hrcak mascot   Srce   HID

Stručni rad
https://doi.org/10.15644/asc52/1/9

Zeleno obojenje zuba povezano s razinom bilirubina

Gabriel S. Barbério ; Zavod za pedodonciju Stomatološkog fakulteta Sveučilišta u Sao Paulu, Bauru, Brazil
Ana C. G. Zingra ; Zavod za pedodonciju Stomatološkog fakulteta Sveučilišta u Sao Paulu, Bauru, Brazil
Paulo S. S. Santos   ORCID icon orcid.org/0000-0002-0674-3759 ; Zavod za kirurgiju, stomatologiju, patologiju i radiologiju Stomatološkog fakulteta Sveučilišta u Sao Paulu, Bauru, Brazil
Maria A. A. M. Machado ; Zavod za pedodonciju Stomatološkog fakulteta Sveučilišta u Sao Paulu, Bauru, Brazil

Puni tekst: hrvatski, pdf (197 KB) str. 61-64 preuzimanja: 92* citiraj
APA 6th Edition
Barbério, G.S., Zingra, A.C.G., Santos, P.S.S. i Machado, M.A.A.M. (2018). Zeleno obojenje zuba povezano s razinom bilirubina. Acta stomatologica Croatica, 52 (1), 61-64. https://doi.org/10.15644/asc52/1/9
MLA 8th Edition
Barbério, Gabriel S., et al. "Zeleno obojenje zuba povezano s razinom bilirubina." Acta stomatologica Croatica, vol. 52, br. 1, 2018, str. 61-64. https://doi.org/10.15644/asc52/1/9. Citirano 29.11.2020.
Chicago 17th Edition
Barbério, Gabriel S., Ana C. G. Zingra, Paulo S. S. Santos i Maria A. A. M. Machado. "Zeleno obojenje zuba povezano s razinom bilirubina." Acta stomatologica Croatica 52, br. 1 (2018): 61-64. https://doi.org/10.15644/asc52/1/9
Harvard
Barbério, G.S., et al. (2018). 'Zeleno obojenje zuba povezano s razinom bilirubina', Acta stomatologica Croatica, 52(1), str. 61-64. https://doi.org/10.15644/asc52/1/9
Vancouver
Barbério GS, Zingra ACG, Santos PSS, Machado MAAM. Zeleno obojenje zuba povezano s razinom bilirubina. Acta stomatologica Croatica [Internet]. 2018 [pristupljeno 29.11.2020.];52(1):61-64. https://doi.org/10.15644/asc52/1/9
IEEE
G.S. Barbério, A.C.G. Zingra, P.S.S. Santos i M.A.A.M. Machado, "Zeleno obojenje zuba povezano s razinom bilirubina", Acta stomatologica Croatica, vol.52, br. 1, str. 61-64, 2018. [Online]. https://doi.org/10.15644/asc52/1/9
Puni tekst: engleski, pdf (197 KB) str. 61-64 preuzimanja: 1.118* citiraj
APA 6th Edition
Barbério, G.S., Zingra, A.C.G., Santos, P.S.S. i Machado, M.A.A.M. (2018). Green Teeth Related to Bilirubin Levels. Acta stomatologica Croatica, 52 (1), 61-64. https://doi.org/10.15644/asc52/1/9
MLA 8th Edition
Barbério, Gabriel S., et al. "Green Teeth Related to Bilirubin Levels." Acta stomatologica Croatica, vol. 52, br. 1, 2018, str. 61-64. https://doi.org/10.15644/asc52/1/9. Citirano 29.11.2020.
Chicago 17th Edition
Barbério, Gabriel S., Ana C. G. Zingra, Paulo S. S. Santos i Maria A. A. M. Machado. "Green Teeth Related to Bilirubin Levels." Acta stomatologica Croatica 52, br. 1 (2018): 61-64. https://doi.org/10.15644/asc52/1/9
Harvard
Barbério, G.S., et al. (2018). 'Green Teeth Related to Bilirubin Levels', Acta stomatologica Croatica, 52(1), str. 61-64. https://doi.org/10.15644/asc52/1/9
Vancouver
Barbério GS, Zingra ACG, Santos PSS, Machado MAAM. Green Teeth Related to Bilirubin Levels. Acta stomatologica Croatica [Internet]. 2018 [pristupljeno 29.11.2020.];52(1):61-64. https://doi.org/10.15644/asc52/1/9
IEEE
G.S. Barbério, A.C.G. Zingra, P.S.S. Santos i M.A.A.M. Machado, "Green Teeth Related to Bilirubin Levels", Acta stomatologica Croatica, vol.52, br. 1, str. 61-64, 2018. [Online]. https://doi.org/10.15644/asc52/1/9

Rad u XML formatu

Sažetak
Svrha: Opisan je oblik zubne pigmentacije kod nedonoščadi uzrokovan taloženjem serumskog bilirubina tijekom kalcifikacije zuba. Razina bilirubina praćena je tri mjeseca nakon rođenja, u razdoblju dok se još uvijek razvijaju krune primarnih zuba. Takva je anomalija asimptomatska, ali je i razlog za veliku zabrinutost i tjeskobu u obitelji. Prikaz slučaja: Navedeni slučaj potvrđuje koliko je važna medicinska
anamneza, a u ovom slučaju i testovi za dugotrajnu konjugiranu hiperbilirubinemiju kako bi se potvrdila dijagnoza i utješili roditelji. Estetska terapija nije poduzeta jer je dijete bilo premalo, a i njegovo stanje nije zahtijevalo takvu intervenciju. Plan liječenja uključivao je kontrolu svaka tri mjeseca kako bi se održavalo oralno zdravlje bez karijesa. Zaključak: Budući da ovo rijetko stanje utječe na zube, roditelji će najvjerojatnije zbog terapije potražiti doktora dentalne medicine koji zna o kakvoj je anomaliji riječ pa će odabrati multidisciplinarni pristup.

Ključne riječi
obojenja zuba; novorođenče, prerano rođeno; bilirubin, hiperbilirubinemija, zubi, dijagnoza

Hrčak ID: 195402

URI
https://hrcak.srce.hr/195402

▼ Article Information



Introduction

Green teeth are an extremely uncommon abnormality that can affect both primary and permanent teeth. When excessive hyperbilirubinemia occurs in the plasma, it causes reversible staining of all tissues except for the teeth (1), because the bile-pigments are permanently trapped due to loss of metabolic activity after maturation. The pigmentation may vary from yellow to deep shades of green (2). It is a cause of anxiety to the family who often visit a dentist to obtain a diagnosis. The management of this abnormality may be complicated (3) and must be a result of a collaboration of a dentist and a physician. This paper reports a case in which green pigmentation of primary teeth is caused by hyperbilirubinemia. This is the first report demonstrating bilirubin levels during the first three months of life of a premature baby, period in which the crowns of deciduous incisors are still forming.

Case report

The parents of a 3-year-old Caucasian male child accompanied their son to a dental office due to the presence of green pigmentation on his maxillary incisors. The medical history reported by the parents included that the male infant was born at 27 weeks and 1 day of gestation by Cesarean section and weighted 940 grams at birth. After having contacted the hospital in which the child was born, more information was gathered: the newborn developed a severe respiratory failure due to the respiratory distress syndrome, severe retinopathy of prematurity, grade III peri-intraventricular hemorrhage, bronchopulmonary dysplasia, convulsive syndrome, and he needed gastrostomy due to a deglutition disturbance.

The physical examination focused on general nutritional status as well as on signs of liver disease. Due to the deglutition disturbance, the newborn could not be breastfed (nutritive suction). Up to the fourth month he had been fed exclusively through a nasal catheter and after that a gastric catheter was installed. Due to the prematurity complications, the child exhibited a severe neuro-psychomotor development delay, and, therefore, he needed a special care, nutritional support, physiotherapy and multidisciplinary approach. He had undergone a tetracycline therapy and was continuously using magnesium milk, phenobarbital, cephalexin and vitamins A and D.

Apart from the green teeth pigmentation, an intra-oral clinical examination revealed normal development, no gingival abnormalities, normal texture and color of the oral soft tissues. A normal pigmentation of canines and molars, which were formed 6 months after birth, was observed. The parents reported that the maxillary incisors erupted when the child was 15 months old. They also said that the green pigmentation was present in the crown of the maxillary incisors from the moment they appeared in the mouth (Figure 1). The maxillary incisors are usually completely formed one month after birth. As the pigmentation was present in the maxillary incisors but was not present in the canines, we concluded that what caused the pigmentation had occurred around the infant’s first month of life.

Figure 1 Abnormal clinical appearance of the crowns in the primary dentition.
ASC_52(1)_61-64-f1

Due to systemic complications, blood samples were collected during the first three months after birth, and bilirubin levels were measured (Figure 2). A dental treatment plan was elaborated after the family had been reassured that the green teeth represented no worries to the present situation of the child because it was caused by a complication that had happened in the past. The parents’ only complaint was the esthetics. There were no symptoms, the child had special needs and was still not mature enough to receive a cosmetic treatment. Therefore, it was decided to have regular checkups every 3 months to maintain oral health with no caries until the teeth exfoliation.

Figure 2 Unconjugated bilirubin (red), Conjugated bilirubin (blue) and Total Bilirubin (green) Concentrations (mg/dl) in neonate at birth (day 0) until 957 days after.
ASC_52(1)_61-64-f2

Discussion

The permanent green pigmentation of dentin tissues as the main alteration caused by hyperbilirubinemia is of interest to the dentist. It is also important to know that jaundice is caused by many disease processes ranging from benign to life threatening (4).

The green teeth pigmentation is an alteration that occurs in the dentin only during its calcification (5), both for primary and permanent teeth (6). The teeth formation stages are already well known, the calcification period for the maxillary central incisors starts at 15 weeks in utero and is completed around one month after birth for males. We can then presume that for the child described in this case, hyperbilirubinemia occurred within this range. However, it was difficult to determine to what extent the bilirubin levels were elevated. There is only an assumption regarding a correlation between various degrees of green staining in the primary dentition and severity of pigmentation (7). Teeth areas that had been calcified after the hyperbilirubinemia period usually show normal color and a sharp dividing line is observed separating the green portion from the normal one. In this case, no line was visible, suggesting a more prolonged period of hyperbilirubinemia (2, 8)

Enamel hypoplasia in both maxillary incisors could have been caused by changes in the organic matrix of the developing enamel resulting from metabolic disturbances, but it is more likely that it is related to the effects of osteopenia and other disturbances of calcium and phosphate metabolism encountered in chronic liver disease (4). Also, this patient had undergone a tetracycline therapy. One of the side-effects of tetracycline is its incorporation into the tissues that are calcifying at the time of its administration. However, the permanent discoloration varies from yellow or gray to brown, but it is never green as it was in this patient. Moreover, during the tetracycline administration for this patient, the primary teeth crowns had already been calcified.

The prevention of all preterm births must be a priority. In this case, the child passed through a prolonged period of hyperbilirubinemia and was born as an extremely premature and underweight baby, which is one of the predisposing risk factors for many abnormalities such as the green teeth eruption in late infancy (9). More common causes of severe indirect hyperbilirubinemia are sepsis, prematurity, blood group incompatibility and G6PD deficiency (9). In the present case, the baby was born very preterm, at a very low birth weight and blood group incompatibility. In cases where the child is capable of receiving a cosmetic treatment, it involves composite resin restorations or transillumination with ultraviolet light aiming at bilirubin breakdown (6).

Most of the reviewed literature consisted of case reports. Further research is needed to provide information on the prevalence, severity, etiology and clinical presentation of green teeth. From this case, we concluded that health professionals should take a multidisciplinary approach when dealing with green teeth and similar abnormalities. There is some evidence to suggest that the patient experienced a period of hyperbilirubinemia during the formation of dental crown and the green pigmentation of the teeth is a rare consequence of neonatal hyperbilirubinemia. Since the green teeth pigmentation is not a common abnormality, families are often frightened and look for a dentist in order to solve the problem. When identifying green teeth, the dentist should be aware of medical causes e should look for a physician in order to establish a final diagnosis. Serum bilirubin levels must be checked in the first months after birth to confirm the diagnosis of green teeth.

Notes

[1] Conflicts of interest There are no conflicts of interest between any authors of the manuscript (Barbério, Zingra, Santos and Machado) and other co-workers, companies or organizations that could inappropriately influence the authors’ work.

References

1 

Rammal M, Meador M, Rodriguez M, Lish B. Green teeth in a premature infant following hemolytic jaundice. Gen Dent. 2013 Jul;61(4):28–9. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23823340

2 

Amaral TH, Guerra Cde S, Bombonato-Prado KF, Garcia de Paula ESFW, de Queiroz AM. Tooth pigmentation caused by bilirubin: a case report and histological evaluation. Spec Care Dentist. 2008 Nov-Dec;28(6):254–7. DOI: http://dx.doi.org/10.1111/j.1754-4505.2008.00048.x PubMed: http://www.ncbi.nlm.nih.gov/pubmed/19068066

3 

Sommer S, Magagnin K, Kramer PF, Tovo ME, Bervian J. Green Teeth Associated with Neonatal Hyperbilirubinemia Caused by Biliary Atresia: Review and Case Report. J Clin Pediatr Dent. 2010 Winter;35(2):199–202. DOI: http://dx.doi.org/10.17796/jcpd.35.2.em06x41541776004 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/21417125

4 

Winger J, Michelfelder A. Diagnostic approach to the patient with jaundice. Prim Care. 2011 Sep;38(3):469–82. [viii.] DOI: http://dx.doi.org/10.1016/j.pop.2011.05.004 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/21872092

5 

Bimstein E, Magliocca K, Cohen D, Morelli G, Katz J. Hyperbilirubinemic stain: location and extent in dental tissues. J Clin Pediatr Dent. 2011 Fall;36(1):75–8. DOI: http://dx.doi.org/10.17796/jcpd.36.1.8646325256141166 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/22900448

6 

Rangé H, Camy S, Cohen J, Colon P, Bouchard P. Dental treatment of an adult patient with a history of biliary atresia. Quintessence International. Quintessence Int. 2012 Apr;43(4):337–41. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/22532949

7 

Fernandes KS, Magalhaes M, Ortega KL. Green Teeth. J Pediatr. 2011 Mar;158(3):510. DOI: http://dx.doi.org/10.1016/j.jpeds.2010.09.065 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/21074177

8 

Carrillo A, Rezende KM, de Carrillo SR, Arana-Chavez VE, Bonecker M. Hyperbilirubinemia and intrinsic pigmentation in primary teeth: a case report and histological findings. Pediatr Dev Pathol. 2011 Mar-Apr;14(2):155–6. DOI: http://dx.doi.org/10.2350/10-10-0929-LET.1 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/21050063

9 

Najib KS, Saki F, Hemmati F, Inaloo S. Incidence, risk factors and causes of severe neonatal hyperbilirubinemia in the South of iran (fars province). Iran Red Crescent Med J. 2013 Mar;15(3):260–3. DOI: http://dx.doi.org/10.5812/ircmj.3337 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23984010


This display is generated from NISO JATS XML with jats-html.xsl. The XSLT engine is libxslt.

[engleski]

Posjeta: 1.350 *