Tooth discoloration is abnormal tooth color, hue or translucency. External discoloration is accumulation of stains on the tooth surface. Internal discoloration is due to absorption of pigment particles into tooth structure.

1. TEETH DISCOLOURATIONS AND
STAINS.
BDS III.

2. • Tooth discolouration is any change in the hue,
colour or translucency of a tooth from the normal
white/ yellowish-white colour, due to a number
of causes.
• A tooth stain is any pigment deposited on the
tooth surface.
classification

3. Intrinsic tooth discolourations

4. Pre-eruptive•
a) Disturbance in tooth germ formation.
• It can affect a single tooth or multiple teeth e.g Localized stain seen in
Turner’s teeth due to trauma during development. Generalized disturbance
is seen in infections like CMV, measles, Varicella zoster, streptococcal
infection. Nutrition deficiency of vitamins C and D, calcium and phosphates
lead to enamel hypoplasia. Colour changes between white to brown
a) Genetic disorders
Amelogenesis imperfecta
A group of conditions caused by defects in the genes encoding enamel
matrix proteins.
Type 1 AI (Hypoplastic): Here there is defective enamel matrix deposition with
normal mineralization. The enamel is rough, pitted, and thin revealing the
yellow color of dentine beneath. It has propensity for extrinsic staining.

5. Cont…
 Type 2 AI (Hypocalcification): In this type there is normal matrix
deposition but defective mineralization. The enamel is yellow,
orange, soft, and lost soon after eruption. It often develops dark
stains and is at higher risk of developing dental caries.
 Type 3 AI (Hypomaturation): The enamel crystallites remain immature in
this type. The enamel is soft, mottled opaque white, yellow, or brown
discoloration.

6. Dentinogenesis imperfecta
is a genetic disorder of tooth development. This condition is a type of
dentin dysplasia that causes teeth to be discolored (most often a blue-
gray or yellow-brown color) and translucent giving teeth an opalescent
sheen.
DI type I (associated with osteogenesis imperfecta, a mixed connective tissue
disorder of type I collagen)
In DI type II teeth are bluish or brownish in colour. The pulp chambers often
become obliterated and dentine undergoes rapid wear once enamel has
chipped away. Once dentine is exposed teeth show brown dicolouration
DI type III (brandy wine isolate hereditary opalescent dentine). Teeth may be
outwardly similar to both types I and II.

7. Metabolic disorders
i. Congenital erythropoeitic porphyria
Is a rare, recessive autosomal metabolic disorder in which there is a defective
porphyrin metabolism leading to their accumulation in the bone marrow,
urine, and teeth. Porphyrins have a high affinity for CaPO4 .
ii. Alkaptonuria. Defective metabolism of tyrosine and phenylalanine and this
affects the primary dentition causing a brown discoloration.
iii.Congenital hyperbilirubinemia (neonatal jaundice). It causes a yellow green
discolouration

8. Medication
• i. Tetracycline. Chelates calcium ions on the surface of
hydroxyl apatite crystals forming a stable orthophosphate
complex. Teeth appear yellow brown
• ii. minocycline. Cause grey-green staining
• iii.Ciprofloxacin. Causes a green discolouration.

9. Dental fluorosisis an extremely common disorder, characterized
by hypomineralization of tooth enamel caused by
ingestion of excessive fluoride during enamel formation
Mild fluorosis appears as faint white lines or streaks on
enamel.
Moderate fluorosis shows prominent opaque areas known as
enamel mottling
Severe fluorosis shows extensive mottling that easily chips
and stains and leads to pitting and dark brown/black
appearance
A daily fluoride intake of more than 0.05 -0.07mg fluoride per
kg daily is thought to cause fluorosis.

10. Post-eruptive
• Dental conditions
Initial lesion appears opaque. Hard arrested carious lesion
is black due to staining by exogenous sources. Abrasion,
attrition, and erosion cause enamel thinning
• Dental material
Eugenol, phenolic acid and poly antibiotic base materials
used in endodontic therapy contain pigments.
Amalgam appears as a bluish tinge around the restoration
due to the penetration of tin in dentinal tubules
Lederman that contains dimethyl chlorotetracycline and
is used with in the teeth for endodontic therapy has also
reportedly caused dark-grey-brown discolouration

11. CONT…
• Pulpal hemorrhagic products: Severe trauma of teeth causes black
intrinsic staining of teeth due to hemolysis of red blood cells releasing
haem that combines with putrefying pulpal tissue forming a black product,
iron sulphide.
• Root resorption: It is often clinically asymptomatic however the initial
presenting feature occasionally is a pink appearance at the amelo-dentinal
junction. Resorption always begins at the root surface either Pulpal
(internal) or periodontal (external) aspect.
• Ageing: The natural laying down of secondary dentine affects light-
transmitting properties of teeth resulting in teeth darkening with age.
• Dental caries: Incipient caries cause white spot of discoloration of teeth
due to demineralization. Extensive caries that involve the destruction of
both the enamel and dentin produce a color that ranges from light brown,
to dark brown, or almost black.

13. EXTRINSIC DISCOLOURATIONS.
• Are located on the outer surface of the teeth
or restorations.
• Quite common.It can be due to;
• Poor oral hygiene: This results in stain by
chromogenic bacteria giving green an orange
stains to the teeth.
• •Drugs such as iron supplements and
minocycline which results in black stains.

14. Extrinsic tooth discolouration
• It is divided into two categories, those
compounds which are incorporated into the
pellicle and those which lead to staining caused by
chemical interaction at the tooth surface
Predisposing factors
These include: Enamel defects, salivary dysfunction
e.g. in (sjögren syndrome, cancer therapy, anti
cholinergics), poor oral hygiene, microscopic pits
and fissures.

15. .
.

16. Cont…
Extrinsic tooth discolouration has usually been classified
according to its origin whether metallic or non-metallic.
Non-metallic stains. Are adsorbed onto tooth surface
deposits such as plaque or the acquired pellicle
Metallic extrinsic staining may be associated with
occupational exposure to metallic salts and to a number
of medicines containing metal salts e.g. staining of black
in people using iron supplements and iron foundry
workers. Copper causes a green stain in mouth rinses
containing copper II salt ions. Silver nitrate salt used in
dentistry causes a grey colour.

18. dental plaque and calculi
• Plaque is a sticky, colorless film of bacteria
that constantly forms on our teeth and along
the gum line. Calculi is calcified plaque

19. Beverages and food such as kola nuts, coffee, berries etc.
• •Prolong use of chlorhexidine(anti-septic in mouth wash.)
results in brown or black stains of the tooth.
• Poor oral hygiene: stains usually follow the gingival
contour at cervical third of the tooth.
 Aging changes. In older patients stains on the surfaces of
the teeth are most likely to be brown, black or gray and
occur on areas adjacent to the gingival tissue due to
recession. As enamel ages, it loses its initial surface
texture this causes a reduction in light refraction and
reflection and results in light penetrating deeper into the
tooth. This leads to less lustrous and shade differences
becoming more obvious leading to appearance of a darker
tooth.
 Tobacco stains due to smoking.
 Some restorations or fillings.

20. Mechanism of chlorohexidine staining
i) Non-enzymatic browning reactions. Berk suggested that
the protein and carbohydrates in the acquired pellicle
undergo a series of condensation and polymerization
reactions leading to discolouration of the pellicle.
Chlorohexidine may accelerate formation of the pellicle.
ii) Formation of pigmented sulphides of iron and tin.
Chlorohexidine denatures the pellicle to expose Sulphur
radicals.
iii)Precipitation of dietary chromogens by chlorohexidine
• Most evidence indicates that the likely cause of staining is
the precipitation of anionic dietary chromogens onto
adsorbed cations in antiseptics or polyvalent metal ions.

23. STAINS.
• Pigmented deposit on teeth. There are many types of stains;
• Brown stain
• Green stains
• Black stains
• Orange stain
• Metallic stain
• Tobacco stain
• The acquired or developmental coating become
pigmented by:
(i) Chromogenic bacteria[ gram negative bacteria that
produce carbepenemase]
(ii) Foods
(iii) chemicals

24. Brown stain:
• This is a thin, translucent free pigment pellicle.
Colour due to chromogenic bacteria.
• The color is also seen in arrested caries.
• Causes: - insufficient brushing
• inadequate cleaning action of dentifrice
Site:
i. Buccal surface of maxillary molars
ii. Lingual surface of mandibular incisors

26. MANAGEMENT OF TOOTH
DISCOLOURATIONS.
• EXTRINSIC DISCOLOURATIONS..
Patient with poor oral hygiene will need to be taught
good tooth brushing techniques.
Few simple lifestyle changes e.g. stop smoking, reduce
coffee intake.
For fruit stains, brush teeth immediately after eating.
Some fruits e.g. pears, carrots, stimulate saliva
production which washes away food debris.
Getting your teeth cleaned by a oral hygienist every 6
months.
Use of abrasives and chemicals like hydrogen peroxide.
Use of dentifrices.
Flossing .

27. • Enamel microabrasion. It involves the rotary application of a likely to respond to
bleaching that those stained dark gray. mixture of weak hydrochloric acid and silicon
carbide particles in a water soluble paste.
• Bleaching (tooth whitening). Bleaching is not indicated for treatment of
discolouration of primary teeth.
• Vital bleaching. Is indicated primarily for patients with generalized yellow, orange
or light brown extrinsic discolourations. Bleaching agents used are; carbamide and
hydrogen peroxide.
• Non-vital bleaching. Is indicated for treatment of teeth with discolouration
secondly to pulpal degeneration. It involves placing a mixture of 30% hydrogen
peroxide and sodium Perborate into the pulp chamber for as long as one week.
• Carbamide peroxide is a tooth whitener found in toothpastes and dental strips
(breaks down to hydrogen peroxide and urea).
• Hydrogen peroxide degrades into free radicals that break double bonds in the
stain there by lightening and removing the color from the stained material. Non
vital teeth can be bleached from the internal aspect, but bleaching of vital teeth
surface has variable results that may be difficult to predict in that teeth with light
yellow and or brown stains are more

28. NEW MODALITIES.
• Novamin
• releases calcium and phosphate for
remineralisation
- bioavailable
- can be contained in Ml paste (GC America),
G.I cements

29. INTRISINIC DISCOLOURATION.
• Cant be treated mechanically only chemically
• Treated with carbamide peroxide (which breaks
down to hydrogen peroxide and urea).
• Hydrogen peroxide degrades into free radicals
that break double bonds in the stain thereby
lightening and removing the colour from the
stained material.
• Incase of non vital teeth, discoloration can be
removed by bleaching from the internal aspect of
the crown of the tooth.

30. TOOTH WHITENERS.
• These can be found in some tooth pastes and
dental strips.
• They can be acquired in shops( Home
whitening kit contains carbamide peroxide, a
bleach that can remove both deep and surface
stains. )or dispensed by the dentist.

32. • Tetracycline stains do not respond well to
bleaching as the stain is intrinsic therefore…
• Tetracycline staining can be treated by cosmetic
dentists that use porcelain veneers to mask the
discoloration of the tooth. Complications of a
gray appearing tooth can occur if the dentist
uses ordinary materials because these will still
allow the deep stains to come through
therefore, a cosmetically experienced dentist
should handle these cases.

33. BLEACHING.
Prognosis for bleaching root canal filled teeth is
much better than for vital teeth because of better
access to the stained area
• Bleaching vital teeth is a safe process but the
results are variable and hard to predict
• Teeth with light yellow and or brown stains are
more likely to respond to bleaching than those
stained dark gray
• Success will vary depending on the etiology of the
discoloration and the individual.
• It changes the inherent natural color of tooth