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Section Questions and Answers

Staining of Teeth

  1. What are "extrinsic" stains?
  2. Can poor oral hygiene cause stains on teeth?
  3. Can teeth be stained by food and drink?
  4. Why does smoking leave stains on teeth?
  5. Can medications stain the tooth surface?
  6. How can stains be removed by dental cleaning, whitening and micro-abrasion?
  7. What is "intrinsic" staining of teeth?
  8. What causes internal staining of developing teeth?
  9. Can internal stains develop in teeth that have already erupted?
  10. Can deeper stains in a tooth also be removed?
  11. What can be done if stain removal is not successful?

 
1. What are "extrinsic" stains?

  • These are stains that develop on the outer surface of a tooth.
    They are not part of the structure of the tooth.

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Extrinsic staining

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2. Can poor oral hygiene cause stains on teeth?

  • It can. Teeth that are not brushed properly and regularly can turn a greenish-yellow colour, particularly near the gum line.

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Poor oral hygiene

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3. Can teeth be stained by food and drink?

  • Beverages such as tea, coffee or fruit juices can leave stains, which are not easy to remove by brushing.
    These stains develop slowly and become more visible as we grow older.

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Staining with ageing

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4. Why does smoking leave stains on the teeth?

  • The nicotine in tobacco is the cause of brown staining that is a familiar sight on the teeth of smokers.
    • The nicotine is difficult to remove by brushing alone.
    • It penetrates into the grooves and pits of teeth, and sticks onto all the tooth surfaces.

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Nicotine staining

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5. Can medications stain the tooth surface?

  • Some medications do stain teeth:
    • Iron supplements can stain the teeth black.
    • Chlorohexidine, sometimes found in mouthwashes, can cause brown or black stains on the teeth.

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6. How can stains be removed by dental cleaning, whitening and micro-abrasion?

  • Professional dental cleaning
    • This is a most effective way of removing the stains.
    • It will prevent the staining from becoming permanently established on your teeth.
    • Have your teeth scaled and cleaned by your dentist twice a year.
  • Tooth whitening
    • Stains in the enamel can be removed by a bleaching or whitening treatment.
    • Whitening techniques are able to lighten the colour of teeth.
    • Your dentist can provide a tooth whitening treatment that is very successful.
    • Off-the-shelf whitening packs are available and can be effective.
    • They do, however, need some "do-it-yourself" skills.

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Before
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After whitening
  • Micro-abrasion
    • Stains in the enamel layer can also be polished away with a mixture of hydrochloric acid and pumice.
    • This is called the "Micro-abrasion Technique".
    • It is used to remove surface marking caused by infection or injury, and other staining of unknown origin.
    • The micro-abrasion removes a very thin layer of the enamel.
  • Whitening toothpastes
    • Toothpastes with whitening properties are available, and can be used to reduce the staining.
    • It is a gradual and long term measure.
    • Brushing twice a day with a whitening toothpaste can lighten the colour and prevent stains from forming on teeth.

See Whitening and Innovations in Dentistry

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7. What is "intrinsic" staining of teeth?

  • This is internal staining of the tooth, from sources within the tooth.
    • Internal stains are situated within the structure of the tooth, and usually form while the tooth is still developing.
    • The cause of this type of staining is hypoplasia or abnormal tooth growth.
    • Internal staining can also develop after a tooth has erupted.

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Staining from hypoplasia

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8. What causes internal staining of developing teeth?

  • Internal staining can be caused by the following:
    • Abnormal tooth development can cause staining.
    • Childhood illnesses during tooth formation can cause mottled stains.
    • An excess of fluoride while teeth are developing can cause fluorosis, seen as a whitish-brown mottling of the tooth.
    • Injury or infection of a baby tooth may lead to discolouration of the permanent tooth that replaces it.
    • Tetracycline medication can cause creamy brown staining.

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Tetracycline staining
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Fluorosis
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Staining from abnormal
tooth development

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9. Can internal stains develop in teeth that have already erupted?

  • Injury to a tooth can cause the nerve and blood vessels to die.
    • This will darken the tooth from within.
    • The discoloration is caused by the breakdown of blood cells in the pulp of the tooth.
    • A root canal treatment has to be done to remove the dead pulp.
      The tooth can gradually darken from within, after such a treatment.
  • Teeth normally darken with age. They change from white to a dull creamy/yellow shade. This can be remedied with a whitening treatment.

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Internal staining after
root canal treatment

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10. Can deeper stains in a tooth also be removed?

  • Stains within the tooth, such as those caused by a dead nerve and blood vessels can be removed by bleaching.
    • The tooth is opened and bleach is placed into the cavity to lighten the colour.
    • This method of tooth whitening can be moderately successful if it applied at the first sign of tooth darkening.

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11. What can be done if stain removal is not successful?

  • Porcelain veneers and replacement crowns are the remedies:
    • Veneers and replacement crowns can be used to correct staining.
    • Porcelain veneers are able to replace the thin enamel layer of the tooth, and are very successful in improving the appearance of teeth.
    • A replacement crown can be made to replace the entire outer layer of the affected tooth.
    • This is a successful remedy for staining, but is only resorted to if the teeth are not suitable for veneers to be fitted.

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Veneers on upper teeth

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Lower teeth staining
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After crowns

See Replacement Crowns and Veneers

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