Figure 1 - uploaded by Paul Clarke
Content may be subject to copyright.
Significant fading of previously green teeth in Case 1 patient with prolonged conjugated hyperbilirubinemia by postnatal age of 18 months (corrected age: 14 months).
Source publication
Eruption of green, discolored teeth affecting the primary dentition has been described in association with congenital viral infection, sepsis, hemolytic jaundice, and cholestasis. The purpose of this paper was to present the cases of 3 extremely low birth weight preterm infants who were noted to have green teeth at the corrected ages of 10 to 12 mo...
Citations
... Only primary teeth and newly erupted permanent teeth (incisors and first molars) in patients with biliary atresia (which accounts for 50% of newborn cholestasis cases) are affected. 8 The Notch signalling pathway participates in tooth regeneration as well as the development of several organs, including the skeleton and face. 9 In NOTCH2-related ALGS and JAG1-related cohort probands, the prevalence of clinical signs was compared, according to Kamath BM et al. ...
Alagille-2 syndrome (AGLS-2) is a rare autosomal dominant illness that affects the Notch signalling pathway, with few studies reported in the literature related to dental science. It is recognized clinically, with anomalies of the liver, skeleton, kidneys, eyes, and face manifesting. The JAG1 gene accounts for about 97 percent of instances of Alagille syndrome variation, whereas mutations in NOTCH2 account for only 1 percent. When serum bilirubin levels in children are higher than 30 mg/dl, bilirubin builds up in dental tissue and results in varied greenish-brown dyschromia of the teeth. We discussed the dental findings of a patient diagnosed with NOTCH-2 who sought out dental treatment at the government college of dentistry in Indore, MP (India), complaining of pain and a stain in his teeth with typical features of facial dysmorphism.
... Así, la bilirrubina se distribuye por los tejidos corporales y se acumula en los tejidos duros, incluso en los dientes primarios de forma irreversible, ocasionando el aprisionamiento de la bilirrubina y causando la coloración intrínseca. 1 En la gran mayoría de los casos los pacientes presentan episodios severos de hiperbilirrubinemia neonatal causados por sepsis, atresia biliar, incompatibilidad sanguínea o policitemia, prematuridad extrema y bajo peso. [2][3][4][5] Dado que se trata de una enfermedad que lleva a manifestaciones bucales, como dientes verdosos, hipoplasia de esmalte, retardo de la erupción dental, aumento de la cámara pulpar y de los conductos radiculares, 6 exige, por ello, una conducta terapéutica individualizada y el reconocimiento de su etiología. 2 En relación a la pigmentación dental, esta ocurre durante la formación de la matriz de esmalte y dentina en pacientes con niveles altos de bilirrubina -entre 200 y 500 mmol/l-, 7, 10 sin embargo, no todos los pacientes con historial de hiperbilirrubinemia presentan dientes verdosos. ...
Definida como uma concentração súmade de bilirrubina, a hiperbilirrubemia é uma condição rara e pode ser causada por qualquer fator que eleve a carga de bilirrubina a ser metabolizada pelo fígado. Assim, a bilirrubina é distribuída através de tecidos corporais e se acumula em tecidos duros, mesmo nos dentes primários. O objetivo deste trabalho é relatar um caso clínico sobre o impacto severo da hiperbilirrubemia nos dentes primários, e suas manifestações orais na primeira infância, tais como: dentes esverdeados. Paciente do sexo masculino, de 3 anos e 8 meses, procurou clínica odontológica para avaliação de "manchas verdes nos dentes". No histórico médico observou-se que a criança nasceu prematura e teve complicações pós-parto que evoluíram para sepse, e devido ao uso de vários medicamentos, desenvolveram um quadro de hiperbilirrubemia. O exame clínico odontológico mostrou a presença de manchas verdes nos 20 dentes primários, ausência de lesão na cavidade, gengivas saudáveis e boa condição de higiene bucal. Conclui-se que os altos níveis de bilirrubina desenvolvidos pela criança prematura associada à sepse podem levar à pigmentação verde (coloração intrínseca) nos dentes primários e até mesmo ao envolvimento de dentes permanentes. Portanto, o conhecimento do histórico médico da criança desde o nascimento é relevante para o estabelecimento do diagnóstico e prognóstico de alterações dentárias.
... Other oral problems inherent to premature infants include lacerations caused during intubation [33,48], as well as the accumulation of bilirubin in the developing dental tissues, associated to the neonatal cholestasis seen in some premature children -giving rise to a greenish color of the primary dentition [104]. There have also been reports of an increased prevalence of anomalies in dental shape, affecting particularly the permanent upper lateral incisors [16]. ...
Background Preterm delivery, defined as delivery occurring before 37 completed weeks of pregnancy, represents 6-10% of all births in developed countries. Preterm infants are characterized by a short prenatal development period and are at an increased risk of systemic disorders as a result of their immaturity. Few studies have analyzed oral alterations among preterm infants. This systematic review examines the orofacial characteristics most commonly found among preterm infants versus infants born at term, and evaluates their repercussions upon oral health and quality of life. Methods The search was limited to articles published in English or Spanish and that studied the prevalence of oral sequelae and alterations in preterm children. Their methodological quality was assessed based on the guidelines of the Joanna Briggs Institute (JBI). Results Most of the studies found the prevalence of structural enamel defects of the primary dentition to be greater among preterm infants. Other disorders such as structural enamel defects of the permanent dentition, caries, malocclusions or alterations in dental composition, size and development also appeared to be more frequent among preterm infants, though the supporting evidence was weak. Conclusions Further studies are needed, analyzing the association between preterm delivery and certain orofacial disorders such as caries, malocclusions and dental anomalies.
... Other oral problems inherent to premature infants include lacerations caused during intubation (33,48), as well as the accumulation of bilirubin in the developing dental tissues associated to the neonatal cholestasis seen in some premature children -giving rise to a greenish color of the primary dentition (100). There have also been reports of an increased prevalence of anomalies in dental shape, affecting particularly the permanent upper lateral incisors (16). ...
Background Preterm delivery, defined as delivery occurring before a gestational age of 37 weeks, represents 6-10% of all births in developed countries. Preterm infants are characterized by a short prenatal development period and are at an increased risk of systemic disorders as a result of their immaturity. Few studies have analyzed oral alterations among preterm infants. This systematic review examines the orofacial characteristics most commonly found among preterm infants versus infants born at term and evaluates their repercussions upon oral health and quality of life.
Methods The search was limited to articles published in English or Spanish that compared orofacial characteristics of preterm infants versus infants born at term. Their methodological quality was assessed based on the guidelines of the Joanna Briggs Institute (JBI).
Results Most of the studies found the prevalence of structural enamel defects of the primary dentition to be greater among preterm infants. Other disorders such as structural enamel defects of the permanent dentition, caries, malocclusions or alterations in dental composition, size and development also appeared to be more frequent among preterm infants, though the supporting evidence was weak.
Conclusions Further studies are needed, analyzing the association between preterm delivery and certain orofacial disorders such as caries, malocclusions and dental anomalies.
... The primary teeth affected more frequently than permanent dentition. The most common causes of hyperbilirubinemia leading to this type of discoloration are as follows: 1) erythroblastosis fetalis, 2) biliary atresia, 3) biliary hypoplasia, 4) premature birth, 5) ABO incompatibility, 6) neonatal respiratory distress, 7) significant internal hemorrhage, 8) congenital hypothyroidism, 9) tyrosinemia, 10) α1-antitrypsin deficiency, 11) hemolytic anemia, 12) viral infection, and neonatal hepatitis [9,[33][34][35]. In addition, Swann and Guimaraes reported two cases of green teeth associated with cholestasis caused by sepsis [36,37]. ...
Purpose: There has been a recent increasing interest in the management of dental staining as shown by the large number of tooth whitening materials appearing in the market. The aim of this review is to search the literature regarding tooth discoloration in order to introduce a new classification in terms of different clinical colors.
Methods: The PubMed database was searched for articles pertaining to the topic between the year 1932 and 2012. The search strategy for PubMed based on MeSH terms was: “tooth discoloration”, OR “tooth discolorations”, OR “tooth diseases”, OR “tooth bleaching”.
Results: Based on the relevant evidence, it was shown that tooth discoloration can be found in nine different color spectrums: black, brown, blue, green, grey, orange, pink, red, and yellow. Each color may represent various origins, which needs further investigations to be revealed.
Clinical significance: Our new classification based on clinical features of discolored teeth helps clinicians achieve timely diagnosis and avoid inappropriate therapeutic measures.
Multiple causes of congenital neonatal cholestasis have been identified, and are classified as extrahepatic or intrahepatic. Biliary atresia (BA), Alagille syndrome (AGS), and progressive familial intrahepatic cholestasis (PFIC) are the most common of these. Many factors associated with cholestatic diseases are known to degrade the oral health of these children. What are the oral manifestations associated with these diseases in the pediatric population? The aim of this article was to evaluate the impact of congenital cholestasis on oral health in pediatric patients. A systematic review of case reports and case series was carried out in PubMed, the Cochrane Library, and the Web of Science to identify relevant articles in French and English published up to April 2022. The review included 19 studies, 16 case reports, and three case series. Only studies dealing with BA and AGS were found. These studies showed an impact on jaw morphology, dental structure, and periodontal health. The facial dysmorphism observed in AGS was specific. Exposure to high levels of bilirubin during the period of dental calcification led to particular coloration. Regarding periodontal status, gingival inflammation was common in these patients, probably resulting from the use of certain treatment-associated drugs and poor oral hygiene. Cohort studies are needed to confirm the classification of these children as being at high individual risk of caries. Many major oral manifestations are found in children with AGS and BA, confirming the need to include a dentist in the care team of patients with congenital cholestatic disease as early as possible. It appears necessary to carry out individual prospective studies of each phenotype in order to confirm and better describe the oral impact of these cholestatic diseases and provide adequate medical care.
This chapter is about dental developmental defects, regarding both the whole tooth as a unit and its hard dental tissues individually. Regarding the tooth anomalies like tooth number, size, and morphology, after shortly addressing dental development to introduce the reader into the biology and genetics of the disturbances, it presents possible causes, their clinical expression, and treatment modalities. Regarding the malformations in the structure of hard dental tissues, it first reminds of the formation and structure of enamel, dentin, and cementum, and then it addresses the defects in terms of clinical and histological appearance, etiology, diagnosis, and restorative treatment. This is done by following a classification into environmentally induced, mainly the very common molar incisor hypomineralization, and genetically transmitted defects, either expressed alone or within various syndromes. The last section discusses developmental color changes of the teeth and their correction.
Alagille syndrome (AGS) is a multisystem disorder classically involving liver and heart failure, characteristic vertebral and facial features and ocular abnormalities. AGS is caused by heterozygous mutations in JAG1 or NOTCH2, with variable phenotype penetrance. We report two cases of AGS in children with tooth defects characterised by green discolouration and hypomineralisation. The role of hyperbilirubinaemia (HB) in this atypical colour, a classical feature of AGS, has been well described. However, it does not totally explain the dental phenotype. As JAG1 and NOTCH2 mutations can affect bone development and considering common physiological pathways between bone and tooth mineralisation, both mutations could participate in this unusual dental phenotype. The role of HB and genetics in the development of the dental phenotype of AGS is discussed in two prototypical cases. Future research should focus on the underlying genetic component of tooth abnormalities.
Preterm birth is the birth of a baby of less than 37 weeks gestational age. The cause of preterm birth is in many situations elusive and unknown. Premature infants have a short prenatal development period and are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development. The prevalence of oral defects in the deciduous and permanent dentition has been reported to be higher in premature infants. Premature birth can cause enamel defects such as quantitative loss of enamel (hypoplasia), qualitative change in the translucence (opacity) of the enamel, or a combination of both. Other dental defects in preterm babies include notching of the alveolar ridge, palatal grooving, high arched palate, dental crossbite and palatal asymmetry. Moreover, delayed eruption/maturation and developmental defects of both the primary and permanent dentitions have also been reported. With the introduction of intensive medical care including the increased use of antenatal corticosteroids and the recent routine administration of surfactant replacement therapy, survival of prematurely born infants has improved markedly. However, the significant progress has been made in the care of premature infants but not in reducing the prevalence of preterm birth, making the reduction of preterm birth a challenging proposition.
Green staining of the dentition is a phenomenon associated with the deposition of bilirubin in the matrix of hard tissue during formation. This article presents a case of green teeth in a patient born 28 weeks premature with a medical history of hemolytic jaundice and grade IV intraventricular hemorrhage at birth.
