The Prevalence of Etiologic Factors for Tooth Discoloration in Female - - PDF document

*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 Dental Research Journal (Vol. 5, No. 1, Spring-Summer 2008)

13

The Prevalence of Etiologic Factors for Tooth Discoloration in Female Students in Isfahan High Schools

Faezeh Khozeimeh*, Heidar Khademi**, Parichehr Ghalayani**

Introduction

Often, the first evidence of abnormality in human dentition is an observable difference in the color of the teeth.1 During the past decade, the demand for conservative esthetic dentistry has grown dramati-

• cally. Tooth discoloration is a frequent dental find-

ing associated with clinical and esthetic problems. It differs in etiology, appearance, composition, lo- cation, severity and firmness in adherence to the tooth surface.1 Many factors can cause tooth dis-

• coloration. These factors are classified in four ma-

jor groups: genetics,2-4 congenital factors,5 ac- quired or environmental factors2 and iatrogenic factors.6 Clinical observations indicate that a large proportion of children and adolescents have tooth discoloration,1 In the study by Mahmoodian, Koosari and Mortazavi,7 among 1637 students (7-12 years old), the prevalence of permanent tooth discoloration due to enamel defects was 27%. Tooth discoloration was 89.9% prevalent in the study by Ghalayani and Alizadeh among 14-18- year-old male students in Isfahan.8 Tooth discoloration presents two major chal- lenges to dentistry. The first challenge is to ascer- tain the cause of the stain and the second is its

• management. Correction of these types of dental

problems can produce dramatic changes in appear- ance, which often result in improved confidence, personality and social life.1 The purpose of this study was to determine the prevalence and etiology

• f tooth discoloration in Isfahan’s female teenage

student population.

Original Article 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

• f 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

Khozeimeh et al. Etiologic Factors for Tooth Discoloration

14

Dental Research Journal (Vol. 5, No. 1, Spring-Summer 2008)

Materials and Methods

In this cross-sectional study, 384 female students (14-18 years old) were selected from high schools in various parts of Isfahan. The cluster sampling method was used for selecting the students at each

• school. Data were collected by clinical examina-

tion and recorded in information forms. A separate information form was completed by the parents of each student to gather information about etiologic factors causing discoloration before, during and after birth (Table 1). The clinical examinations were performed under natural light by using a mouth mirror and explorer that was drawn across the tooth to detect any interruptions in the surface.

Table 1. Etiologic factors causing tooth discoloration.

Factors affecting before birth Factors affecting during pregnancy and at birth Postnatal factors Mother’s geographic area

• f residence

Premature birth Childhood diseases Mother’s health history Nutritional deficiencies Allergy Mother’s use of medication during pregnancy Erythroblastosis fetalis Medication Trauma Use of fluoride

Diagnostic criteria All the teeth were examined; any change in hue, color or translucency of even a single tooth, which was based solely on the clinical appearance, was called tooth discoloration.1 Fluorosis was deter- mined by Dean index. External defects Defects were classified as external if they affected the quantity of enamel, and hence, the surface con- tinuity.1 Internal defects Defects were classified as internal if they affected the quality and translucency of the enamel without causing a break in the surface continuity.1 Descriptive analysis were done by using SPSS ver- sion 10.

Results

The prevalence of tooth discoloration among 14- 18-year-old female students in Isfahan high schools was 87.2%. Dental caries was the most common cause of tooth discoloration among the study population (71.1%). The relative frequency

• f tooth discoloration etiologies expressed as a

percentage is shown in Figure 1.

Figure 1. The relative frequency of tooth discoloration causes.

Discussion

A total of 335 (87.2%) female students in this study had tooth discoloration. As compared to re- sults from a similar study of male students con- ducted by Ghalayani and Alizadeh,8 in which tooth discoloration was prevalent in 89.9% of cases, tooth discoloration was more prevalent in male high school students than in female students, but the difference was not significant (P > 0.05). The most common cause of tooth discoloration in this study was dental caries (71.1%). Dental car- ies and periodontal diseases are probably the most common chronic diseases in the world. The worldwide prevalence of these diseases has greatly increased in modern times; the increase is strongly associated with dietary changes.9 Although there may be a certain degree of resistance to dental car- ies based on racial background, the dietary factors appear to be more significant, especially since the caries incidence is increased by eating civilized foods.10 The prevalence of tooth discoloration due to hypoplasia in this study was 19.8%. Defects were classified as hypoplasia if they affected the quan- tity of enamel and hence, the surface continuity.1 In the study of 11-18-year-old students in Tehran

0.3 0.3 0.8 19.8 19.8 71.7 24.7 10 20 30 40 50 60 70 80

Flourosis Chlorhexidine Trauma Filling materials Hypoplasia Caries Stains

Relative frequency (%)

Khozeimeh et al. Etiologic Factors for Tooth Discoloration Dental Research Journal (Vol. 5, No. 1, Spring-Summer 2008)

15

by Tohidast and Moeni, this prevalence was 21.6%.11 According to another study of 14-18- year-old male students in Isfahan by Ghalayani and Alizadeh,8 the prevalence of tooth discoloration caused by hypoplasia was 18.2%. Mahmoodian, Koosari and Mortazavi reported a 5.7% prevalence

• f enamel hypoplasia in 7-12-year-old students.7

King and Wei found that the prevalence of enamel hypoplasia among Chinese children was 62.3%, compared with 27.2% of Caucasian and 36.4% of Indian children.12 The prevalence of tooth discoloration due to fluorosis in this study was 0.3%. Ingestion of drinking water containing fluoride at levels greater than 1 part per million during the time crowns are being formed may result in enamel hypoplasia or hypocalcification, also known as fluorosis. Mild to moderate fluorosis ranges clinically from white enamel spots to mottled brown and white discol-

• rations. Severe fluorosis appears as pitted, irregu-

lar and discolored enamel.2 The prevalence of tooth discoloration due to fluorosis in the Gha- layani and Alizadeh8 study of 14-18 year-old male students in Isfahan was 0.5% and was 0.7% in the Mahmoodian, Koosari and Mortazavi study of 7- 12-year-old students in Isfahan.7 The difference in the results of this study compared to those of other studies may be due to the different patterns of bev- erage consumption and daily diets of different so-

• cieties. Fluoride can be ingested through foods;

some kinds of fish and especially tea have a high fluoride concentration.2, 12 The prevalence of tooth discoloration secondary to using chlorhexidine mouthwash in this study was 0.3%. Chlorhexidine and other potent chemi- cal plaque-preventive agents are protein denatur- ants.13 Investigations have demonstrated the impor- tance of denaturation in extrinsic tooth discolora- tion.14 It has been demonstrated in vitro that alde- hydes and ketones, natural constituents of various foods and intermediate products of bacteria, may react with chlorhexidine to form colored products that may in turn discolor tooth surfaces.15 The prevalence of tooth discoloration due to trauma in this study was 0.8%. Comparing this result with that of the Ghalayani and Alizadeh study of male students (1.4%) shows that traumatic injuries causing tooth discoloration are more com- mon in males than in females of the same age

• group. Local trauma can adversely affect the ame-

loblasts overlying a developing crown, resulting in enamel hypocalcification or hypoplasia. Affected teeth may have areas of coronal discoloration or actual pits and irregularities.2 Finally, the high prevalence of tooth discolora- tion due to external stains (24.7%) and filling ma- terials (19.8%) reflected the poor oral hygiene that results in dental caries among female students in Isfahan high schools. On the basis of the results of this study, and while knowledge alone is not sufficient to eradi- cate caries in any given population, it can be con- cluded that individuals under professional supervi- sion, having good dietary and oral hygiene prac- tices, can indeed live a lifetime caries-free.

Acknowledgment

This study was supported in part by Vice Chancel- lery for Research of Isfahan University of Medical Sciences (Grant No: 81055).

References

• 1. Hattab FN, Qudeimat MA, al-Rimawi HS. Dental

discoloration: an overview. J Esthet Dent 1999; 11(6): 291-310.

• 2. Regezi JA, Sciubba JJ, Jordan RCK. Oral pathology:

clinical pathologic correlations. 4th ed. St. Louis: Sunders; 2003.

• 3. Wright JT, Robinson C, Shore R. Characterization
• f the enamel ultrastructure and mineral content in

hypoplastic amelogenesis imperfecta. Oral Surg Oral Med Oral Pathol 1991; 72(5):594-601.

• 4. Greenberg MS, Glick M. Burket's oral medicine

diagnosis and treatment. 10th ed. Hamilton: BC Decker Inc; 2003.

• 5. Pindborg JJ. Aetiology of developmental enamel

defects not related to fluorosis. Int Dent J 1982; 32(2): 123-34.

• 6. Van der Burgt TP, Mullaney TP, Plasschaert AJ.

Tooth discoloration induced by endodontic sealers. Oral Surg Oral Med Oral Pathol 1986; 61: 84-9.

• 7. Mahmoodian J, Koosari A, Mortazavi Sh. Preva-

lence of enamel defects among 7-12 year old stu- dents in Isfahan. Journal of Dentistry of Tehran Uni- versity of Medical Sciences 2000; 13(1): 2.

• 8. Ghalayani P, Alizadeh A. The prevalence and etiol-
• gy of tooth discoloration among 14-18 year old Is-

fahan boy students [DDS thesis]. Isfahan (Iran): Dental School of Isfahan University of Medical Sci- ences; 2001.

• 9. Sturdevant CM, Roberson TM, Heymann HO, Stur-

devant JR. The Art and science of operative den- tistry, 3rd ed. St. Louis: Mosby; 1995.

Khozeimeh et al. Etiologic Factors for Tooth Discoloration

16

Dental Research Journal (Vol. 5, No. 1, Spring-Summer 2008)

• 10. Shafer WG. Textbook of oral pathology. 4th ed. Phil-

adelphia: Sunders; 1983. p. 406-9.

• 11. Tohidast Z, Moeni S. Prevalence and etiology of

tooth discoloration among 11-18 year old students in Tehran [DDS thesis]. Tehran (Iran): Dental School

• f Shahed University of Medical Sciences; 2000.
• 12. King NM, Wei SH. Developmental defects of ena-

mel: a study of 12 year-olds in Hong Kong. J Am Dent Assoc 1986; 112(6): 835-9.

• 13. Hjeljord LG, Rolla G, Bonesvoll P. Chlorhexidine-

protein interactions. J Periodontal Res Suppl 1973; 12(5): 11-6.

• 14. Ellingsen JE, Rolla G, Eriksen HM. Extrinsic dental

stain caused by chlorhexidine and other denaturing

• agents. J Clin Periodontol 1982; 9(4): 317-22.
• 15. Eriksen HM, Nordbo H, Kantanen H, Ellingsen JE.

Chemical plaque control and extrinsic tooth discol-

• ration. A review of possible mechnisms. J Clin Pe-

riodontol 1985; 12(5): 345-50.