Extensive Intrinsic Tooth Discoloration in Permanent Dentition: Two Cases Report

廣泛性的恆牙齒內染色：兩例病例報告

李睿仁(Ruei-Ren Li) ； 施文宇(Wen-Yu Shih)

《臺灣兒童牙醫學雜誌》 22卷1期 (2022/03) Pp. 25-34

https://doi.org/10.6319/TJPD.202203_22(1).0004

摘要

In this case report, we present two cases with extensive intrinsic tooth discoloration in permanent dentition. Both cases shared a similar pattern of tooth discoloration. The anterior teeth and first molars illustrated discoloration bands at cervical area. While almost all the clinical crowns of premolars and second molars were discolored. We hypothesized that both cases were affected by systemic factors. The medical histories of patients during childhood were carefully reviewed, but both patients cannot recall any long-term medication usage and major systemic disease was denied except sporadic visits to local clinics for common cold or flu. The width and location of the intrinsic tooth discoloration were correlated with stages of tooth development. Thus, the specific pattern of discoloration in the cases provided valuable biological evidence of the actual sequences of tooth calcification. According to the timetable of odontogenesis from literature, we hypothesize that some systemic stressor started to influence the odontogenesis process of both patients earlier than 3 to 4 years old; while case 1 suffer from severer and longer period, case 2 returned to normal after 6.5 years old. The article also reviewed the common etiologies of intrinsic tooth discoloration. Tetracycline or minocycline were the most probable causes of our cases, although both patients could not recall any related medical history. However, idiopathic internal tooth discoloration was also a possible diagnosis.

關鍵字

Tooth discoloration ； Idiopathic ； Intrinsic

並列摘要

本篇病例報告提到兩例廣泛內生性牙齒變色案例，兩例皆為恆牙齒列且皆擁有相同變色模式：門齒與第一大臼齒只有齒頸部有變色、小臼齒及第二大臼齒則是幾乎整顆牙齒皆變色，懷疑應是受到系統性因素影響而造成的牙齒變色。調查了兩病人的病史及系統性疾病，但是病人皆否認長期用藥或是重大疾病，小時候僅偶爾因感冒等因素至診所就醫。內生性牙齒變色的色帶寬度及位置與牙齒生成的時間相關，本報告案例所呈現的牙齒變色模式暗示了恆牙鈣化的特定時序性，可以做為牙齒發育學的珍貴參考。對比有關牙齒發育時間的文獻，我們認為這兩個案例可能在早於3到4歲左右，牙齒發育開始受到一些系統性的影響，案例二可能在接近6.5歲後恢復正常，而案例一則持續更久。本報告同時也回顧了一些造成內生性牙齒變色的常見原因，儘管兩位患者皆無法清楚回顧相關用藥歷史，但四環黴素或米諾環素仍然是最可能造成本案例的原因，而「原因不明的內生性牙齒變色」亦為可能的診斷。

並列關鍵字

牙齒變色 ； 原因不明 ； 內生性