Now rare, a bluish-black line on the gums may signal chronic lead poisoning. The line is about 1 mm from the gum margin, follows its contours, and is absent where there are no teeth. In this example, as is common, periodontitis coexists.
Dental caries is first visible as a chalky white area in the enamel surface of a tooth. This area may then turn brown or black, become soft, and cavitate. Special dental techniques, including x-rays, are necessary for early detection.
(Sources of photos: Pregnancy Tumor, Dental Caries—From Langlais RP, Miller CS: Color Atlas of Common Oral Diseases. Philadelphia, Lea & Febiger 1992. LJsed with permission; Kaposi's Sarcoma in AIDS—Kelley WN (ed): Textbook of Internal Medicine, 2nd ed. Philadelphia, JB Lippincott, 1992; Lead Line—Courtesy of Dr. R. A. Cawson, from Cawson RA: Oral Pathology, 1st ed. London, LJK, Gower Medical Publishing, 1987.)
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Attrition of Teeth; Recession of Gums
In many elderly people, the chewing surfaces of the teeth have been worn down by repetitive use so that the yellow-brown dentin becomes exposed— a process called attrition. Note also the recession of the gums, which has exposed the roots of the teeth, giving a "long in the tooth" appearance.
Hutchinson's teeth are smaller and more widely spaced than normal and are notched on their biting surfaces. The sides of the teeth taper toward the biting edges. The upper central incisors of the permanent (not the deciduous) teeth are most often affected. These teeth are a sign of congenital syphilis.
Teeth may be eroded by chemical action. Note here the erosion of the enamel from the lingual surfaces of the upper incisors, exposing the yellow-brown dentin. This results from recurrent regurgitation of stomach contents, as in bulimia.
Abrasion of Teeth With Notching
The biting surface of the teeth may become abraded or notched by recurrent trauma, such as holding nails or opening bobby pins between the teeth. Unlike Hutchinson's teeth, the sides of these teeth show normal contours; size and spacing of the teeth are unaffected.
(Sources of photos: Attrition of Teeth, Erosion of Teeth—From Langlais RP, Miller CS: Color Atlas of Common Oral Diseases. Philadelphia, Lea & Febiger, 1992. LJsed with permission; Hutchinson's Teeth, Abrasion of Teeth—Robinson HBG, Miller AS: Colby, Kerr, and Robinson's Color Atlas of Oral Pathology. Philadelphia, JB Lippincott, 1990.)
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