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What are the two types of stains according to location
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Extrinsic stain
occurs on the outside of the tooth and can be removed by polishing or scaling. Always exogenous
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Intrinsic stain
occurs within the tooth and cannot be removed by polishing or scaling
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What are the two types of stains according to source
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Exogenous stain
- develops or originates from sources outside the tooth
- may be either extrinsic or intrinsic.
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Endogenous stain
- develops within the tooth and is always intrinsic
- Are usually discolorations of the dentin reflected through the enamel
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What are three etiological factors that can occur according to their medical/dental history
- developmental complications, medications
- use of tobacco
- fluoride histories all contribute necessary information
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What are two additional factors when identifying stains
- food diary
- oral hygiene habits
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What are the two procedures for stain removal
- The stain can be removed from the tooth surface directly by a toothbrush or scaling
- The stain can be removed when the deposit is removed
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Describe the properties of extrinsic yellow stain
- dull, yellowish
- associated with the presence of bacterial plaque
- common to all ages, more evident when personal hygiene is poor
- Etiology - food pigments
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Describe the properties of extrinsic green stain
- Extrinsic, can become exogenous intrinsic
- 1.light or yellowish green to very dark green
- 2.embedded in plaque
- 3. may be a curved line along facial gingival crest
- 4. irregular or streaked following grooves in enamel
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What is the distribution and composition of extrinsic green stain
- mainly facial, may go to proximal, most frequently on facial cervical 1/3 of maxillary anterior teeth
- –May become embedded in surface enamel
- Composition
- – chromogenic bacteria, fungi, and decomposed hemoglobin
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What is the occurrence/recurrence and precautions with extrinsic green stain
- Occurrence –
- –any age, especially in children, affects permanent and primary teeth
- Recurrence
- – depends on oral hygiene
- Do not scale the area as tooth may be demineralized (decalcified) under stain
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Extrinsic green stain is the result of
- –poor oral hygiene
- –chromogenic bacteria
- –gingival bleeding
- –metallic dust
- –chlorophyll preparations
- –marijuana
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what is the clinical appearance and distribution of black line stain
- Clinical appearance
- – a highly retentive black or dark brown, calculus like stain that forms along the gingival margin
- Distribution –
- –facial and lingual follows contour of gingival crest onto proximal areas. Rarely on facial of maxillary anterior teeth, more common on lingual & proximal surfaces of maxillary posterior teeth
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What is the composition and occurrence of black line stain
- Composition
- – Mainly gram + rods. Attachment is by a pellicle like structure
- Occurrence –
- –all ages–
- more common in childhood, in females–frequently in clean mouths Forms despite regular personal care
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What is the clinical appearance/distribution/composition of tobacco stain
- May become intrinsic.
- Clinical appearance
- – light brown to black, may become exogenous intrinsic stain
- Distribution
- – primarily on cervical 1/3, any surface, especially on lingual
- Composition
- – tar and products of combustion, brown pigment from smokeless tobacco
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Describe extrinsic brown stains
- Brown Pellicle
- –brown to gray
- –recurs readily after removal
- –associated with use of non-abrasive toothpaste or plain water and brush
- Stannous Fluoride Dentifrice
- –may resemble brown pellicle
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What are four causes of brown stain
- 1.Foodstuff
- stea, coffee, and soy sauce are often implicated in the formation of a brownish-stained pellicle
- 2.Antibiofilm agents
- chlorhexidine and alexidine are used in mouthrinses and are effective against biofilm formation
- 3.Betel leaf
- betel leaf chewing is common among people of all ages in eastern countries. Betel has a caries-inhibiting effect
- 4.Swimmer Stain
- Frequent exposure to pools disinfected with chlorine
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What is the clinical appearance/distribution/occurrence/etiology of orange and red stains
- 1.Clinical appearance
- cervical 1/3, will be orange or red
- 2.Distribution – mainly anteriors, both facial and lingual
- 3.Occurrence – rare, red more than orange
- 4.Etiology – chromogenic bacteria
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What is the clinical appearance/distribution/manner of formation of metallic stains from industrial sources
- –Clinical appearancea.
- a.copper or brass: green or bluish-green.
- b.Iron: brown to greenish-brown.
- c.Nickel: green.
- Cadmium: yellow or golden brown
- –Distribution
- Primarily anterior; may occur on any teeth. Cervical third more commonly affected
- –Manner of formation
- Industrial worker inhales dust through mouth, bringing metallic substance in contact with teeth
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What is the Clinical appearance/distribution/manner of formation/prevention of metallic stains from substances contained in drugs
- 1.Clinical appearance
- Examples of colors on teeth: Iron: black (iron sulfide) or brown. Manganese (from potassium permanganate).
- 2.Distribution
- Generalized.
- 3.Manner of formationDrug enters biofilm substance, imparts color to biofilm and calculus. Pigment from drug may attach directly to tooth substance
- 4.Prevention
- Use a medication through a straw or in tablet or capsule form to prevent direct contact with the teeth
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What is the clinical appearance/formation of Endogenous Intrinsic Stains on Pulpless Teeth
- Clinical appearance - gray/black
- Formation - blood and pulp break down from hemorrhage and penetrate dentin
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What is an amalgam tattoo
- Gray shadow
- Restorative material showing through the tissue
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What are the properties of Endogenous Intrinsic Stains Internal Resorption
- Pink tooth.
- Resorption of dentin.
- Pulp and blood supply show through the enamel.
- May be due to trauma
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What are the properties of Endogenous Intrinsic Stains Amelogenesis Imperfecta
- enamel is partially or completely missing because of a generalized disturbance of the ameloblasts
- teeth are yellowish brown or gray brown
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What are the properties of Dentinogenesis Imperfecta
- opalescent dentin, dentin is abnormal as a result of disturbances in the odontoblastic layer during development
- The teeth appear translucent or opalescent and vary in color from gray to bluish-brown
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What are the properties of Enamel Hypoplasia
- Generalized hypoplasia –
- –Teeth erupt with white spots or pits. May become discolored over time
- Local hypoplasia
- Affects a single tooth, may become stained
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What are the properties of Dental Fluorosis
- Fluoride ingestion of more than 2 ppm in water.
- –Standard is 1 ppm
- Occurs only during mineralization
- Damage to ameloblast forming of enamel
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What are the properties of Tetracycline
- 1.Common stain.
- 2.Drug administered during 3rd trimester or the child in infancy and early childhood.
- 3.Seen more in older patients
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What are two restorative materials that can cause exogenous intrinsic
- Silver amalgams - discolors tooth around the restoration
- Endodontic treatment - silver points from a root canal “Black point stain”.
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What are the properties of staining from stannous fluoride
light to dark brown, commonly seen in occlusal pits and cervical 1/3 of anterior teeth
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dentinogenesis imperfecta
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