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Indian Pediatr 2012;49: 1015

Green Pigmented Teeth


Kamaldeep Arora, Rashmi Ranjan Das and Ramesh Agarwal

Department of Pediatrics, All India Institute of Medical Sciences (AIIMS),
New Delhi, India.
Email: [email protected]
 
 


A male child born with rhesus-isoimmunisation was treated with double volume exchange transfusion followed by phototherapy for 96 hours. On day 10, he was found to have conjugated hyperbilirubinemia which gradually progressed (maximum value, 42 mg/dL; conjugated fraction, 32 mg/dL on day 30). Hepatobiliary-iminodiacetic-acid (HIDA) scan showed delayed clearance. He received phenobarbitone for five days, keeping the possibility of inspissated bile plug syndrome. Gradually the bilirubin level decreased to 6mg/dl by 2 months of age. The baby had eruption of deciduous teeth at 7 months of age which were green-to-black stained. At current age of 18 months, all the teeth are green-to-black stained (Fig. 1).

Fig.1 Green-to-black stained deciduous teeth.

Hyperbilirubinemia causes reversible staining of all tissues except the teeth. In the latter, bilirubin is permanently trapped because of loss of metabolic activity after maturation. Differential diagnosis of green teeth includes – neonatal cholestasis (e.g., biliary atresia, sepsis, pathological hyperbilirubinemias, and metabolic diseases), hemolytic-anemia, congenital hyporthyro-idism, hepato-biliary problems, and drug administration. Treatment options include; composite resin restorations, bleaching techniques, and use of transillumination with ultraviolet light.

 

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