4. Diffuse brown discoloration of permanent dentition

A 20-year-old female secretary attended for tooth whitening. Her medical history was clear. Her social history revealed a relatively normal diet with a lot of fruit juices but with no tobacco or alcohol consumption.

Extra-oral examination revealed no significant abnormalities, such as cervical lymph node enlargement, cranial nerve, salivary or temporomandibular joint.

Her dentition was as shown (Figure 1) with tooth discoloration and surface loss, but with no clinical evidence of periodontal attachment loss or pocketing.

c) Tetracycline staining is the cause here. Tetracycline given in pregnant mothers or in children <8 years old causes a diffuse discoloration in deciduous and permanent teeth, respectively, as it is incorporated into the hard tissues (bones, teeth) that are calcifying at that time. The discoloration begins as bright yellow and, with UV light exposure, finally becomes diffuse brown but without enamel hypoplasia. Our patient had a diffuse brown discoloration of all her permanent teeth, which did not show any change in the shape, texture and mineralization. (a) With ageing, the permanent are darker than the deciduous teeth, as these teeth are exposed over the years to external stains such as those from tobacco, tea or coffee and chlorhexidine mouthwashes. In addition, the permanent teeth often suffer attrition and abrasion, exposing the dentine, which finally increase the tooth discoloration.