Causes of Teeth Staining
There are many causes of tooth stain
Some factors such as dental plaque and calculus, foods and beverages, tobacco, chromogenic bacteria, metallic compounds, and topical medications may all cause staining.
Certain factors predispose children and adults to extrinsic stains, including enamel defects, salivary dysfunction, and poor oral hygiene (Hattab, 1999). 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.
Because saliva plays a major role in the physical removal of food debris and dental plaque from the outer and interproximal tooth surfaces, diminished salivary output contributes to extrinsic discoloration. Decreased output may be caused by local disease (eg, salivary obstructions and infections), systemic disease (eg, Sjögren syndrome), head and neck radiation therapy for cancer, chemotherapy, and multiple medications (eg, anticholinergics, antihypertensives, antipsychotics, antihistamines).
The most common cause of extrinsic stains is poor oral hygiene (Hattab, 1999). The inability to remove stain-producing materials and/or the use of dentifrices with inadequate cleaning and polishing actions may cause discolorations.
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 on the outer and inner surfaces of the teeth.
Tobacco stains from cigarettes, cigars, pipes, and chewing tobacco cause tenacious dark brown and black stains that cover the cervical one third to one half of the tooth (midway on the tooth toward the gums).
Pan (a combination of betel nut of the areca palm, betel leaf, and lime) is commonly chewed by more than 200 million persons in the western Pacific basin and South Asian region (Norton, 1998). It is used for its mild psychoactive and cholinergic effects, and it elicits a copious production of blood red saliva that results in a red-black stain on the teeth, gingiva, and oral mucosal surfaces.
Chromogenic bacteria cause stains, typically at the gingival margin of the tooth. The most common is a black stain caused by Actinomyces species. The 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 (Reid, 1977). Green stains are attributed to fluorescent bacteria and fungi such as Penicillium and Aspergillus species (Hattab, 1999). The organisms grow only in light and therefore cause staining on the upper front 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 are also implicated in dental discolorations because of the interaction of the metals with dental plaque to produce surface stains (Hattab, 1999). 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; and iodine solution, brown stain.
Topical medications cause staining. Chlorhexidine rinse (Peridex) causes brown staining after several weeks of use, particularly on acrylic and porcelain restorations. There are other antiseptics which cause staining to a lesser extent and the mechanism proposed could be applicable to staining found with polyvalent metals. The characteristic staining of the tongue and teeth noted by Flotra and co-workers in 1971 is not peculiar to chlorhexidine, it has been reported in other cationic antiseptics, the essential oil/phenolic mouthrinse 'Listerine' and following prolonged use of delmopinol mouthrinses. Cetylpyridinium chloride is an ingredient in several mouthwashes (eg, Cepacol, Scope) that can cause dental staining (Eriksen, 1979).
Staining of saliva-coated tooth and acrylic occurred only when the chlorhexidine treatment was followed by a dietary chromogen such as tea. This has to some extent been replicated in vivo, where reciprocal rinsing with chlorhexidine and iron sulphate produced no staining in volunteers who abstained from food and beverages. However, chlorhexidine or iron sulphate followed by tea rinse produced immediately the characteristic brown and black discoloration of the teeth and tongue reported for chlorhexidine and iron respectively. It is recommended that the patient should not eat or drink for thirty minutes after rinsing with any chlorhexidine, or fluoride containing mouthrinses.
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 (Hattab, 1999). Some systemic medications (eg, minocycline, doxycycline) can cause extrinsic staining. We will often see black staining on children’s teeth on chewable vitamins.
Extrinsic causes
- Brown stain
- Tobacco products
- Dental plaque
- Tea, coffee, wine, and other beverages
- Certain foods
- Metals
- Iodine
- Chlorhexidine rinse
- Cetylpyridinium chloride rinse
- Stannous fluoride
- Khat leaf
- Doxycycline
- Black stain
- Tobacco products
- Betel nut
- Dental plaque
- Chromogenic bacteria
- Tea, coffee, wine, and other beverages
- Certain foods
- Metals
- Green stain
- Chromogenic bacteria
- Tea
- Metals
- Orange stain
- Chromogenic bacteria
- Metals
- Doxycycline
In Review :
When patients exhibit staining on teeth oral hygiene habits should be reviewed. The patient may be further questioned as to the cause of the staining.
Dietary habits? Smoking, Coffee, teas, Colas, Wine.
Medications? Anticholinergics, antihypertensives, antipsychotics, antihistamines. Chemotherapy, Radiation therapy, Vitamins.
Mouth rinses? Chlorhexidine, fluoride containing rinses, Listerine, Scope.
Working environment? Dealing with metallic compounds, welders, painters.
In many cases, the staining may be decreased by avoiding the stain producing items and improved oral hygiene.
If you are having problems with excessive tooth staining, we can help. Give us a call at 404-255-6782
Cosmetic Dentist in Atlanta GA |