0.05. RESULTS: Following the application of SDF and RIVA STAR, the baseline mean gray values showed no statistical significance. On day 1, the mean gray values were highest in Group IV (208.30) and lowest in Group I (178.51). Similarly, on day 14, the highest mean gray values were observed in Group IV (208.45) and lowest in Group I (147.6) which were statistically significant. CONCLUSIONS: The restorations after SDF application attained dark stain eventually, whereas with the application of SDF followed by KI (RIVA STAR), the restorations showed the least staining.

A influência da ingestão de corantes durante e após o clareamento dental: uma revisão de literatura / The influence of color ingestion during and after dental whitening: a literature review

Introdução: O clareamento dental é um dos procedimentos estéticos mais realizados em todo mundo. Para garantir sua estabilidade e longevidade, muitos autores preconizam o estabelecimento de uma dieta branca durante e logo após o tratamento. Objetivo: Realizar uma revisão bibliográfica sobre a influência da ingestão de corantes relacionada à estabilidade de cor dos dentes durante e após o clareamento dental. Materiais e Métodos:Realizou-se uma revisão bibliográfica de estudos publicados nos últimos 16 anos (2003-2019), por meio de busca nas bases de dados: PubMED/Medline, Scielo (Scientific Eletronic Library) e Google Acadêmico. Para a pesquisa, foram utilizados os seguintes descritores: clareamento dental (dental whitening), manchamento dentário (dental staining) e dieta corante (dyediet). Após uma filtragem criteriosa, 27 trabalhos e 1 livro foram selecionados para inclusão no estudo. Resultados: A dieta branca muitas vezes é indicada, durante e logo após o tratamento clareador, devido à susceptibilidade de manchamento da estrutura dentária, causada pela desmineralização superficial e transitória dos géis clareadores, a qual faz com que os pigmentos advindos da dieta sejam incorporados facilmente à estrutura dentária. Conclusão:Não há evidências suficientes na literatura que apontam que a ingestão de corantes, durante e após o tratamento clareador, comprometa a estabilidade de cor da estrutura dentária.

Introduction:Tooth whitening is one of the most widely performed aesthetic procedures in the world.To ensure its stability and longevity, many authors advocate establishing a white diet during and right after treatment. Objective: To carry out a bibliographic review about the influence of dye ingestion related to the teeth color stability during and after tooth whitening. Material and Methods:A literature review of the studies published in the last 16 years (2003-2019) was carried out by a search on the databases: PubMed / Medline, Scielo (Scientific Electronic Library), and Google Scholar. For the search, the following descriptors were used: tooth whitening, tooth staining, and dye diet. After careful filtering, 27 articles and 1 book were selected to be included in the study. Results: The white diet is often indicated during and shortly after whitening treatment due to the susceptibility of staining the tooth structure caused by the superficial and transient demineralization of the whitening gels, which makes the pigments from the diet easily incorporated into the tooth structure. Conclusion:There is no sufficient evidence in the literature to indicate that dye ingestion during and after whitening treatment compromise the color stability of the tooth structure.

Real-time binding kinetic analyses of the interaction of the dietary stain orange II with dentin matrix.

OBJECTIVES: Dietary stains can be adsorbed into the dentin of teeth. Using Orange II as a model dietary stain, this study investigated the strength of its interaction with the mineral and protein components of dentin matrix and how hydrogen peroxide (H2O2) treatment influences this interaction. METHODS: Dentin slices were prepared from human teeth and were either deproteinized (5.6% sodium hypochlorite, 12 days), demineralised (0.5 M EDTA, 3 days) or left as intact control samples. Samples were stained with Orange II for 1-168 h, during which staining intensity was quantified by image analysis. Similarly, uptake of stain by deproteinized / demineralized samples treated with 10 or 30% H2O2 was investigated. Using surface plasmon resonance technology, real-time binding kinetics were determined assessing the interaction of Orange II with the dentin matrix protein constituents, collagen type I, biglycan, decorin, dentin sialoprotein and osteopontin. RESULTS: Deproteinization of dentin matrix reduced the uptake of the Orange II compared to the intact control. Conversely, demineralization of dentin samples increased the uptake of the dye. Treatment of samples for 48 h with H2O2 reduced subsequent uptake of the Orange II. Real-time kinetic analysis indicated moderate strength of binding for Orange II with collagen type I, weak binding with decorin and biglycan and negligible binding with dentine sialoprotein and osteopontin. CONCLUSION: These results indicate a predominant role for collagen type I, which accounts for 90% of the organic protein matrix of teeth, for attracting dietary stains. Binding analyses indicate that the interaction is highly dissociable, and further binding is reduced following H2O2 treatment. CLINICAL SIGNIFICANCE: This study provides new information regarding adsorption of dietary stains into tooth dentin, suggesting that they are attracted and moderately bound to the collagen type I matrix. This study also contributes valuable information for discussion for considering the effect of H2O2 on bleaching teeth and its influence on subsequent uptake of dietary stains following whitening treatments.

Effects of two different post-surgical protocols including either 0.05 % chlorhexidine herbal extract or 0.1 % chlorhexidine on post-surgical plaque control, early wound healing and patient acceptance following standard periodontal surgery and implant placement.

OBJECTIVES: The aim of this study was to compare early wound healing, tooth staining and patient acceptance with two different post-surgical maintenance protocols. MATERIALS AND METHODS: Forty patients scheduled for flap surgery to treat periodontal pockets or accommodate dental implants were randomly assigned to receive the following two different post-surgical maintenance protocols: (a) 2 weeks rinsing with a 0.05 % chlorhexidine digluconate (CHX)/herbal extract combination (test) or (b) a 0.1 % CHX solution (control). Early wound healing was evaluated clinically and immunologically. Tooth staining and patient acceptance were assessed by means of visual analogue scale (VAS). RESULTS: Both groups presented with comparable wound healing profiles. No statistically significant differences were observed between the two protocols regarding early wound healing and plaque index (p > 0.05). However, in the control group, statistically significantly more patients felt discomfort due to tooth staining (p = 0.0467). Compared with patients from the test group, patients in the control group reported statistically significant more irritation of taste at week 1 (p = 0.0359) and at week 2 (p = 0.0042). CONCLUSIONS: The present findings indicate that the two CHX protocols resulted in comparable healing and inhibition of plaque formation. Tooth staining and subjective discomfort related to irritation of taste were more frequent in the control group. CLINICAL RELEVANCE: A post-operative protocol including 0.05 % CHX/herbal extract may have the potential to improve patient compliance during post-operative maintenance.

Tooth polishing: The current status.

Healthy teeth and gums make a person feel confident and fit. As people go about their daily routines and with different eating and drinking habits, the tooth enamel turns yellowish or gets stained. Polishing traditionally has been associated with the prophylaxis procedure in most dental practices, which patients know and expect. However, with overzealous use of polishing procedure, there is wearing of the superficial tooth structure. This would lead to more accumulation of local deposits. Also, it takes a long time for the formation of the fluoride-rich layer of the tooth again. Hence, now-a-days, polishing is not advised as a part of routine oral prophylaxis procedure but is done selectively based on the patients' need. The article here, gives an insight on the different aspects of the polishing process along with the different methods and agents used for the same.

In vitro investigations into the etiology of mineral trioxide tooth staining.

AIM: To investigate the role of bismuth oxide, a constituent of contemporary mineral trioxide aggregate (MTA) materials, and its response to various solutions that may contribute to the potential discoloration that occurs following MTA applications within the scope of endodontics. SETTING AND DESIGN: Laboratory assessment of chemical reactions with white ProRoot(®) MTA and white Portland cement (WPC). MATERIALS AND METHODS: Set specimens and freshly mixed specimens of white ProRoot(®) MTA and white ProRoot(®) MTA powder, along with specimens of WPC were exposed to distilled water, phosphate buffered saline (PBS), 10% formalin, hydroxyethylmethacrylate (HEMA), sodium hypochlorite, sodium hydroxide (NaOH) base, and hydrochloric acid (HCl) acid. Specimens were visually inspected periodically for color changes. RESULTS: All forms of ProRoot MTA showed discoloration when exposed to 10% formalin within 30 min, as opposed to WPC, and were completely blackened at 4 days. Bismuth oxide alone and with calcium oxide also turned black within 30 min after exposure to 10% formalin. No discoloration was seen when exposed to the other solutions. CONCLUSIONS: Exposing MTA in various forms to a variety of liquids has determined that bismuth oxidein combination with other chemical moieties is the prime cause of staining observed by clinicians.

The efficacy of chlorhexidine dentifrice or gel on plaque, clinical parameters of gingival inflammation and tooth discoloration: a systematic review.

AIM: Based on the existing scientific literature, the effect of chlorhexidine (CHX) dentifrice/gel as compared to a regular or placebo dentifrice/gel is established in healthy adults on the primary outcome parameters of plaque and gingivitis scores. As secondary parameter, tooth surface discoloration was evaluated as a side effect. MATERIALS AND METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials were searched up to July 2013 to identify eligible studies. Included were (randomized) controlled clinical trials, regarding self-performed brushing by adults without periodontitis with a minimum duration of 4 weeks. RESULTS: Independent screening of 389 unique titles and abstracts resulted in 16 comparisons. Of these, nine evaluated CHX dentifrice (0.4-1.0%) and 7 CHX gel (0.2-2.0%). It was not possible to perform a meta-analysis; therefore, a descriptive analysis was carried out. Regarding plaque score reduction, the majority of the experiments using a CHX dentifrice provided a significant positive effect. All studies assessing gingival bleeding as parameter for gingivitis observed a significant reduction in favour of CHX dentifrice over placebo dentifrice. Tooth surface discoloration was more pronounced with CHX dentifrice. The combined data concerning parameters of interest for CHX gel compared with a placebo did not show a trend towards a beneficial effect on plaque and bleeding scores. CONCLUSIONS: Within the limitations of this analysis, it may be concluded that toothbrushing with a CHX gel does not provide conclusive evidence. Brushing with a CHX dentifrice can be effective with regard to the control of plaque and gingivitis. Tooth surface discoloration was observed as side effect, which potentially can have a negative impact on patients' compliance.

Avaliação, após clareamento, da alteração decor de dentes bovinos imersos em soluçõescom elevado potencial de pigmentação / Postbleaching color change evaluation ofbovine teeth immersed in high-pigmentationpotential solutions

Introdução: O clareamento dentário é um dos tratamentos estéticosmais procurados na Odontologia atualmente. Entretanto alteraçõessubclínicas da micromorfologia superficial dos tecidos dentáriospodem ocorrer após o clareamento, levando a uma maior facilidadede manchamento nos períodos imediatamente posteriores à suarealização. Objetivo: Avaliar, após clareamento dentário, a alteraçãode cor de dentes bovinos imersos em quatro soluções com elevadopotencial de pigmentação. Material e métodos: Clarearam-se 50 dentesbovinos com gel à base de peróxido de hidrogênio a 35%. A análise dadeterminação da cor (parâmetros do sistema CIELab) foi realizada comauxílio de um espectrofotômetro digital. Os dentes foram distribuídosem cinco grupos e imersos nas soluções (n = 10): água destilada (controle), café, chá-preto, vinho tinto e refrigerante à base de cola, por1 hora por dia durante 15 dias. Em seguida, submeteram-se novamenteos dentes a análise de cor, e as diferenças de cores (?E) entre a primeirae a segunda leitura foram calculadas. Os dados foram sujeitados aanálise de variância (Anova) e ao teste de Tukey (? = 5%). Resultados:Entre todas as substâncias, a que promoveu maior manchamento foio chá-preto (18,49), seguido pelo vinho tinto (16,41), pelo refrigeranteà base de cola (15,73) e por último pelo café (9,37). Conclusão: Todasas soluções com elevado potencial de pigmentação foram capazes demanchar os dentes bovinos, entretanto o chá-preto, juntamente com ovinho tinto e o refrigerante, causou maior escurecimento.

Introduction: Dental bleaching is one of the most commonly usedaesthetic treatments in dentistry nowadays. However, subclinical changesin the surface micromorphology of dental tissues may occur afterbleaching, leading to a greater easiness of tooth staining in the periodimmediately after its completion. Objective: To evaluate the color changeof bovine teeth immersed in four solutions with high-pigmentationpotential, after tooth whitening. Material and methods: Fifty bovineteeth were bleached using a 35% hydrogen peroxide gel. Color analysiswas performed by a digital spectrophotometer for the acquisition ofCIELab parameters. Teeth were divided into 5 groups and immersedin the following solutions (n = 10): distilled water (control), coffee,black tea, red wine and cola soft drink, for 1 h/day, during 15 days.Teeth were again submitted to color analysis and the color differences(?E) between the first and second reading were calculated. Data weresubjected to ANOVA and Tukey?s test (? = 5%). Results: Among allthe substances tested, black tea provoked the highest color difference(18.49), followed by red wine (16.41), cola soft drink (15.73), and coffee(9.37). Conclusion: All high-pigmentation potential solutions were ableto promote the staining of bovine teeth. However, black tea, red wine,and cola soft drink produced the highest color differences.