Theory - Intrinsic and Extrinsic Staining and Removal

Classifications of Stains

Extrinsic and Intrinsic

Sources of stains

exogenous and endogenous

Can intrinsic stains be removed?

NO - they are within the tooth surface

How to recognize stains

-med history
-food records
-oral hygiene habits

Extrinsic stains

-On external tooth surface, can be removed
-Yellow
-Green
-Metallic
-Black Line
-Tobacco stains
-Brown Stains
(less common stains: orange, red, metallic)

Yellow stains

Dull, yellowish discoloration of dental biofilm

Green stains

Caused by chromogenic bacteria, fungi, chlorophyll

Metallic stains

Metallic dust industry, or drugs

Black line stains

Calculus like stain forms along gingival margin

tobacco stains

light brown to dark leathery brown

Brown stains

Due to brown pellicle
Stannous Fluoride
Betel Nut

Endogenous Intrinsic Stains

Stains within tooth structure; formed in the period of development

Pulpless teeth appearance

Appear slate gray, reddish-brown, dark brown

Tetracycline Staining

-Endogenous
-Intrinsic
-Light green to dark yellow
(Depends on dosage and length of time)
-Can be passed through placenta

Amelogenesis Imperfecta

- Enamel missing due to disturbances of ameloblasts
- Yellowish-brown or gray-brown appearance

Dentinogenesis Imperfecta

- Abnormal dentin due to disturbances in odontoblasts during development
- Appearance: Translucent or opalescent, gray to bluish-brown

Enamel Hypoplasia

- systemic-chronologic; ameloblastic disturbance of short duration
- Local affects, usually a single tooth

Dental Fluorosis (mottled enamel)

hypomineralization due to > 2ppm fluoride ingestion during mineralization

Exogenous stains

-Intrinsic or extrinsic stains due to an outside source, not from within the tooth

-Tobacco

-Green stains

Stains from silver amalgam

Metallic ions migrate from the restoration into the enamel and dentin

Copper amalgam stain

-Used in deciduous teeth
-Bluish green color

What to record when staining is observed?

color, type, extent, and location of stain

Example:

Yellow, light, tobacco stains on mandibular anterior lingual surfaces

Stain removal is associated directly with

biofilm or pellicle

Tenacious Stain

- Abrasion of tooth
- Removal of Fluoride-rich surface
- Overheating with power-driven polisher

purpose of polishing

to remove biofilm and stain

cautions with polishing

-Aerosols provide a means for disease transmission (use HVE or Isovac)
-Spatter (use PPE)
- can remove fluoride-rich enamel layer (remineralization interrupted)

Contraindications for polishing

- Newly erupted teeth
- when no extrinsic stain is present
- Gold, porcelain, composite resins
- Areas at risk for dental caries
- Caries
- Xerostomia
- Respiratory problems
- Head/neck radiation patients
- Patients with spongy, friable gingiva
- Not recommended on same day as SRP

Why to not polish newly erupted teeth

they have Fluoride rich enamel (fluorosis) that can be removed

Armamentarium (equipment) for polishing

-Prophy angle/brush
-Prophy paste (fine*, med, coarse)
-Slow speed handpiece

Supplemental Aids Stain removal

-Dental floss
-Abrasive polishing strips
-Saliva ejector
-Safety glasses (both patient and clinician)
-Disclosing agent

Polishing technique

1) Explain procedure to patient

2) Give pre-procedural rinse

3) Apply paste to tooth surfaces

4) Start low speed

5) Adapt rotating cup to tooth surface

(Flare cup on tooth surface)

6) Adapt cup to cervical area

(Cup flared under gingival margin, Apply light pressure to flare edges out and into sulcus)

7)Proceed across cervical

8)Polish incisal or occlusal portions

precautions while polishing

-Avoid holding up in area over 2 seconds

-Do not use abrasive on exposed root surfaces

-Use prophy brush on enamel surfaces only

-Apply abrasive with dental tape or finishing strips

-Floss all proximal spaces

when to use tin oxide/fine grit abrasive

-Gold
-Porcelain
-Composite resins

what does polishing produce?

- Produces smooth, glossy surface which reflects light
- Produces minute scratches on a surface

Types of Abrasives

finishing, polishing, cleansing

Finishing abrasives

-Fine agent
-Produces glossy surface

Mild abrasive

-Used for light to moderate stain
-More abrasive than finishing type

Cleansing Abrasives

-Coarse abrasive
-Most abrasive
-Removes moderate to heavy stain

Abrasive Action: Application Factors

-Speed
-Grit of paste & pumice
-Quantity of abrasive
-Pressure