Deposits and stains of teeth

1. BY:
ABDULLAH , MOAHMMED GAMAL
AL-MANSORI , MOHAMMED A
MUBARAK A , WARSAME

2. Dentalstains:
•Pigmented deposits found on the tooth
surface is dental stains or extrinsic stains.
•In some conditions the stains will be
incooperated in the tooth structure known
as intrinsic stains.

3. Cause of dental stains
• Oral cavity is subjected to many exogenous
and endogenous substances that stains the
teeth.
• Also the oral flora contains many type of
chromogenic deposits which also causes stain
deposit.
• Intrinsic stains are seen in porphyria,
erythroblastosis fetalis and tetracycline
therapy.

4. Types of dental stains
Dental stains classifications :
• Extrinsic stains.
• Intrinsic stains.

5. Extrinsicstains
• Extrinsic stains are defined as stains located on
the outer surface of the tooth structure and
caused by topical or extrinsic agents.
• Extrinsic dental stains are caused by predisposing
factors and other factors such as dental plaque
and calculus, foods and beverages, tobacco,
chromogenic bacteria, metallic compounds, and
topical medications.

6. Predisposing factors
•
•
•
Certain factors predispose children and adults to extrinsic
stains, include enamel defects, salivary dysfunction, and
poor oral hygiene
.
Microscopic pits, fissures, and defects in the outer surface
of the enamel are susceptible to the accumulation of stain-
producing food, beverages, tobacco, and other topical
agents.
The most common cause of extrinsic stains is poor oral
hygiene.

7. Other factors
•
•
•
•
•
Accumulations of dental plaque, calculus, and food particles cause
brown or black stains .
Deposition of tannins found in tea, coffee, and other beverages
cause brown stains .
Tobacco stains from cigarettes, cigars, pipes, and chewing tobacco
cause dark brown and black stains that cover the cervical one third
to one half of the tooth.
Pan chewing results in a red-black stain on the teeth, gingiva, and
oral mucosal surfaces.
Metallic compounds are also implicated in dental discolorations
because of the interaction of the metals with dental plaque to
produce surface stains.Industrial exposure to iron, manganese, and
silver may stain the teeth black. Mercury and lead dust can cause a
blue-green stain.

8. Red extrinsic stain at gingival margin and
interproximal and incisal region-habit
of chewing pan.

10. Sever tobacco stain

11. Intrinsicstains
• Intrinsic dental stains are caused by certain
dental materials, dental conditions like caries,
trauma, infections, medications, nutritional
deficiencies, genetic defects and hereditary
diseases (e.g. those affecting enamel and
dentin development or maturation).

12. Causes of intrinsic dental
stains
• Numerous causes for intrinsic tooth discoloration
exist.
• Stain distribution varies from localized (e.g. 1 or 2
teeth) to a regional or generalized involvement of
primary and secondary teeth.
• Following are some of the causes of intrinsic
stains.

13. 1.Dental materials
• Dental restorations most commonly cause
intrinsic discoloration. Amalgam restorations can
generate corrosion products leaving a gray-black
colour in the tooth, especially in large cavity
preparations with undermined enamel.
• Composites, and glass ionomer and acrylic
restorations gradually can leave a gray hue in the
tooth adjacent to the material.
• Other dental materials that cause intrinsic
discoloration include eugenol, root canal sealers,
and polyantimicrobial pastes.

14. 2. Dental conditions and caries
•
•
•
The erosion of enamel caused by frequent ingestion of acidic foods
and beverages and from the regurgitation of acid from the stomach
can lead to a yellow tooth discoloration .
the dentin, the overlying translucent enamel reveals the color of
the underlying caries and appears yellowish brown. Extensive caries
that involve destruction of both enamel and dentin produce a color
that ranges from light brown .
produced by cariogenic bacteria, melanin, lipofuscins, and uptake of
various food colours and bacterial .

15. 3 . Trauma
•
•
Trauma to developing unerupted, teeth can disturb enamel
formation and may result in enamel hypoplasia, which is
visualized as a localized opacity on the erupted tooth.
Trauma that occurs to erupted teeth also causes
discoloration. This discoloration frequently occurs in teeth
that have fully formed roots and have sustained
irreversible pulpal injury caused by avulsions, intrusions, or
fractures involving the pulp chamber..

16. Intrinsic dental discoloration caused by
trauma to the mandibular incisors that led
to pulpal necrosis.

17. 4. Infections
• Periapical odontogenic infections of the primary teeth
can disrupt normal amelogenesis of the underlying
permanent successors and involve a potential for
localized enamel hypoplasia
• .
• Rarely maternal rubella or cytomegalovirus infection
and toxaemia of pregnancy can lead to tooth
discoloration.
• Crown formation of the secondary dentition occurs until
the child is aged approximately 8 years. Systemic
postnatal infections
•
•
•

18. 5. Medications
•
•
Tetracyclines diffuse through dentin to the enamel interface,
chelating calcium ions and incorporating into hydroxyapatite as a
stable orthophosphate complex .
Minocycline is a second-generation derivative of tetracycline. The
ingestion of minocycline can lead to a green-gray or blue-gray
intrinsic staining of teeth. Staining occurs during and after the
complete formation and eruption.Minocycline was prescribed for
long-term acne therapy in adolescents and adults, although it is
being replaced by other medications.

19. Contd…
• Doxycycline has recently been reported to cause
extrinsic staining of teeth, possibly by binding to
glycoproteins in the dental pellicle in patients
with poor oral hygiene in whom oxidation occurs.
• Dental fluorosis is characterized by enamel
discoloration resulting from subsurface
hypomineralization due to the excessive
ingestion of fluoride during the early maturation
stage of enamel formation.Fluorosis affects
primary and secondary dentitions

20. Tetracycline staining
of mandibular teeth
caused by the
ingestion of
tetracycline when the
patient was aged 3
years.

21. Severe fluorosis of the teeth.

22. 6 . Genetic defects and hereditary
diseases
• Genetic defects in enamel or dentin formation include
amelogenesis imperfecta , dentinogenesis imperfecta , and
dentinal dysplasia . These are hereditary diseases with a
propensity for intrinsic tooth discoloration.
• Amelogenesis imperfecta affects both primary and
secondary dentitions
• Other hereditary diseases include erythropoietic
porphyria and epidermolysis bullosa (EB).
• Erythropoietic porphyria is a rare disease of porphyrin
• metabolism.

23. Physical characteristics
• Extrinsic stains:
Discoloration include brown, black, gray, green, orange,
and yellow. The scratch test is usually used to distinguish
between extrinsic and intrinsic discoloration.
• Intrinsic stains:
Discoloration colours include brown, black, gray, green,
orange, and yellow. Unlike extrinsic discoloration, teeth
with intrinsic discoloration may be red or pink. Under
ultraviolet light, teeth with tetracycline staining and
congenital porphyria may fluoresce yellow or red,
respectively. Intrinsic discoloration cannot be removed by
using the scratch test.

24. Treatment
Medical care:
•
•
•
• Dental treatment of tooth discoloration involves identifying the
etiology and implementing therapy.
Diet and habits: Extrinsic staining caused by foods, beverages, or
habits (eg, smoking, chewing tobacco) is treated with a thorough
dental prophylaxis and cessation of dietary or other contributory
habits to prevent further staining.
Tooth brushing: Effective tooth brushing twice a day with a
dentifrice helps to prevent extrinsic staining.
Professional tooth cleaning: Some extrinsic stains may be removed
with ultrasonic cleaning, rotary polishing with an abrasive
prophylactic paste, or air-jet polishing with an abrasive powder.
However, these modalities can lead to enamel removal; therefore,
their repeated use is undesirable.

25. Contd…
• Bleaching (tooth whitening ) :
bleaching is a safe, easy, and inexpensive modality that is used to
treat many types of tooth discoloration. Usually, bleaching is not
indicated for the treatment of discoloration of the primary teeth.
Bleaching includes 2 types of techniques: vital and non vital.
– Vital bleaching
• Bleaching of vital teeth is indicated primarily for patients with
generalized yellow, orange, or light brown extrinsic discoloration
(including chlorhexidine staining), it may be helpful in mild cases of
tetracycline-induced intrinsic discoloration and fluorosis.
– Nonvital bleaching
• Nonvital bleaching is indicated for the treatment of teeth with
discoloration secondary to pulpal degeneration. This technique involves
placing a mixture of 30% hydrogen peroxide and sodium perborate into
the pulp chamber for as long as 1 week.

26. Others
• Recommend all patients to perform daily oral
hygiene by using a toothbrush, a dentifrice
containing, and use dental floss.
• Individuals who wear dentures should brush
the prostheses after each meal to keep the
prostheses free of plaque, calculus, and stains.
Partial and complete removable prostheses
(dentures) should always be removed during
sleeping hours.