Retrospective Analysis of Causative Factor for Tooth Discoloration among Male Patients in Indian Population

Tasleem Abitha S and Subash Sharma^*

^*Correspondence: Subash Sharma, Department of Conservative Dentistry and Endodontics, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India, Email:

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Introduction

A smile has been said to be among man’s most important interactive communication skills. The public’s importance for white teeth has driven dentists to strive to meet their patients expectations of dental aesthetics 1. The appearance of the dentition is of concern to a large number of people seeking dental treatment and the colour of the teeth is of particular cosmetic importance [1,2].

There has been a recent increase in interest in the treatment of tooth staining and discolouration as shown by the large number of tooth whitening agents appearing on the market [3]. Discoloration being the prime cause of esthetic dental treatment, etiology should be known to the clinician. There are numerous factors that result in tooth discoloration. Tooth discoloration can occur as a result of intrinsic or extrinsic factors. Also, it occurs as a result of surface stains due to actual changes in our tooth material, or because of a combination of both factors. Dental professionals have identified different categories of tooth discoloration [4].

Extrinsic discolouration

It is caused by agents resulting in staining of enamel or causing some kind of damage to the enamel. The involvement of the outermost layer of the tooth is usually seen which can be prevented by simple oral prophylaxis. Yellowish brown to black discoloration primarily on the lingual surfaces of the tooth involving the cervical portion is caused by cigarettes, cigars and pipes 5. Stains penetrating the deep enamel are caused by tobacco chewing. Brown to black tenacious discoloration is seen with the use of frequent intake of tea and coffee [5,6].

Intrinsic discolouration

The deposition and incorporation of substances within enamel and dentin causes this kind of staining, for instance, tetracycline stains, stains in dentin genesis imperfect, fluorosis, jaundice (greenish discoloration due to bilirubin), dental trauma (gray or blue gray discoloration due to the breakdown of haemoglobin), dental materials used in restorative dentistry and medicines [7]. Long standing non vital tooth and periapical pathology also contribute to intrinsic staining [8].

Tetracycline staining

Tetracycline staining was first reported in mid-1950s, less than a decade after widespread use of this antibiotic. Teeth are most susceptible to tetracycline discoloration during their formation (i.e. 2nd trimester to 8 year after birth) due to tetracycline chelate formation with calcium and its incorporation into hydroxyapatite crystals 9. It predominantly involves dentin and its severity depends on time, duration and dosage of the administration of tetracycline. Different forms of tetracycline cause different kinds of tooth discoloration [9,10]. There are various types of treatment available for teeth discoloration which includes removal of surface stains, micro abrasions, macro abrasions, veneering, placement of porcelain crowns and bleaching [11].

The psychological and social impact of tooth staining on patients has been greatly reported. Tooth staining may be the result of different etiological factors, it may have different appearances, location and severity [11,12]. Our team has extensive knowledge and research experience that has translated into high quality publications [13-32].

Materials and Methods

This study is a retrospective cross sectional study conducted in a Private Dental Institution, in Chennai to determine the class I vs. class II dental caries with the approval from the Institutional Review Board.

Data collection

Data is extracted from Patient management software of Saveetha dental college from the time period February 2020 to February 2021 based on the following inclusion and exclusion criteria’s.

Inclusion criteria

✔Patients who had fluorosis.
✔Patients with discolored tooth.

Exclusion criteria

✔Patients below the age of 18 years.
✔Teeth with pulpal involvement.
✔Teeth with dental caries.

Data analysis

The data collected were reviewed and cross verified. The collected data is entered in MS Excel sheet, and transferred to SPSS version 21 for analysis. Independent variables were PID, Name; Dependent variables were age, gender, tooth number, apical preparation size. Chi square test was used to analyse the association. P value less than 0.05 was considered statistically significant. Results were presented in the form of bar diagrams.

Results

The results of the study are presented as bar diagrams below. Figure 1 represents the frequency distribution of age group. Figure 2 represents the frequency distribution of teeth numbers. Figure 3 represents the frequency distribution of etiology of tooth discoloration.

Figure 1: This bar chart represents the frequency distribution of age group. Majority of the patients were between the age group of 18-30 years (50.9%) followed by less than 18 years (33.9%), 31-40 years and more than 40 years (7.5%).

Figure 2: The bar chart represents the frequency distribution of teeth numbers. Majority of the participants have undergone treatment in sextant 2 (79.7%) followed by sextant 5 (15%), sextant 1 (3.7%) and sextant 6 (1.8%).

Figure 3: The bar chart represents the frequency distribution of etiology of tooth discoloration. Majority of the patients have undergone due to aesthetic reasons (66%) followed by fluorosis (22.6%) and stains (11.3%).

Discussion

From our current study it is seen that around 50.9% of the participants were between the age group of 18-30 years which correlates with the study done by Felmen et al. [33].

As we age, the teeth naturally yellow over time. This is a result of both extrinsic and intrinsic discoloration. For starters, the dentin layer of the teeth becomes more yellow over the years. And the dental enamel also grows thinner with time, which makes the yellow dentin more visible. For younger adults this occurs most commonly due to the kind of food they consume and their everyday habits [33,34].

From the findings of the current study it is seen that, around 79.2% of the patients have undergone treatment for discoloration in relation to sextant 2 which is maxillary anterior which correlates with the study done by Tunca et al., [35,36].

Esthetics has become a major component of modern dentistry especially in the upper anterior of a patient. Good esthetics is achieved through art and symmetry of the teeth and face which enhances the appearance as well as the function of the teeth, oral cavity, and face. Also in case of upper anterior ceramic veneers displayed promising results when considering the esthetic and mechanic criteria’s. The new smile of the patient was satisfactory with excellent esthetic appearance [37].

The findings from the current study shows that around 66% of the participants have undergone bleaching therapy due to aesthetic reasons followed by fluorosis (22.6%) and stains (11.3%). Association between age and etiology was done and P value was found to be 0.075 which is statistically not significant. Fluorosis is an endemic disease, prevailing in about 25 countries globally [38]. Dental fluorosis is an acquired defect of enamel due to the exposure of an individual to excessive fluoride levels during tooth development. It could result in mild-to-severe discoloration of teeth, which might necessitate esthetic correction. Bleaching is one of the common treatment modalities used in the esthetic correction of such cases. In-office power bleaching is one of the techniques of tooth bleaching that involves clinical application and activation of the bleaching agent with light to accelerate the bleaching process [39]. Discolored teeth are more of a cosmetic issue rather than a medical issue. Brownish-yellow or white patches are usually a sign of poor cleaning habits or staining caused by food, drinks, and other activities [40]. However, some stains can be indicative of unhealthy behavior that can lead to serious issues with the teeth.

Conclusion

Within the limits of the current study it is proven that, the majority of the patients have undergone treatment for discoloration due to aesthetic reasons. Tooth Staining has several etiologic factors ranging from simple enamel hypoplasia to severe dental fluorosis. Many colour changes can be encountered when dealing with tooth discoloration. An understanding of the disease process is essential in determining the appropriate treatment modalities. Good preventive care can prolong the clinical health of dental tooth structures.

Acknowledgement

The authors would thank all the participants for their valuable support and authors thank the dental institution for the support to conduct.

Conflict of Interest

Nil.

Source of Funding

The present project is supported/funded/sponsored by

✔ Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha University, Chennai, India.
✔Al Fajr index.

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