Tooth Discoloration

Teeth made of many colours, with natural gradation from the darker cervical to the lighter incisal third
Variation affected by thickness of enamel and dentine, and reflectance of different colours
Blue, green and pink tints in enamel, yellow through to brown shades of dentine beneath
Canine teeth darker than lateral incisors
Teeth become darker with age (secondary/tertiary dentine, tooth wear/dentine exposure)

Stains (chromogens) that lies on/attach to the tooth surface or in the acquired pellicle, or
The incorporation of extrinsic stain within the tooth substance following dental development. It occurs in enamel defects and in the porous surface of exposed dentine (‘stain internalisation’).
Extrinsic Discoloration – E.g.
- Plaque, chromogenenic bacteria
- Mouthwashes (chlorhexidine)
- Smoking / chewing tobacco
- Beverages (tea, coffee, red wine, cola)
- Foods (curry, cooking oils and fried foods, foods with colorings, berries, beetroot)
- Antibiotics (erythromycin, amoxicillin-clavulanic acid)
- Iron supplements

Intrinsic Discoloration occurs following a change to the structural composition or thickness of the dental hard tissues.
Pre-eruptive:
Disease:
- Haematological diseases
- Liver diseases
- Diseases of enamel and dentine (e.g. Amelogenesis/ Dentinogenesis imperfecta)
Medication:
- Tetracycline, other antibiotic s
Fluorosis stains (excess F)
Enamel hypoplasia (trauma or infection)
Post-eruptive:
Trauma (e.g. pulpal haemorrhagic products)
Primary and secondary caries
Tooth wear
Dental restorative materials
Ageing
Chemicals
Antibiotics
Minocycline (used to treat acne)

Types of Discoloration	Colour Produced
Extrinsic (Direct stains) Tea, coffee and other foods Cigarettes/cigars Plaque/poor oral hygiene	Brown to black Yellow/brown to black Yellow/brown
Extrinsic (Indirect stains) Polyvalent metal salts and cationic antiseptics e.g. Chlorhexidine	Black and brown
Intrinsic (Metabolic causes) e.g. Congenital erythropoietic porphyria (Inherited causes) e.g. Amelogenesis Imperfecta e.g. Dentinogenesis Imperfecta (Iatrogenic causes) Tetracycline Minocycline Fluorosis (Traumatic causes) Enamel hypoplasia Pulpal haemorrhage products Root resorption (Ageing causes)	Purple/brown Brown or black Blue-brown (opalescent) Banding appearance: classically yellow, brown, blue, black or grey Grey White, yellow, grey or black Brown Grey black Pink spot Yellow
Internalized Caries Restorations	Orange to brown Brown, grey, black

Treatment option	Indications	Advantages	Disadvantages
No treatment	Patient with poor oral hygiene/ caries/ PA pathology, large ant restorations/crowns	Non invasive, no cost	Will not address patients aesthetic concerns
Removal of surface stain-Scale and polish-Microabrasion	-Extrinsic staining-Fluorosis, white spot demineralisation, enamel hypoplasia	Non/minimally invasive	May not improve aesthetics significantly, may require further RxMicroabrasion- soft tissue irritation/ excessive tooth prep (technique sensitive)
Bleaching-Home bleaching, Walking bleach	-See later slides	Non/minimally invasive	Cost, limitation on shade improvement (a few shade lighter only), may fail/ need repeating, compliance (home bleaching)
Restorative treatment-Veneers, crowns	Severely discoloured teeth, e.g. tetracycline staining (may bleach 1st)Unaesthetic tooth morphology (e.g. AI/DI)Heavily restored teeth	May achieve a more aesthetic result	Destructive, irreversible (tooth tissue removal), changes natural shape of teeth, cost, maintenance, oral hygiene compliance (interdental cleaning)