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Background – During tooth development, green discoloration of the teeth may occur in patients with serious liver disease such as biliary atresia and acute liver failure. The disease causes accumulation of bilirubin in the blood and the liver. The condition is called hyperbilirubinemia, which in the skin is seen as jaundice. When the concentration of bilirubin remains elevated, the coloring product becomes integrated into all tissues undergoing metabolic processes. In contrast to bone, which continuously undergoes remodelling, the teeth become permanently discolored. Case study – The dental impact of hyperbilirubinemia caused by liver disorders is illustrated in three patients with the main focus on a patient from Aalborg municipality. Conclusion – Green discoloration of the teeth is a very rare condition caused by hyperbilirubinemia during the formation of dental tissues. The condition causes cosmetic problems, but does not compromise the masticatory function of the teeth, and does not increase the risk of dental or periodontal disease. The present cases show the relevance of the dentist’s knowledge to the early medical history of the child. The treatment options of bilirubin discolored teeth include covering with composite, and eventually prosthetic treatment with crowns or veneers.

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