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Dental Tribune Middle East & African Edition

Dental Tribune Middle East & Africa Edition | March-April 2015hygiene tribune10B < Page 8B cantly increased compared to the other 3 rinses. The antiad- hesive/chlorhexidine rinse pro- duced no more staining than the anti-adhesive or water rinse. However, the parallel plaque re- growth study suggested this in- hibition of staining resulted from the vitiation of the chlorhexidine activity by the anti-adhesive.79 b - Cetylpyridinium chloride: Cetylpyridinium chloride (CPC) is a cationic quaternary ammo- nium compound used in some types of mouthwashes, tooth- pastes, lozenges, throat sprays, breath sprays, and nasal sprays. It is an antiseptic that kills bac- teria and other microorganisms. It has been shown to be effective in preventing dental plaque and reducing gingivitis.80, 81 It has also been used as an ingredient in certain pesticides. Cetylpyri- dinium chloride may cause brown stains between the teeth and on their surfaces.82 How- ever, these stains can be easily removed by a dental hygienist during a routine check-up. As known, Cationic antiseptics such as chlorhexidine (CHX) and cetyl pyridinium chloride (CPC) interact with dietary chro- mogens to produce extrinsic stain, and this can be used as a measure of activity of products. A study was done in vitro to de- termine if toothpaste influenced the tea staining effects of CHX and CPC as a predictor of action in vivo. Little staining was seen with toothpaste (TP) and wa- ter combinations. TP followed by CHX reduced the activity of CHX. Toothpaste appears to ad- versely affect the activity of CHX and CPC particularly if used im- mediately after the antiseptics. The data further supports the concept of separating the use of antiseptics until sometime after the use of toothpaste, and the idea of developing mouthwash friendly toothpastes.83 8 - Chromogenic Bacteria Chromogenic Bacteria cause stains mostly when the child has received liquid Ammoxicillin for a prolonged period of time.84 Chromogenic stains are a type of extrinsic stains of the teeth which can be seen in children and can sometimes be intrinsec if the bacteria affect the tooth during development stage. The black stains in the cervical re- gion are due to the Actinomyces species bacteria. The bacteria produce hydrogen sulfide, re- sponsible for oral malodour,85 which reacts with iron in the saliva and gingival exudates to form a bacterial plaque that is usually black or has black dis- coloration to it.86 Green stains are attributed to fluorescent bac- teria and fungi such as Penicil- lium and Aspergillus species.87 A recent study has investigat- ed the presence of the black- pigmented bacteria Prevotella nigrescens and Prevotella in- termedia, the non-black-pig- mented bacteria Actinomyces spp and particularly the cari- ogenic pathogen Streptococcus mutans in the dental biofilms of patients with or without black extrinsic tooth stains, using the multiplex polymerase chain reaction (PCR) technique. The result showed that the similar bacterial composition of dental biofilms of black tooth stains and healthy tooth surfaces indicates that black tooth stains are not free of cariogenic bacteria.88 9 - PROFESSIONAL INTOXI- CATION: Iron dust Copper dust Iron deficiency is estimated to be the most common nutritional deficiency in both developed and underdeveloped nations.89 Iron supplements are generally consumed in the form of syrups or drops for children. Besides its undesirable taste, one of its main problems is black discoloration of teeth after consumption.90 The quality of the consumed drinking water may also affect oral health. For example, the presence of iron in drinking wa- ter can cause aesthetic problems related to changes in dental enamel color. Rebelo de Sousa has assessed the prevalence of extrinsic enamel color changes and their relationship with the quality of the water.91 Staining is more obvious on hy- pomineralized and decalcified areas. Tooth staining due to iron supplement might be caused by an insoluble ferric compound such as ferric sulfide produced by interaction between Fe ions or gingival fluid composition and hydrogen sulfide produced by bacteria.92 This staining on the teeth sur- faces can deposit in the form of insoluble ferric like ferric sulfide93 and is thought to result from a chemical interaction be- tween hydrogen sulfide produc- ing micro-flora and iron.94, 95 So combining the iron intake with water or other liquids such as fruit juice and drinking it with straw or dripping the drops on posterior parts of mouth can prevent tooth discoloration. Brushing teeth before consum- ing iron supplements is effective on decreasing the rate of stain- ing96 and a simple scaling by the dentist is sufficient to remove these stains as reported by K. Adcock et al.97 Copper causes a green stain in mouthrinses con- taining copper salts and in work- ers in contact with the metal in industrial circumstances.98, 99 As already mentioned, the stain production is related to the pro- duction of the sulphide salt of the metal involved. The extrin- sic stain coincide with the colour of the sulphide of the metal con- cerned.98 Even the margin of the gums, at the base of the teeth, can pre- sent stains like the Burton line or Burtonian line which is a clinical sign found in patients with lead poisoning.100, 101 Drug-induced tooth discolora- tion can be prevented by avoid- ing prescriptions of well-known offender drugs known to cause tooth discoloration during preg- nancy and in young children.102 Conclusion The etiology of tooth staining is important in making a proper diagnosis, in clarifying the caus- es of discoloration to the patient and, in some instances, in help- ing the dentist establish a treat- ment plan. He may even refuse to perform the whitening pro- cedure in cases of rapid relapse risk such as in heavy smokers. Different clinical indices and photometric techniques have been used in order to evaluate extrinsic discolorations. Many promoting factors are incrimi- nated. In order to differentiate between extrinsic and intrinsic discol- oration, the scratch test may be used with a dental explorer or scaler instrument over discolor- ed tooth surfaces. Weakly ad- herent plaque will be removed by a light scratching. Tenacious stains require removal with a sharp dental scaler. Intrinsic dis- coloration cannot be removed by using the scratch test. Tooth discoloration is a major problem in our society today be- cause of the presence of numer- ous chromogenic products on the market as well as environ- mental chemicals. In addition to that, esthetics has become a top priority for patients, because a bright smile is now a must for social integration and strength- ened self-esteem. 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