Tooth discoloration can be either extrinsic or intrinsic. Extrinsic discoloration is on the outer surface of teeth and caused by factors like tobacco, tea, and calculus. Intrinsic discoloration is below the tooth surface and caused by factors that affect tooth development like tetracycline use or systemic conditions like jaundice. Common causes of intrinsic discoloration include pulp necrosis, trauma, pulpal hemorrhage, calcific metamorphosis, and filling materials like silver amalgam that can stain teeth over time. Proper classification and identification of the cause is needed to effectively treat tooth discoloration.

1. Tooth discoloration
Dr Bindu kumari(BDS)

2. Tooth discoloration
Tooth discoloration (also
termed tooth staining) is
abnormal tooth color, hue or
translucency.
Classification
Tooth discoloration can be classified as
either extrinsic or intrinsic.

3. Extrinsic discoloration
 Found on outer surface of teeth.
 The stains deposited on the tooth
surface are a result of attractive
forces which are long range
interactions such as van der waals
and electrostatic forces and short
range interactions such as hydration
force, hydrophobic interaction, and
hydrogen bonds.

4.  Usually of local origin, such as
tobacco stains.
 Some discoloration , such as green
discoloration associated with the
Nasmyth’s membrane in children and
tea and tobacco stain can be removed
by oral prophylaxis.

5.  Other type of extrinsic discoloration,
such as silver nitrate stains, are
almost impossible to eliminate without
grinding because the stains penetrate
the surface of the crowns and difficult
to remove by chemical means alone.

6. Classification
Past classification-
1. Metallic stain
2. Non-metallic stain
Newer classification
1. N1 type or direct dental stain
2. N2 type or direct dental stain
3. N3 type or indirect dental stain

7. 1. N1 type- the colored material
(chromogen) bind to the tooth surface and
cause discoloration. The color of the
dental stain is same as the color of the
chromogen.
2. N2 type- the chromogen changes color
after binding to the tooth.
3. N3 type- colorless material or a
prechromogen binds to the tooth and
undergo chemical reaction to cause a
stain.

8.  Daily acquired stain
1. Dental plaque – yellowish discoloration
of teeth.
2. Calculus – the color of calculus varies,
and may be grey, yellow, brown or
black.
3. Cigarettes, pipes, cigars, chewing
tobacco, marijuana – brown to black
appearance.
4. Food and beverages – tea , coffee , red
wine, curry and colas , if taken in

11.  Tea , coffee stain

12.  Chemical
5. Metallic compounds – exposure to such
metallic compounds may be in form of
medication or other enviroment
exposure.
Example
 Iron (black stain)
 Iodine (black)
 Copper(green)
 Nickel (green)
 Cadmium (yellow-brown)

13. 6. Chlorhexidine stain – yellowish
brown to brownish in nature.

14. Intrinsic discoloration
 An intrinsic tooth stain is staining
below the surface of the tooth.
 It occurs when stain-causing particles
work through the exterior of the tooth
and accumulate within the tooth
enamel.
 Causes of intrinsic discoloration
generally fall into those that occur
during tooth development and those
acquired later in life.

15.  Intrinsic discoloration are due to the
presence of chromogenic material
within enamel or dentin, incorporated
either during odontogenesis or after
tooth eruption.
 Most common pre eruptive staining is
endemic flouosis caused by
excessive fluoride ingestion during
tooth development.

16. A. Genetic conditions
amelogenesis imperfecta- brown , black
dentinogenesis imperfecta- brown ,
blue
B. Systemic condition blue- green,
brown,
Jaundice purple-brown
Porphyria
C. Medication during tooth development
Tetracycline brown, gray,
black

21. D. Body by- product
Bilirubin blue-green, brown
Hemoglobin gray , black
E. Pulp changes
 Pulp canal obliteration yellow
 Pulp necrosis
With hemorrhage gray, black
Without hemorrhage yellow, gray-brown

24. Causes of tooth discoloration
 Decomposition of pulp tissue- most
common cause.
Intensity of discoloration is directly
related to the duration of time the pulp
has been necrotic.
 Trauma – traumatic injury of a tooth
may cause the blood vessel in the
pulp to rupture, with diffusion of blood
into the dentinal tubules.

25.  Pulpal hemorrhage during extirpation
– discoloration may occur if
hemorrhage is excessive during pulp
extirpation.
 Calcific metamorphosis - it is a
condition characterized by rapid
deposition of hard tissue within the
root canal.
Usually seen in the anterior teeth

26.  Traumatic injury transient
disruption of blood supply
cause destruction of odontoblast
replaced by cells of the
indifferenciated mesenchymal cell
lay down tertiary dentin tooth
become opaque due to loss of
translucency.

27.  Filling material –
Discoloration Depends on the kind of
filling used.
Silver amalgum– slate gray to dark
gray
Copper amalgum– bluish black to
black stain
Stain from amalgum are likely to occur
when the dentinal wall is thin.

28. Microleakage of old resin composite
restoration might cause dark
discoloration of the margins and may
stain the dentin overtime.
Metal post can be seen through the
translucent enamel or may release
metallic ions causing discoloration.
Fewer than 5% of treated pulpless teeth
become noticeably discolored because
of dehydration of tooth substance with
subsequent loss of translucency.

29.  Root canal medicaments–
certain medicaments cause
discoloration.
Some stain the tooth diretly
Other stain only on decomposing or
combining with other agents used in
endodontic treatment.
Example- essential oils from resinous
substance.

30.  Aging– during natural aging process,
the physiological deposition of
secondary dentin.
 Iatrogenic discoloration– caused by
certain dental material or inappropriate
operating techniques.