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Section Questions and Answers

Staining of Teeth

  1. What are extrinsic stains?
  2. Can poor oral hygiene result in teeth being stained?
  3. Can teeth be stained by food and drink?
  4. Can medication stain the tooth surface?
  5. How can these surface stains be prevented?
  6. What is meant by intrinsic staining?
  7. What causes internal staining of developing teeth?
  8. Can internal stains develop in teeth that have already erupted?
  9. How can staining be removed from the enamel of permanent teeth?
  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 external stains that build up on the outer surface of a tooth.
  • They are not part of the structure of the tooth.

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2. Can poor oral hygiene result in teeth being stained?

  • It can. Teeth that are not brushed properly and regularly can turn a yellow/greenish colour, particularly around the gums.
    • It is essential that the brushing of children's teeth should be well supervised until they have sufficient skill and self-discipline to do it for themselves.
    • Teeth should be brushed twice a day, and flossed once a day.
    • Brushing should be after breakfast and before bedtime.
    • Regular cleaning by the dentist is part of an ongoing programme of good oral hygiene.
    • It is very important not to neglect the care of baby teeth, which also require regular brushing.

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Yellow staining
Poor oral hygeine

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3. Can teeth be stained by food and drink?

  • Beverages such as tea, coffee or fruit juices leave stains that are not easy to remove by brushing.
    Highly coloured sweets can also cause staining of children's teeth.
    The build up of stains caused by food and drink takes place slowly.

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4. Can medication stain the tooth surface?

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

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5. How can these surface stains be prevented?

  • Professional cleaning and good home care will keep teeth free of stains.
    • Your child's teeth should be brushed twice a day to prevent and remove stains on teeth.
    • Permanent teeth should be cleaned by the dentist twice a year, as professional dental cleaning is the most effective way of removing the staining.

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6. What is meant by "intrinsic" staining?

  • 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.
    • This staining begins in childhood and persists into adulthood.
    • Internal staining can also develop after a tooth has erupted.

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Staining from
hypoplasia
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Staining from
hypoplasia

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Staining from dysplasia
(hereditary cause)

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7. What causes internal staining of developing teeth?

  • There are numerous causes of internal staining
    • Abnormal tooth development can cause staining. This abnormality may be caused by congenital or hereditary factors.
    • Childhood illnesses during tooth formation can cause mottled stains.
    • An excess of fluoride while teeth are forming can cause fluorosis, which is a whitish-brown mottling of the teeth.
    • Fluorosis occurs mainly in areas where the fluoride content of the drinking water is very high.
    • Fluoride is very important for the prevention of tooth decay, and is safe to use in toothpastes and mouthwashes.
    • Injury or infection of a baby tooth may lead to discolouration of the permanent tooth that replaces it.
    • Always remember that the health of baby teeth influences the health and appearance of the permanent teeth that replace them.
    • Tetracycline medication can cause creamy brown staining.

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Tetracycline
staining
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White spot
staining
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Fluorosis
Staining

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

  • Injury to a tooth can cause the nerves and blood vessels to die. This will blacken the tooth from within. The discolouration is caused by the breakdown of the dead blood cells in the pulp of the tooth.
  • The treatment to remove dead nerves and blood vessels in permanent teeth can be followed by the gradual darkening of the tooth from within.

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Discoloured tooth
(non vital)

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9. How can staining be removed from the enamel of permanent teeth?

  • Staining of the enamel can be removed by bleaching or whitening.
    Stains in the enamel layer can also be removed by a micro-abrasion treatment.
    • The micro-abrasion technique polishes away stains by using a mixture of hydrochloric acid and pumice.
    • 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 outer enamel.

See Whitening

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

  • Stains within a permanent tooth, such as those caused by dead nerves and blood vessels, can be removed by bleaching.
    • The tooth is opened, bleach is placed into the cavity, and the tooth colour is lightened.
    • This treatment is unlikely to be used for baby teeth.

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

  • Stains can usually be lightened, but the tooth may still look different from the surrounding front teeth. Other solutions can then be found.
    • A veneer made of porcelain or of a composite material can be made to cover the front of the affected tooth.
    • This can be made to match the colour of the surrounding teeth. A temporary, plastic veneer would first be made for a child's permanent tooth.
    • This will be replaced by a more permanent porcelain veneer at an older age. Your dentist is unlikely to suggest a veneer for a baby tooth.
  • In older children a plastic replacement crown may be made to replace the entire outer covering of a permanent tooth.
    • This will be replaced with a porcelain crown a few years later.
    • Crowns are made to match the colour, size and shape of the surrounding teeth.

Click to enlarge
Tetracycline staining
Click to enlarge
Upper teeth with
plastic veneers

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