Erythrodontia

Erythrodontia, or red teeth, is a dental condition in which the enamel and dentin acquire a reddish discoloration. The color results from deposition of porphyrin pigments within developing teeth, a process that can give the teeth a red-brown appearance and, under ultraviolet light, a characteristic red fluorescence.

The best-known cause is congenital erythropoietic porphyria (Günther disease), an autosomal recessive disorder of the heme biosynthesis pathway. In this condition, excess porphyrins accumulate in tissues, including teeth during their formation, producing erythrodontia. The appearance is often evident in infancy and can involve both deciduous and permanent dentition. Porphyrin-related erythrodontia may be accompanied by photosensitivity and other systemic features of porphyria.

Diagnosis is clinical, supported by demonstration of red fluorescence under Wood’s lamp or UV light. Biochemical testing for elevated porphyrins in urine, blood, or stool helps confirm the porphyria. Genetic testing can identify mutations in genes involved in porphyrin synthesis (for example, UROS in congenital erythropoietic porphyria). Differential diagnosis includes intrinsically stained teeth from other causes (such as tetracycline or fluorosis) and extrinsic staining, which do not typically fluoresce red under UV light.

Management centers on addressing the underlying porphyria and cosmetic dental concerns. There is no specific therapy to reverse erythrodontia; treatment of porphyria may reduce systemic symptoms, but tooth coloration persists. Cosmetic options for affected teeth include bonding, veneers, or crowns. Prognosis is variable and depends largely on the systemic disease course and the extent of dental involvement.