Have you ever seen this staining under your provisionals (Fig. 1)? Did you assume, as most of us do, that it must be your fault? Did you think your margins were insufficient? So you cleaned the stain and re-made the provisionals (Fig. 2) on your time apologizing all the way, only for a new stain to show when the patient returned for the final restorations.
Would you be open to the possibility that most conditions that we see in dentistry are multi-factorial and ambiguous? I thought so.
In a recent Spear TALK discussion thread, Great Neck, NY, dentist David Schwartz, was sharing a story of a patient who had obvious new staining two days after a cleaning appointment. He noted that his patient was a triathlete who also had some recession and root exposure and wondered if fluoride varnish would help.
As fate would have it, Dr. Andrew Cohen (Jenkitown, PA) had just read an article in AGD Impact (Damaging Diets: How Weight Loss Fads and Popular Health Drinks Can Hurt Teeth), outlining the impact of acidic additives such as chologenic acid, alpha lipoic acid, and citric acid. Weight loss supplements and protein shakes are traditionally very high in these acids, as are the contents in Detox diet and energy drinks. Even if we ask our patients to avoid these drinks, even if only while wearing our provisionals, we are still struggling with open tubules that are subject to sensitivity and stain.
A recent article outlining the benefits of desensitizing agents on dentin permeability noted that dentin permeability was reduced to virtually zero using MS Coat and Gluma . An application of either one of these agents or immediate etching and bonding of the preparation will obviously reduce the likelihood of stain under provisionals. Certainly, there are other documented reasons for dark marginal stains under restorations, but if we address these three possible etiologies with intention, the odds will be in our favor:
- Poor marginal seal of provisional material
- Lack of dentin seal with desensitizing agent or bonding
- Temporary or permanent removal of protein shakes, weight loss supplements, etc.
By addressing these possible etiologies, we'll have a clean preparation when the patient returns and will spend less time re-making provisionals and apologizing for the inconvenience and embarrassment.
Am J Dent. 2009 Jun;22(3):143-6. Effect of desensitizing agents on dentin permeability. Ishihata H, Kanehira M, Nagai T, Finger WJ, Shimauchi H, Komatsu M.