Original Article The Prevalence of Etiologic Factors for Tooth Discoloration in Female Students in Isfahan High Schools Faezeh Khozeimeh*, Heidar Khademi**, Parichehr Ghalayani** ABSTRACT Background: Tooth discoloration has different etiologic factors, many of which can be prevented. The exact mode of inheritance has been clearly established in only a few of these conditions. The aim of this study was to determine the prevalence and etiology of tooth discoloration in female teenage students of Isfahan. Methods: In this cross-sectional study, 384 female students were examined for tooth discoloration. The examination was conducted by explorer and mirror. The information was recorded and analyzed by an SPSS program. Results: Relative frequency for etiologic factors of tooth discoloration consisted of caries 71.1%, extrinsic stains 24.7%, hypoplasia 19.8%, root and crown filling materials 19.8%, trauma 0.8%, chlorhexidine mouth wash 0.3% and fluorosis 0.3%. Conclusion: Dental caries were the most common cause of tooth discoloration, according to the re- sults of this study. It is important, therefore, to search for the agents that are responsible for produc- ing such a high prevalence of dental caries. This requires careful analysis of oral hygiene and other nutritional attributes of all foods and drinks. Keywords: Dental caries, dental fluorosis, stains, tooth discoloration. Received: November 2007 Accepted: March 2008 Dent Res J 2008; 5(1):13-16 Introduction Often, the first evidence of abnormality in human (7-12 years old), the prevalence of permanent tooth dentition is an observable difference in the color of discoloration due to enamel defects was 27%. the teeth. 1 During the past decade, the demand for Tooth discoloration was 89.9% prevalent in the conservative esthetic dentistry has grown dramati- study by Ghalayani and Alizadeh among 14-18- year-old male students in Isfahan. 8 cally. Tooth discoloration is a frequent dental find- ing associated with clinical and esthetic problems. Tooth discoloration presents two major chal- It differs in etiology, appearance, composition, lo- lenges to dentistry. The first challenge is to ascer- cation, severity and firmness in adherence to the tain the cause of the stain and the second is its tooth surface. 1 Many factors can cause tooth dis- management. Correction of these types of dental coloration. These factors are classified in four ma- problems can produce dramatic changes in appear- jor groups: genetics, 2-4 congenital factors, 5 ac- ance, which often result in improved confidence, quired or environmental factors 2 and iatrogenic personality and social life. 1 The purpose of this factors. 6 Clinical observations indicate that a large study was to determine the prevalence and etiology proportion of children and adolescents have tooth of tooth discoloration in Isfahan’s female teenage discoloration, 1 In the study by Mahmoodian, student population. Koosari and Mortazavi, 7 among 1637 students *Assistant Professor, Department of Oral Medicine and Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. **Associate Professor, Department of Oral Medicine and Torabinejad Dental Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. Correspondence to: Faezeh Khozeimeh, Department of Oral Medicine, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: khozeimeh@dnt.mui.ac.ir 13 Dental Research Journal (Vol. 5, No. 1, Spring-Summer 2008)
Khozeimeh et al. Etiologic Factors for Tooth Discoloration Materials and Methods schools was 87.2%. Dental caries was the most common cause of tooth discoloration among the In this cross-sectional study, 384 female students study population (71.1%). The relative frequency (14-18 years old) were selected from high schools of tooth discoloration etiologies expressed as a in various parts of Isfahan. The cluster sampling percentage is shown in Figure 1. method was used for selecting the students at each school. Data were collected by clinical examina- tion and recorded in information forms. A separate 80 information form was completed by the parents of 71.7 70 each student to gather information about etiologic factors causing discoloration before, during and 60 Relative frequency (%) after birth (Table 1). The clinical examinations 50 were performed under natural light by using a 40 mouth mirror and explorer that was drawn across the tooth to detect any interruptions in the surface. 30 24.7 19.8 19.8 20 Table 1. Etiologic factors causing tooth discoloration. 10 Factors Factors affecting 0.8 0.3 0.3 Postnatal affecting during pregnancy 0 factors before birth and at birth Flourosis Chlorhexidine Trauma Filling materials Hypoplasia Caries Stains Mother’s Premature birth Childhood geographic area diseases of residence Mother’s health Nutritional Allergy history deficiencies Figure 1. The relative frequency of tooth discoloration Mother’s use of Erythroblastosis Medication medication during fetalis causes. pregnancy Discussion Trauma A total of 335 (87.2%) female students in this study had tooth discoloration. As compared to re- Use of fluoride sults from a similar study of male students con- ducted by Ghalayani and Alizadeh, 8 in which tooth Diagnostic criteria discoloration was prevalent in 89.9% of cases, All the teeth were examined; any change in hue, tooth discoloration was more prevalent in male color or translucency of even a single tooth, which high school students than in female students, but was based solely on the clinical appearance, was called tooth discoloration. 1 Fluorosis was deter- the difference was not significant (P > 0.05). The most common cause of tooth discoloration mined by Dean index. in this study was dental caries (71.1%). Dental car- External defects ies and periodontal diseases are probably the most Defects were classified as external if they affected common chronic diseases in the world. The the quantity of enamel, and hence, the surface con- worldwide prevalence of these diseases has greatly tinuity. 1 increased in modern times; the increase is strongly associated with dietary changes. 9 Although there Internal defects may be a certain degree of resistance to dental car- Defects were classified as internal if they affected ies based on racial background, the dietary factors the quality and translucency of the enamel without appear to be more significant, especially since the causing a break in the surface continuity. 1 caries incidence is increased by eating civilized Descriptive analysis were done by using SPSS ver- foods. 10 sion 10. The prevalence of tooth discoloration due to hypoplasia in this study was 19.8%. Defects were Results classified as hypoplasia if they affected the quan- The prevalence of tooth discoloration among 14- tity of enamel and hence, the surface continuity. 1 18-year-old female students in Isfahan high In the study of 11-18-year-old students in Tehran 14 Dental Research Journal (Vol. 5, No. 1, Spring-Summer 2008)
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