Idiopathic Pulpal Recession A

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tooth may, on occasion, display idiopathic pulpal recession. Such teeth remain vital, but usually display a yellow to brown darkening. The appearance is often one of a non-vital tooth, but the tooth's actual condition can be differentiated on the basis of vitality testing.

Discoloration Non Vital Teeth
Fig. 3-11

Such teeth will usually show greatly diminished pulp chamber size radio-graphically.

Recession Pulp Chamber
Fig. 3-12

Treatment: Standard tooth whitening procedures should be instituted if the desired result is an overall whitening of all the teeth. This will be effective in removing the discoloration of the tooth with the idiopathic pulpal recession, and will usually result in a whitening effect on all the neighboring teeth as well. The discolored tooth will whiten more rapidly than the other teeth, so the result will be a blending and better matching of shades. The patient will eliminate the problem of a single, non-matching tooth, and will lighten all the other teeth in the process. On occasion (such as in the presence of multiple porcelain crowns which match the current dominant shadej this may not be desirable. Under those circumstances, the older heat/peroxide bleaching techniques may sometimes be effectively used. An alternative would be to utilize bonding to mask the discoloration.

Non-Alloy Dental Materials. Many of the materials which we use routinely have the potential for causing discoloration of teeth. Eugenol, formocresol, root canal sealers, and others can create a veritable rainbow of effects in tooth coloring.23

Treatment: The treatment is the same as for the dental alloy material staining. If the tooth has vitality\ standard vital tooth whitening is usually effective. The difficulty most commonly found with this category of staining is that it can be extremely localized. Thus, the procedure selected should be dictated by the same factors as in staining from idiopathic pulpal recession. If the tooth is non-vital, standard non-vital bleaching should be utilized. Sometimes the stains are so dark and resistant to whitening that supplemental bonding is indicated.

Non Vital Bleaching

Traumatic injury. Trauma to the tooth occasionally results in internal hemorrhage. The ensuing diffusion of bilirubin into the dentinal tubules creates a pink discoloration which usually is followed by the development of a diffuse reddish-brown stain.24 (From Ishikawa's Color Atlas of Oral Pathology. Ishikawa G , Waldron G, St. Louis: Ishiyaku Euro-America, 1987.)

If the pulp is able to avoid necrotic degeneration, the natural color of the crown returns within a few weeks after the injury If the pulp degenerates, the natural color will not return, and the discoloration can darken. In some cases, a slowly growing pink spot on the enamel surface will appear, indicating ongoing internal resorbtion.

Treatment: No treatment should be instituted until it is felt that the tooth has fully recovered from the trauma. Sometimes the natural color will return without intervention. In those cases with residual discoloration, the tooth should be tested for vitality and radiographed. If the tooth is vital' and there is no evidence of internal or external resorption, tooth whitening can be instituted. If the tooth is non-vital, endodontic therapy should be initiated, followed by non-vital bleaching. If the tooth is vital, but exhibits internal resorbtion, endodontic therapy should be instituted, and non-vital bleaching begun.

Darkened non-vital tooth.

Amelogenesis Imperfecta
Fig. 3-14


Extrinsic Stains

Intrinsic Stains


Foods and Beverages Medications

Pre-cruptivcly Caused Discolorations

Alkaptonuria Amelogenesis Imperfecta Dentinogenesis Imperfecta Endemic Fluorosis Erythroblastosis Fetalis Porphyria

Sickle Cell Anemia Thalassemia Tetracycline Staining

Posl-Eruptively Caused Discolorations

Dental Metals

Foods, Beverages, and Habits Such As

Smoking Idiopathic Fulpai Recession Non-alloy Dental Materials Tiaumatic Injury

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