A few nights ago, I went to a seminar on paediatric dentistry held at the Belfast City Hospital. The seminar was delivered by the President of the British Society of Paediatric Dentistry (BSPD) Janice Fearne, a consultant in paediatric dentistry. This seminar wasn’t part of our course, hence non-compulsory, so only a handful of students went for it. It was more geared towards briefing practising dentists on paediatric cases and findings. The talk was quite enlightening, it highlighted several key points in clinical paediatrics and some new research findings regarding developmental defects in deciduous (baby/milk) teeth.
During the Q&A session, one of the dentists asked a question regarding a patient (who was a 5 year old child) having green teeth. She explained that this patient had liver transplants, and yellowish skin, associated with the green teeth scenario. In this post I will write about how liver diseases work, and why it could lead to green teeth. Note that I’ve only just begun my paediatric dentistry course not long ago, and I’m still very green (pun intended!) on this field, so I’m only writing based on what I’ve read on articles online.
This is how it looks like:
Nope, it’s not a scene from The Hulk.
Before we talk about this, let’s start with a little bit on how the liver works, and how liver diseases can lead to this.
Liver disease
Liver disease encompasses a wide spectrum of disorders to the liver. They can be caused by damage from alcohol, drugs, poisons, viruses and direct injury. In many cases of liver disease, the organ undergoes cirrhosis – scarring of the liver due to long term damage. The damage caused by cirrhosis can’t be reversed and eventually can become so extensive your liver stops functioning. This is called liver failure. [1] In almost all cases of liver diseases, one of the most prominent clinical signs is jaundice (yellow discolouration of the skin and the whites of the eyes).
In the case of this patient, a young child who underwent liver transplant, one can only assume that he/she had some form of liver failure that needed to be transplanted. And that before the transplant, the liver condition had already manifested itself in jaundice.
What is jaundice?
Jaundice is caused by hyperbilirubinaemia (what a mouthful!). This is the condition where there is an excess of the pigment bilirubin in the blood. This is the result of liver diseases – the inability of the liver to metabolise and excrete bilirubin – which leads to a build-up of of bilirubin in the blood. The bilirubin simply can’t make it to your digestive tract to be eventually removed through your stool. [2]
But wait, if bilirubin makes you yellow, why does it make teeth green?
Green teeth as a complication of hyperbilirubinaemia
When bilirubin levels are elevated for several months, bilirubin pigments deposit throughout the body, including the teeth. Microscopic images of green-stained deciduous teeth from patients with hyperbilirubinaemia has shown bilirubin deposits. [3]
Staining of deciduous teeth may vary in color from yellow to dark green. In the soft tissues such as skin, the pigment is removed over time. However, in the hard dental tissues, the pigment becomes trapped because of the lack of metabolic activity and thus results in permanent green discolouration. [4]
Although the prevalence of this condition is still unknown, this phenomenon of green teeth has freaked out parents. Whether or not the child’s adult teeth will have green pigments remains to be seen. Hyperbilirubinaemia during a child’s life may very well stain the adult teeth as well – as adult teeth are slowly formed throughout a child’s life underneath their baby teeth.
Treatment
Treatment of pigmented teeth is mainly cosmetic. Stained deciduous teeth will eventually be replaced with normal permanent teeth. As children age, treating the teeth can help improve self-esteem, although most experts do not recommend treatment of baby teeth. Composite veneers or crowns and bleaching are 2 of the treatment options available. [5]
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This post not only highlights the mechanism of how a disease can affect the outlook of your teeth, but also outlines the importance of dentists having a strong grasp of medical knowledge in order to know how to address a scenario like this.
References
[2] Yellow Skin (Jaundice): Signs, Symptoms and Causes
[3] Watanabe K, Shibata T, Kurosawa T, et al. Bilirubin pigmentation of human teeth caused by hyperbilirubinemia. J Oral Pathol Med. 1999;28:128-130.
[4] Guimarães LP, Silva TA. Green teeth associated with cholestasis caused by sepsis: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:446-451.
[5] Rosenthal P, Ramos A, Mungo R. Management of children with hyperbilirubinemia and green teeth. J Pediatr. 1986;108:103-105.
KAI DENTAL 