Tooth discolouration can be extrinsic or intrinsic. Extrinsic stains are superficial and occur after eruption from foods, drinks, smoking or poor oral hygiene. Intrinsic discolouration results from developmental defects or internal staining and causes include tetracyclines, fluorosis, trauma or systemic illnesses. Treatment depends on the specific cause but may include polishing to remove extrinsic stains or bleaching and veneers for intrinsic stains.

2. • Tooth discolouration may be extrinsic or intrinsic
in nature.
• Extrinsic stains are superficial & occur after tooth
eruption.
• Intrinsic discolouration may result from
developmental defect of enamel or internal staining of
the tooth.

3. Causes of tooth discolouration
Extrinsic staining Intrinsic discolouration
Green/orange stains Generalized intrinsic staining
of teeth
Black stains
Localized staining of one or
several teeth
Yellow stains
Chronological staining of
Brown stains dentition

4. Extrinsic Staining
Agents responsible are deposited in enamel
defects or become attached to the enamel without
bringing out a change in its surfaces.
Aetiological agents causing extrinsic stains are :
* Beverages / food
* Smoking
* Poor oral hygiene
* Drugs
- Iron Supplements
- Minocycline
- Chlorhexidine

5. 1. Green / orange stain
Poor oral hygiene
Chromogenic bacteria
Usually in cervical & gingival areas of tooth
More common in mouth – breathers & young persons
Occur more readily on the labial surface of the maxillary
anterior teeth

6. 2. Black stains
Tobacco Drugs
Iron supplements
Minocycline
chlohexidine

7. The stain may be seen as a line following the
gingival contour or it may be apparent in a
more generalized pattern on the clinical
crown.
If it collects in pitted areas, it is difficult to
remove.
Black staining by iron supplements is caused

8. 3. Yellow stains
 Caused by beverages /
foods
 Due to bile pigments
from
gingival crevicular
fluid (biliary
atresia & jaundice)

9. 4. Brown stains
Arrested caries
Chromogenic bacteria
Discolouration is due to sub-surface
decalcification
with intact surface which has undergone

10. Intrinsic discolouration
Factors causing these conditions
include blood-borne pigments, blood
decomposition within the pulp, and
drugs used in procedures such as root
canal therapy.

11. a. Generalized intrinsic staining of teeth:
i. Yellow brown to dark yellow
 Due to Amelogenesis Imperfecta
 Both dentitions affected
 The term A.I. is applied to inherited defects of the
enamel of both primary and permanent teeth

12. Amelogenesis Imperfecta
Hypoplastic A.I.
Types Hypomineralized A.I.
Hypocalcified A.I.
 Enamel may be rough, smooth or
randomly pitted
 Enamel is thin & yellow to brown
in colour

13. • Blue brown (Opalescent)
Dentinogenesis Imperfecta
 All teeth are uniformly
affected
 Often associated with
osteogenesis imperfecta

14. Dentinogenesis Imperfecta
 D.I. is an inherited disorder of dentin
 Dental manifestations are –
* Amber, bluish-brown discolouration or
opalescence
* Pulpal obliteration
* Relatively bulbous crowns
* Short, narrow roots

15. iii. Reddish brown
Congenital erythropoietin porphyria
 The porphyrias are inherited & acquired disorders in which the
activities of the enzymes of the haeme biosynthetic pathway are
partially or almost completely deficient
 Discolouration is due to deposition
of porphyrin in developing structures
 All teeth are affected

16. iv. White
Fluorosis / non-fluorotic
 The mildest form of fluorosis is manifest
as hypomineralization of the enamel,
leading to opacities.
 Opacities range from tiny white flecks to
confluent opacities throughout the
enamel, making the crown totally lacking
in translucency
 Usually only permanent dentition is
affected

17. v. Green - blue
Hyperbilirunaemia
Seen in children with end stage liver
disease and premature infants
Common disorders that cause this
intrinsic staining are erythroblastosis
fetalis and biliary atresia

18. Erythroblastosis Fetalis
Leads to Rh-incompatibility
Causes anaemia & Jaundice due to red cell destruction
Which in turn leads to Hyperbilirunaemia
Persistent Jaundice during the neonatal period,
also can cause such discolouration

19. b. Localized staining of one or several teeth
i) Pink
Internal resorption
Seen before exfoliation of
primary tooth after trauma
(Pink tooth of mummery)
Pink colour is seen when
vascular resorptive process
approaches the surface i.e.
the coronal pulp

20. ii) Grey – black
Amalgam staining
 Leakage of old amalgam restoration
causing discolouration around the
restoration
 Mostly occurs in younger patients who have open dentinal
tubules
 Large class II proximal restorations of posterior teeth & deep
lingual metallic restorations on anterior incisors significantly
stain underlying dentin & produce greyish discolouration

21. iii) Yellow brown / White
Developmental defects
Subsurface decalcification Turner's hypoplasia
in permanent teeth after
Enamel defects seen in permanent
trauma or infection
teeth are caused by periapical
inflammatory disease of the
overlying deciduous tooth. The
altered tooth is called Turner's
tooth .

22. iv. Greyish brown
Non-vitality
 Usually after trauma
 This discolouration is due to severe pulpal damage i.e.
pulpal degeneration followed by necrosis (pulpal
obliteration calcific metamorphosis)

23. c. Chronological staining of dentition
i) TETRACYCLINES
Yellow Yellow to Orange to Grey to
bright yellow Grey brown blue brown
Tetracycline Oxytetracycline Chlortetracycline Dimethyl chlortetra
hydrochloride cycline
unoxidized fluorophore seen erupted teeth, oxidized
in newly erupted teeth fluorophore odour also depends on
the type of tetracycline

24.  Discolouration is noticed in children who have
received
tetracycline therapy during the period of
calcification of primary or permanent teeth.
 Tetracyclines chelate calcium salts & so, are
incorporated into bones & teeth during calcification.
 Tetracyclines administered during pregnancy can
be transferred through the placenta, & cause
discolouration.

25. ii) SYSTEMIC ILLNESS
Yellow / brown
Vitamin D deficiency
Developmental defects of
enamel affecting all teeth
forming during illness
Severe measles

26. TREATMENT
• Extrinsic stains :
* Can be removed from the surface of
the teeth by polishing with a
rubber cup & an abrasive material
( flour pumice )
* Improving the oral hygiene will
minimize the recurrence of the
stains

27. b) Intrinsic stains:
* Vital bleaching & laboratory laminate veneers must be
considered state-of-the-art treatment for aesthetic dentistry
* Bleaching & enamel microabrasion may be used in
combination for certain types of discolouration
* Direct resin veneers or laboratory laminate veneers are often
the treatment of choice, especially in young patients, when
bleaching fails to improve aesthetics

28. References:
1. Welbury RR. Paediatric dentistry 2 edn , Oxford university Press, 2001: 204- 5
2. McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent
8th edn, Mosby, 2004 :133-5, 447-8
3. Neville BW, Damm DD, Allen CM, Buoquot JE. Oral and maxillofacial
pathology, 2nd edn Saunders, 2005: 53-4, 59-66
4. Cameron AC, Widmer RP. Handbook of pediatric dentistry 2nd edn, Mosby,
2003: 209-12