Prevalence of Intrinsic Stains in Libyan Adults and Clinical Measurement of Tooth Color and Stain

الملخص

Intrinsic tooth stains (IS) are discolorations incorporated within enamel or dentin during or after tooth formation, with common causes including dental fluorosis, tetracycline use, and developmental enamel defects. Such discoloration can have significant aesthetic and psychosocial impacts. While the prevalence of IS has been investigated globally, data on Libyan adults remain scarce. Determine the prevalence of ISs in a random sample of consecutive patients attending the Oral Diagnosis Clinic, to describe the general characteristics and clinical presentation of ISs such as the extent of involvement, the type of stain, and the surfaces mostly involved, and to measure tooth colour and stain by visual shade matching method. A cross-sectional clinical study comprised Libyan adults attending the Faculty of Dentistry, University of Benghazi, and the target number was 200 patients. Participants were examined under standardized lighting using visual inspection and a 3D Master VITA shade guide for color assessment. Data were analyzed using descriptive statistics. All the obtained information was tabulated in a Microsoft Excel spreadsheet, and the validated data were exported to SPSS for statistical analysis. The obtained information was analyzed by descriptive analysis for the mean, median, mode, SD & range of the general information. The intra-examiner and inter-examiner reliability tests were done by the Cohen kappa test of a pilot study consisting of 50 cases. Intrinsic stains were detected in females, n=111 (55%), and males, n=89 (45%). The number of females was more than the number of males except for the age group over 70 years. The highest concentration of participants was observed in the 20–30 years age group comprising a total of 65 participants (32.5%). This was followed by the age group 41–50 years, which comprises 43 participants (21.5%). The most prevalent cause of intrinsic stains is necrotic pulp, accounting for 83 (41.5%) of cases, followed by demarcated enamel opacity 20 (10.0%), and generalized severe dental fluorosis19 (9.5%), while generalized moderate fluorosis was17 (8.5%). Other notable diagnoses included localized moderate fluorosis 17 (8.5%) and staining associated with restorative fillings15 (7.5%). Conditions such as diffuse enamel opacity13 (6.5%), generalized mild fluorosis5 (2.5%), and localized enamel hypoplasia 4 (2.0%) are less frequent. Rare diagnoses included amelogenesis imperfecta (hypoplastic type) and localized mild fluorosis (3, each 1.5%), while internal resorption was the least common, comprising 1(0.5%) of cases. Stains were more common in the Localized region, 158 (79.0%). Generalized fluorosis affected 40 patients (65.6%) of the patients while localized fluorosis was observed in 21 (34.4%). Moderate degree of fluorosis severity 34 patients (55.7%), whereas severe fluorosis was noticed in 19 patients (31.1%). Coexistence of external dental stains was observed in 131 (65.5%) of the patients with intrinsic stains. More than half of the patients, 105 (52.5%), had non-vital teeth, 44 fractured teeth (22.0%), 22 filled teeth (11.0%), and 7 mobile teeth (3.5%). The labial surface was the most commonly affected by fluorosis, accounting for 99 (29.7%) of stained surfaces. The majority of patients (52.0%) had staining confined to a single tooth or 2 to 6 teeth (25.5%). The most recorded shade of stained teeth was 5M1 (37.5%), followed by 5M3 (22.0%), and the most common stain color was white (35.5%), yellow (33.5%), and brown (30.0%). Statistically significant associations were found between stain type and both age and sex of the participant p-value (<0.05). Intrinsic tooth stains are prevalent among Libyan adults, with pulp necrosis and fluorosis as the most common causes. Findings highlight the role of environmental fluoride exposure, trauma, and systemic factors in their occurrence.