stained teeth

Most of the people worldwide struggle with the practice of oral hygiene maintenance. Moreover, everyone loves to indulge in eating sugary and acidic food. Such practices slowly eat away the tooth enamel and initiate a vicious cycle of tooth pain, cavity, and gum disease. Another complication of poor oral hygiene is the development of unsightly stains on the tooth surface.

According to a survey conducted by the American Academy of Cosmetic Dentistry, 90% of the population wanted to improve the appearance of the smile by brightening their teeth. Tooth staining is usually caused by foreign substances such as food color, smoking, or tobacco chewing that affect the enamel surface only. Extrinsic stains can be managed efficiently by professional teeth cleaning and whitening procedures.

However, some genetic disorders or pre-natal medications can permanently damage the dental tissues and lead to intrinsic staining of the tooth. Such stains are difficult to remove and require extensive cosmetic management. Today’s article will highlight the different types of tooth discoloration. Moreover, we will discuss the treatment of modalities and management.

What do you mean by tooth staining or discoloration?

black tartar on teeth

Tooth discoloration is described as an abnormality in the color and transparency of teeth. The outermost layer of enamel usually reflects the natural color of the teeth. Generally, the enamel is a yellowish-white and semi-transparent layer. (1)

Presence of yellow teeth or unsightly stains on the tooth surface are one of the prime aesthetic concerns of people who seek cosmetic dental treatment.

Tooth discoloration can happen due to several reasons like medications, the habit of tobacco chewing, advancing age, tooth decay, excessive fluoride uptake, and many more. It is, therefore, essential to identify the exact cause behind the changes in tooth color and manage the condition for an effective outcome. (2)

What are the types of tooth discolorations?

The change of tooth color usually depends upon several factors. Tooth discoloration is typically categorized into three types –

Extrinsic tooth discoloration

As the name suggests, external tooth discoloration affects the outermost layer of enamel. Usually, this happens when a pigmented residue from different food and beverages builds up as a layer on the tooth surface. Sometimes, extrinsic tooth stains that remain for a long time on the tooth surface can become intrinsic. (3) Typically, extrinsic tooth discolorations can be caused by the following factors –

  • Poor oral hygiene – one of the most widespread causes of external tooth discoloration is poor oral hygiene. Excessive accumulation of plaque forms a sticky yellowish layer on the tooth surface and around the gum line. Generally, dental plaque acts as a host for bacterial growth in the mouth.

Often, chromogenic bacteria – bacteria that can cause tooth staining increase as the plaque layer develops on the tooth surface and cause visible discoloration of the tooth.

  • Calculus or tartar – often people neglect plaque accumulation and fail to get their teeth cleaned. As a result, the plaque calcifies around the teeth and gums to form a hard deposit called calculus or tartar. Color of calculus often varies from yellow, brown, grey, and black.

Unlike dental plaque, calculus is difficult to remove with regular brushing. Therefore, professional teeth cleaning is essential to take care of your oral hygiene.

  • Bad oral habits – many people who have the habit of smoking develop black or greyish stains on the tooth surface. Tobacco chewing can also lead to the formation of a greyish black layer of stain over the tooth surface. Prolonged use of tobacco can permanently affect the color of the teeth and turn it yellow.

Betel chewing is another type of oral habit that can also take a toll on the appearance of your smile. Often betel chewing tuns the teeth dark red, brown or black.

  • Many types of food and beverages can cause tooth discoloration Vegetables rich in carotenoids can change the color of the teeth. Drinks like fizzy cola, coffee, tea, and red wine are well known for causing tooth staining.
  • Medications like antibiotics may form insoluble complexes in the mouth that may react with the tooth minerals and cause extrinsic tooth discoloration. Persistent use of chlorhexidine mouthwash or mouthwash with cetylpyridinium chloride has shown to discolor the teeth.

Many medications contain metallic components, such as iron and iodine. These minerals are capable of reacting with the enamel layer to cause extrinsic staining.

Intrinsic tooth discoloration

Intrinsic tooth discoloration usually occurs during the development of the tooth structure. However, some intrinsic stains can be acquired later in life. Some of the common inherent tooth stains can be categorized as follows –

  • Tooth decay – this is one of the prime causes of intrinsic tooth discoloration. Often, tooth decay initiates as an opaque white spot on the tooth surface. With continuous demineralization of the tooth, the decay progresses deeper and forms a cavity. This process turns the affected part brown in color.
  • Infected pulp tissue – extensive tooth decay often involves the pulp tissue. Other causes of pulp infection may include traumatic tooth injury. Dead pulp reflects out as a greyish black discoloration which is visible on the tooth surface.
  • Dental trauma – often, traumatic injuries can cause tooth luxation. This condition is characterized as a red discoloration which happens due to damage of blood supply to the tooth. Gradually, the decomposed blood forms a brownish discoloration. (4)

Traumatic injury of a developing adult tooth can change its color to yellowish-brown. This discoloration may not be apparent at an early stage. However, as it may become evident when the tooth erupts in the mouth.

Another form of dental trauma is internal resorption. In this condition, the dentin gets resorbed by the hyperplastic pulp tissue. As the pulp continues to replace the layer of dentin, the tooth turns pink in color. Such condition is also termed as ‘pink tooth of mummery.’

  • Fluorosis – fluoride is an essential mineral for strengthening the teeth and bones. However, excessive intake of fluoride during the developmental stages of the teeth can have some adverse effects.

In the mildest form, fluorosis usually appears as small white specks on the tooth surface. Severe cases of fluorosis may lead to the formation of hypoplastic patches on the surface of the tooth. These patches often attract surface stains and turn yellowish-brown in color.

An advanced stage of fluorosis may lead to the formation of thick white bands on the tooth surface, which is unpleasant to look at.

  • Root canal treated tooth – improper cleaning during root canal treatment leaves the necrotic tissue inside the tooth. This reflects out as a change of color.
  • Tooth fillings – amalgam fillings are silver in color. Often old amalgam fillings can corrode to the surrounding tooth structure and make it appear darker in color.
  • Medications – broad-spectrum antibiotics like tetracycline chelate the calcium ions present in the teeth and bones. Prolonged use of such medication during the developmental stages of the tooth can cause yellowish-green discoloration of the dentin. As tetracycline oxidizes the tooth structure, it turns the tooth brown in color.

Tetracycline has a unique property to cross the placental barrier. This can have severe effects on the child’s tooth discoloration during the mother’s pregnancy.

  • Genetic disorders – several genetic disorders cause abnormal tooth appearance, for example, enamel hypoplasia and hypocalcification.

Amelogenesis imperfecta is a type of condition that affects the formation of enamel. It makes the enamel fragile and yellow. Moreover, the flaky layer of enamel attracts surface stains which can further change the color of the tooth. Dentinogenesis imperfecta is another developmental dental defect that causes abnormal development of the dentin. This condition leads to the formation of a blue-grey or amber tooth.

  • Blood disorders – Gunther disease is a variant of porphyria which causes red or brown discoloration of the tooth. Hyperbilirubinemia can turn the teeth yellowish-green in color due to excess of bilirubin in the body. Thalassemia and anemia are well known to cause greenish-yellow or blue discoloration of the teeth.

Age-related tooth discoloration

Age-related tooth staining often occurs as a combination of both intrinsic and extrinsic stains. As the age advances, the enamel layer becomes thin, reflecting the underlying dentin. This makes the teeth yellow. Additionally, extrinsic stains from food and beverages or a habit of tobacco chewing can further discolor the teeth and make it look less appealing.

How can you manage tooth staining?

Usually, tooth discolorations can be seen on the tooth surface. Treatment of tooth staining or discoloration depends on the underlying cause. Before performing a procedure, a dentist may document the medical and dental history of the patient. This is done to rule out any genetic disorders or previous incidence of traumatic injury.

A complete oral examination reveals the extent, location, and type of teeth affected by tooth staining. Some of the conventional treatment modalities used for tooth discoloration or staining include the following –

Management of intrinsic stains

Intrinsic stains of the teeth are difficult to remove at home. These conditions usually require professional dental attention. Some of the treatment options for the removal of inherent stains include –

Teeth whitening

Professional teeth whitening procedures use a high concentration of the bleaching gel, which effectively helps to improve the color of the teeth. Mild intrinsic tooth discolorations are perfect for teeth whitening. Laser teeth whitening is the most effective and shows excellent results within one to two hours of a single dental visit. (5)

At-home teeth whitening techniques can also be used to mask the intrinsic stains. However, this technique takes a longer time as compared to professional teeth whitening. The dentist may provide a custom fit tray and a bleaching gel. The tray with the bleaching gel should be placed for at least 30 minutes. It usually takes two weeks or more to see the improvement of the tooth color. However, the longevity of the result depends upon proper oral health care practice and maintenance of the teeth.

Veneers and crown placement

Dental Veneers Pros and Cons

Deep intrinsic stains may persist after teeth whitening procedure. Such stains can be treated with restorative modalities such as crowns and veneers. Bonding with tooth-colored material such as composite is also a viable option to mask the intrinsic stains. (6) Moreover, bonding techniques also help to improve the shape and size of a tooth and make the smile more appealing.

Management of extrinsic stains

Extrinsic stains are one of the most accessible types of tooth stains that can be removed by simple dental techniques.

Professional teeth cleaning

Teeth cleaning by a dentist helps to remove the plaque and bacteria from the tooth surface. Moreover, people with calculus should get their teeth cleaned once every six months. Professional teeth cleaning is also useful in the removal of food stains.

Removal of stains by enamel microabrasion

Enamel microabrasion is an advanced, painless technique of removing yellow, brown or white spots and stains from the surface of the teeth. Typically, this procedure is performed by a dentist wherein hydrochloric acid is used with pumice to gently remove a thin layer of enamel containing the surface stains. (7)

Teeth whitening is considered as the last treatment option for improving the color of the teeth.

What are the preventive methods?

The best way to prevent tooth staining is to take proper care of your oral hygiene. Moreover, you can follow some preventative measures to maintain your pearly whites –

  • Routine oral health care practice which includes adequate tooth brushing and flossing is the key towards preventing tooth staining. Teeth whitening toothpaste is a good option for people looking to improve the color of their teeth. (8)
  • Avoid food and beverages that cause tooth stainings such as coffee, tea, and red wine.
  • Use a straw to consume the beverages mentioned above. This minimizes tooth contact with acidic drinks.
  • Rinse your mouth with water after every meal or drink plenty of water to remove plaque that forms immediately after eating food.
  • Routine dental check-ups and professional teeth cleaning are necessary to avoid unnecessary plaque and tartar build-up in the mouth.

Take away message

Tooth staining is one of the most widespread dental problems for which people seek dental care. Everyone has become more conscious about the appearance of their smile. For this reason, it is essential to understand the cause behind your tooth staining. Tooth discoloration can be intrinsic or extrinsic. Intrinsic stains are caused by underlying genetic disorders or incidents that occur during the development of the tooth.

Extrinsic stains as the name suggests are caused by factors like food substances, tooth decay, traumatic dental injury, and oral habits like tobacco chewing. A treatment towards stain removal will only be effective if it can eliminate the root cause of the problem. Routine dental check-ups and professional treatments are therefore necessary to provide the perfect smile.