Discoloration of teeth / dental implant courses by Indian dental academy

SEMINAR
ON
DISCOLORATION OF TEETH
Chinarfating
www.indiandentalacademy.com

INDEX
Introduction
Definition
Effects
Types
Classification
Treatment

INTRODUCTION
 Teeth are considered to exhibit many color
reflections (polychromatic).
 These colors can be absorbed and interpreted
from our eyes in different ways.
 This because the color of our teeth varies from
many other factors for example: color of the
gingiva, shape of the tooth, type and
translucency of dentine and enamel..

 The translucency of enamel varies because of the
degree of calcification and dentine.
 One of the factors that influences tooth
discoloration is stain.
 Stain is divided into two categories Extrinsic
and Intrinsic stains

DEFINITIONS OF TOOTH
DISCOLORATION:
 Any change in the hue, color, or translucency of a
tooth due to any cause. Restorative filling
materials, drugs (both topical and systemic),
pulpal necrosis, or hemorrhage may be
responsible.
(Jablonski, Dictionary of Dentistry, 1992, p253)

DISCOLORATION CAN HAVE SIGNIFICANT
EFFECT
 Personality
 Mentally and socially unpleasant effects
 Self confidence
 Can cause the stress
 May be a sign of a systemic disease.
 Teeth with hypo plastic defects, have higher tendency
for developing caries

TYPES
Extrinsic
Intrinsic

 Extrinsic tooth discoloration :
This occurs when the enamel is
stained as by some drinks or foods or by smoking.
These are external stains that build up on the outer
surface of a tooth.
They are not part of the structure of the tooth.

 Age-related discoloration : Teeth change with age,
their mineral structure changes becoming less porous
and making teeth to appear darker.
The enamel that covers the teeth
gets thinner with age, allowing the underlying layer of
yellowish dentin to show through.
 Advancing age. As you age, the outer layer of enamel
on your teeth gets worn away revealing the natural
yellow color of dentin.
 Genetics. Some people have naturally brighter or
thicker enamel than others.

THERE ARE SEVERAL REASONS WHY
TEETH MAY DARKEN.
 Foods/drinks. Coffee, tea(tannins), colas, wines, and
certain fruits and vegetables (for example, apples and
potatoes) can stain (brown)your teeth.
 Tobacco use. Smoking or chewing tobacco can
stain(brown to black stains ) teeth. (cervical one third
to one half of the tooth
 Poor dental hygiene. Inadequate brushing and
flossing to remove plaque Accumulation of dental
plaque and tartar may alter the natural appearance of
the tooth

Dental materials. Some of the materials used in
dentistry, such as amalgam restorations , especially
silver sulfide-containing materials, can cast a gray-
black color to your teeth.
[ Amalgam restorations generate corrosion products (e.g., silver
sulfide)]
 Composites, and glass ionomer and acrylic restorations
gradually can leave a gray hue in the tooth adjacent to the
material.
Citrus fruits
Having frequent intake of citrus fruits like lemon and
oranges can also cause yellow to brown discoloration in
ones teeth. So it is necessary for one to gargle his
mouth after having citrus fruits.
 Due to the extremely high acid content in soft drinks, the
deterioration of the enamel on your teeth is sped up

Environment. Excessive fluoride
 Naturally high fluoride levels in water
 Excessive use (fluoride applications, rinses, toothpaste, and
fluoride supplements taken by mouth) can cause teeth
discoloration.
Trauma.
 Damage from a fall can disturb enamel formation in young
children whose teeth are still developing (pink tooth).
 Trauma can also cause discoloration to adult teeth.
 Intrapulpal hemorrhage and iron sulfide deposition along the
dentinal tubules, producing a bluish black cast.

Primary or secondary caries.
 light brown, to dark brown or almost black
 The brown color is attributed to the formation of
Maillard pigments (reaction between proteins and
small aldehydes produced by cariogenic bacteria)
melanins and uptake of various food colors and
bacterial pigments.

Mouth rinse
 Chlorhexidine mouthwashes -- yellow-brown stains
 Stannous fluoride -- light brown or yellowish stain
 Iodine-containing solution medications may also cause
similar stains.
 Cetylpyridinium chloride is an ingredient in several
mouthwashes (e.g., Cepacol, Scope) that can cause
dental staining

 Iron-containing oral solutions used for treatment of
iron deficiency anemia cause black stains.
 Potassium permanganate mouthwash (violet-black
stain), silver nitrate (black stain), and stannous
fluoride (brown stain) also can induce dental
discolorations.
 Chromogenic bacteria cause stains, typically at the
gingival margin of the tooth. The most common is a
black stain caused by Actinomyces species
(stain is composed of ferric sulfide and is
formed by the reaction between hydrogen sulfide produced by bacterial
action and iron in the saliva and gingival exudates)

 Green stains are attributed to fluorescent bacteria and
fungi such as Penicillium and Aspergillus species.
(The organisms grow only in light and
therefore cause staining on the maxillary surface of the anterior teeth. )
 Orange stain is less common than green or brown
stains and is caused by chromogenic bacteria such as
Serratia marcescens and Flavobacterium lutescens.

Metallic compounds
 Industrial exposure to iron, manganese, and silver
may stain the teeth black.
 Mercury and lead dust can cause a blue-green stain.
 Copper and nickel : green–to–blue-green stain.
 chromic acid fumes :deep orange stain.
 Iodine solution :brown stain

 Extrinsic staining is markedly influenced by smoking
habits and age
 Males tend to have more staining than females.
 The effect of tea and coffee consumption was not
pronounced.
 No effect attributable to the use of a stannous fluoride
toothpaste was observed.
(An epidemiologic study of factors
affecting extrinsic staining of teeth in an English population: Leslie Ness,
Davidde L. Rosekrans John F. Welford; Community Dentistry and Oral
Epidemiology Volume 5 Issue 1, Pages 55 - 60)

 Intrinsic tooth stains :
 This is when the dentin darkens or gets a yellow color
from sources within the tooth. Internal stains are
situated within the structure of the tooth and usually
when the tooth is still developing.
 The cause of this type of staining is hypoplasia or
abnormal tooth growth. staining begins in childhood
and persists into adulthood.
 Internal staining can also develop after a tooth has
erupted.
Staining from dysplasia
(hereditary cause)
Staining from
hypoplasia

 Fluorosis - Chalky white spots or brown marks
are caused by excessive fluoride intake
[Even teeth whitening does not
actually remove the white spots but
lightens the background so they are less noticeable]
 Root canal treatment
After root canal treatment, a tooth
may start to darken,
especially if the pulp chamber
area is not thoroughly cleaned
from dead or infected pulp tissue
(formocresol, root canal sealers, ) Discolored tooth
(non vital)

 Decayed milk tooth may lead to infection in the vicinity of
the developing of permanent tooth.
 This infection will disrupt the formation of the enamel of
the permanent tooth, resulting in yellowish-brown patches.
 Disease. Several diseases that affect enamel and dentin.
(dentinogenesis impefecta, amelogenesis impefecta)
 Congenital erythropoietic porphyria causes porphyrin
(occur in nature, such as in green leaves and red blood cells)
to be deposited in teeth, causing a red-brown coloration.
Enamel hypoplasia caused by
rubella infection when the patient
was aged 4 months.

Amelogenesis imperfecta
(hypoplastic type 1 form)
Amelogenesis imperfecta
(hypomaturation type 2 form).

 Blue discoloration may occur with
alkaptonuria( genetic disorder of phenylalanine
and tyrosine metabolism.) and rarely with
Parkinson's disease.
 Erythroblastosis fetalis and biliary atresia
(Biliary atresia is a rare disease in neonate in
which the common bile duct between the liver and the small intestine is
blocked or absent.)
are diseases which may cause teeth to appear
green from the deposition of biliverdin
 Pink and red discolorations are also associated in
patients with leprosy

 In addition, treatments for certain conditions can
also affect tooth color. For example, head and
neck radiation and chemotherapy can cause teeth
discoloration.
 In addition, certain infections in pregnant
mothers can cause tooth discoloration in the
infant by affecting enamel development

Medications.
 The antibiotics tetracycline and doxycycline are known
to discolor teeth when given
to children whose teeth are
still developing
(before the age of 8).
 Antihistamines (like Benadryl), antipsychotic drugs,
and antihypertensive medications can also cause teeth
discoloration. (yellowish-brown discoloration)

CLASSIFICATION
The Nathoo classification system of extrinsic dental
stain describes 3 categories as follows:
 Nathoo type 1 (N1): N1-type colored material
(chromogen) binds to the tooth surface. The color
of the chromogen is similar to that of dental
stains caused by tea, coffee, wine, chromogenic
bacteria, and metals.

 Nathoo type 2 (N2): N2-type colored material
changes color after binding to the tooth. The
stains actually are N1-type food stains that
darken with time.
 Nathoo type 3 (N3): N3-type colorless material or
prechromogen binds to the tooth and undergoes a
chemical reaction to cause a stain. N3-type stains
are caused by carbohydrate-rich foods (e.g,
apples, potatoes), stannous fluoride, and
chlorhexidine.

TREATMENTS
 Using proper tooth brushing and flossing techniques,
scaling
 Avoidance of the foods and beverages that cause
stains like vinegars, soy sauces and strongly colored
fruit drinks
 Bondings
 Veneers
 Using over-the-counter whitening agents
 Swapping sweets with raw vegetables and fruits like
strawberries and lemons.
 Very hot and very cold food and drink will cause fine
cracking of the tooth enamel, which will allow
pigments to penetrate the tooth surface and cause
staining.

 Enamel microabrasion:
This technique involves the
rotary application of a mixture of weak
hydrochloric acid and silicon carbide particles in
a water-soluble paste.
The resultant surface is smooth
and has a glazed appearance. Enamel micro
abrasion is indicated for the removal of
superficial intrinsic tooth discoloration, including
that caused by fluorosis and decalcifications
secondary to orthodontic brackets or bands.

 Chewing gum doesn’t have much of a bleaching
agent, so whitening results are very minor.
However, activating the saliva may help some.
 Whitening toothpastes should only be used in
moderation due to the abrasives. Long use of those
abrasive materials will wear the tooth enamel.
 At-home tooth bleaching kits can provide results,
but they can be difficult to use and ingestion of the
bleach could upset people’s stomachs.
Over-the-Counter Tooth Whitening

PROFESSIONAL TEETH WHITENING
 The bleaching agents are much stronger in the
professional products which will lead to faster
and better results.
 They are safer to use because dentist will use the
proper methods to ensure you don't ingest the
bleach, unlike over-the-counter products.

DENTAL BONDING AND PORCELAIN
VENEERS
 If your staining is too severe, it is important to realize
that tooth bleaching might not give you the results
you desire.
 Dental bonding is a procedure in which resin adheres
to your teeth.
 This is extremely strong and durable and it is
indistinguishable from your natural tooth enamel.
 This resin is essentially replacing the enamel on your
tooth, which will hide stubborn stains.
 Tooth bonding is quick and can typically be completed
in one office visit.

 Porcelain veneers are another option to hide
stubborn stains.
 The veneers are very thin layers of porcelain that
are affixed to the tooth.
 Your natural tooth is carefully filed down in
order for the veneers to properly adhere to the
tooth.
 This option will take slightly longer and involve a
couple of trips to the office.

REFERENCES
 J. Mahmoodian, S. Hashemi; The Frequency of Different
Types of Primary Teeth Discoloration in Children: Journal
of Dentistry, Tehran University of Medical Sciences;
2004; Vol. 1, No. 2, 63.
 Benjamin Volovitz: Absence of Tooth Staining With
Doxycycline Treatment in Young Children : Clinical
Pediatrics, Vol. 46, No. 2, 121-126 (2007)

 Liang Hong, Steven M. Levy: Association of
amoxicillin use during early childhood with
developmental tooth enamel defects: Arch
Pediatric Adolescent Med. 2005;159:943-948
 David Whittaker: A review of tooth discoloration
and staining ; British Dental Journal 190:
305,2001.

 Ali Cemal Tinaz: staining potential of calcium
hydroxide and monochlorophenol followng
removal of AH26 root canal sealer: journal of
contemporary dental practice Vol. 3,no 8, march
2008.

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