The fluorescent, microradiographic, microhardness and specific gravity properties of tetracycline-affected human enamel and dentine

Dental discoloration: an overview

Often the first evidence of variation from normal in human dentition is an observable difference in the color of the teeth. During the past decade, the demand for conservative esthetic dentistry has grown dramatically. Tooth discoloration is a frequent dental finding, associated with clinical and esthetic problems. It differs in etiology, appearance, composition, location, severity, and firmness in adherence to the tooth surface. Basically, there are two types of tooth discolorations: those caused by extrinsic factors and those caused by intrinsic congenital or systemic influence. The intensity of stains may be worsened if there are enamel defects. Tooth discoloration presents two major challenges to the dental team. The first challenge is to ascertain the cause of the stain; the second is its management.

CLINICAL SIGNIFICANCE

This article reviews the etiology and clinical presentation of dental stains and outlines treatment options.

Clinical diagnosis of enamel defects: pitfalls and practical guidelines

Changes in enamel during its development are permanently recorded, and commonly present as either demarcated opacity, diffuse opacity, or enamel hypoplasia. Developmental enamel defects may provide clues regarding their aetiology, and this may have application in clinical dentistry, dental epidemiology and anthropology. However, the usefulness of these applications may be hampered by many pitfalls encountered in the detection and diagnosis of developmental enamel defects. The defects may be masked by saliva, dental plaque, and incorrect lighting. In addition, confounding effects of post-eruptive changes such as dental caries, attrition, and traumatic loss of tooth structure may impair the detection of developmental enamel defects. The non-specificity of appearance of enamel defects may make aetiologic diagnosis of enamel hypoplasia difficult. Furthermore, difficulty is often encountered in the relative timing of events in enamel hypoplasia, due to limited data on the chronology of development of the human dentition. In this review, pitfalls in the clinical assessment of enamel defects are discussed, and guidelines to overcome some of these difficulties are presented.

A scanning electron and confocal laser microscope investigation of tetracycline-affected human dentine

Because of the well reported dental side-effects of tetracycline administration, the drug should not be administered to children. However, it and its derivatives are often administered over a prolonged period for treatment of acne in young adults. Dental side effects are also noticed in these patients. The aim of this study was to examine with scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) the root dentine of a tooth from a young adult affected by tetracycline therapy. The palatal root of an upper third molar, demonstrating distinct areas of tetracycline staining, was removed from the crown and sectioned longitudinally to produce two samples. The pulp tissue was peeled off the dentine and any remaining non-mineralized tissues were removed with sodium hypochlorite. One sample was prepared for SEM and the other as a ground section which was examined with a CLSM. It was demonstrated by SEM that the mineralizing front of unaffected dentine was of a normal calcospherite appearance; in contrast, the mineralizing front of the tetracycline-affected dentine was devoid of calcospherite formation and many surface defects were apparent. In addition, the number of dentinal tubules associated with the defects was reduced. It was shown by CLSM that tetracycline bands were made up of numerous smaller bands and that peritubular dentine not associated with fluorescent bands had incorporated tetracycline. The CLSM examination of the mineralization front of the affected dentine revealed that fluorescence of dentine was restricted to the peritubular dentine. The results confirm that dentine mineralization is affected by systemic tetracycline therapy and that tetracycline can be incorporated into peritubular dentine after mineralization of the primary dentine matrix.

Tetracycline as a marker in hard tissue research: effects on enamel formation in rat maxillary incisors

Tetracycline in low dose is often used as a marker in hard tissue research. A low dose effect on enamel formation has never been proven despite well known toxic reactions in enamel after higher doses. The purpose of the investigation was to evaluate enamel formation in maxillary incisors of rats given a single low dose of a tetracycline with low toxicity, commonly used in research. Eight young rats received an intraperitoneal injection of 2 mg oxytetracycline per 100 g. The rats were terminated after periods between 1 h until 5 days. Undemineralized ground sections were prepared and studied under fluorescence microscopy. Microradiograms were taken to study the degree of mineralization. A diffuse uptake was seen within enamel in areas corresponding to late secretory stage and incisally in maturing enamel with a low mineralization degree. Tendencies of enamel aberrations were seen in all rats. These appeared as splittings within the formed enamel. In conclusion, low toxicity tetracycline disturbs normal amelogenesis, even if administered in low doses. It should therefore be avoided in hard tissue research where enamel formation is studied.

A scanning electron microscope study of the three-dimensional extent of Retzius lines in human dental enamel

A method involving carefully planned sectioning and grinding of human maxillary first premolars, allowing enamel structure to be studied with the SEM in more than one plane at the same time, was employed to demonstrate the extent of Retzius lines within the confines of the three-dimensional enamel cap. It was found that the Retzius lines behaved as could be predicted by the theory stating that the striae represent one-dimensional cuts of two-dimensional, curved growth planes. Retzius lines in adjoining planes were continuous across the edge where the two planes met. In a supernumerary tooth, the surface of its hypoplastic tooth tip was continuous with distinct Retzius lines. The present observations provide for the first time direct morphologic verification of the supposed nature of Retzius lines, with reference to extent and continuity in three-dimensional space.

Dental indicators of growth disturbance in a series of ancient Lower Nubian populations: changes over time

Previous studies of accentuated striae of Retzius in tooth enamel suggest that early childhood growth disturbance tends to be severe in state-level agricultural societies. The present study investigates the diachronic stability of levels of growth disturbance with a series of Lower Nubian agricultural states broadly similar in terms of mode of subsistence and way of life. The sample consists of 114 first permanent molars from the Meroitic (100 B.C. to 300 A.D.) and X-Group (300 to 600 A.D.) cultures. These teeth were sectioned according to standard histological technique. Data on the frequency and severity of accentuated striae of Retzius were then used to derive estimates of the magnitude of individual growth disturbance. Populations were compared by means of a two-way ANOVA, with growth disturbance as the dependent variable, and age and population as the independent variables. The results show that those dying in childhood experienced significantly higher levels of early childhood growth disturbance than did those surviving to adulthood. The results also show a decline in growth disturbance levels over time. Both X-Group children and X-Group adults experience significantly less early childhood growth disturbance than their Meroitic counterparts. These results suggest an improvement in child health status from Meroitic to X-Group times. Tentative explanatory hypotheses imply an increase in village autonomy, an increase in helminthic disease related to a change in irrigation technology, or direct and indirect effects of consumption of naturally-occurring tetracyclines. These hypotheses are not mutually exclusive, and further research is needed before any of them can be tested.

Tetracycline discoloration, enamel defects, and dental caries in patients with cystic fibrosis

The prevalence, distribution, and interrelationship between tetracycline discoloration, enamel defects, and dental caries was determined in 86 patients with cystic fibrosis (age 3 to 24 years). The dental caries experience was compared to control subjects matched for sex, race, exposure to optimally fluoridated water, chronologic age, and dental age. The findings indicate a high prevalence of tetracycline discolorations and enamel defects but a significantly reduced dental caries experience in these patients. However, interrelationships between these three factors were not strikingly evident. The presence of an altered oral health status in cystic fibrosis patients and the increased prevalence of this disease due to recent therapeutic and diagnostic advances in its management suggest the need for further familiarization with the dental manifestations of cystic fibrosis.

Dose-dependent ultrastructural changes induced by tetracycline in developing dental tissues of the rat

Tetracycline was administered to rats in varying doses in order to study the likelihood of ultrastructural alterations to ameloblasts and to study odontoblasts and dentin as well. The changes caused by tetracycline to the mineralization of dentin and the ultrastructural changes to the odontoblasts and ameloblasts increased with larger doses.