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Classification of tooth staining

Asma Tabassum*
Banasthali Vidyapith, India

Accepted on January 29th, 2021

Tooth Staining can be classified on several 3. Decreased saliva can also be the cause of
bases i.e. on the basis of location, aetiology, extrinsic discoloration as saliva helps in
number of teeth involved, etc. removal of food debris and dental plaque
from outer and interproximal tooth surfaces.
Classification based on location of
discoloration (most recent classification): Other factors include
1. Extrinsic stains. 1. Ageing changes of tooth
2. Intrinsic stains. 2. Poor oral hygiene
3. Internalised stains. 3. Gingival bleeding
4. Plaque and calculus accumulation: It can
The most common classification based on
cause brown and black stains.
the location of discoloration was given by Dayan
5. Food and beverages: Tannins can be
et al 1983, Hayes et al 1989, according to them
deposited from the tea, coffee and other
they classified tooth staining into two: beverage products which may finally lead to
1. Extrinsic stains. the brown coloured stains, foods rich in
2. Intrinsic stains. polyphones can also be the cause of tooth
discoloration.
Extrinsic stains 6. Tobacco: Chewing tobacco, taking cigars,
cigarette, pipes can cause dark brown and
1. This kind of stains is found located at the black stains that cover the cervical about one
outer surfaces of the teeth. third to half of the tooth. Pan chewing can
2. Discoloration includes brown, black, grey, lead to red-black coloured stains, gingiva and
green, orange and yellow. oral mucosal surfaces.
3. Extrinsic discoloration can be removed by 7. Chromogenic bacteria: Chromogenic bacteria
scratch test. create the gingival margin of the tooth. The
4. This kind of stains are very common and are colour which appears is mainly black caused
caused by topical or extrinsic agents may be by Actinomyces species. Green stains occur
a result of various causes: due to the presence of fluorescent bacteria
 Predisposing factors. and fungi such as Penicillium and
 Other factors. Aspergillum species. Orange stains arise due
to the presence of chromogenic bacteria such
Pre-disposing factors as Flavobacterium lutescens. Orange stains
1. There are certain factors which predispose are less common in comparison to green and
children and adults to extrinsic stains, include brown stains.
enamel defects, salivary dysfunction, and 8. Mouth washes and rinses such as
poor oral hygiene. chlorhexidine
2. Small and microscopic pits and defects in the 9. Metallic compounds: metals may also impart
outer layer of the enamel can accumulate discolouration due to their interaction with
stain producing substances (food and dental plaque and finally producing surface
beverages) and other topical agents. stains. Industrial exposure to Fe, Mn, and Ag

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 may stain the teeth in black colour while Hg 2. Amelogenesis imperfecta affects both
and Pb dust can impart blue-green stain. primary and secondary dentitions
10. Topical medications: chlorhexidine rinse 3. Dental dysplasia occurs in two types; teeth
create brown staining particularly on acrylic with type 2 dental dysplasia have amber, blue
and porcelain restorations oral solutions or brown translucence.
containing iron can cause black stains, 4. Other dental diseases may be as
potassium permanganate mouth wash can Erithropoietic porphyria and epidermolysis
create violet-black stains, silver nitrate can bullosa.
cause black stain and stannous fluoride can
create brown stain. Some medications which Medications
include minocycline, doxycycline can also
1. Tetracycline diffuses through dentin to
cause extrinsic staining.
enamel interface, chelating Calcium ions and
Extrinsic factors Characteristics incorporating into hydroxyapatite as a stable
Chromogenic bacteria Green, black ,brown and orthophosphate complex. The incorporated
orange amount can be determined by distribution of
Tobacco Black, brown discoloration. The affected teeth first have
Amalgam Black, grey bright yellow band like appearance which
Medicaments Silver nitrate: grey black fluoresces in presence of U.V light and when
Stannous fluoride: black exposed to sunlight the colour of teeth colour
brown changes to grey.
Chlorhexidine: black 2. Minocycline (prescribed for long term acne
brown
therapy in adults) a derivative of tetracycline
Foods and beverages Colour of food items
can create green-grey or blue-grey staining to
Iron Black cervical
discoloration teeth. This medication has now been
replaced.
Intrinsic stains 3. Doxycycline causes extrinsic staining in
those having poor oral hygiene. It causes
1. This type of stain is found in internal surfaces staining by binding glycoproteins in dental
of teeth, and can be defined as discoloration pellicle.
which is incorporated into the structure of 4. Due to the excess intake of fluoride content
either enamel or dentine which cannot be during the early maturation of enamel
removed by prophylaxis, toothpaste or formation, enamel discoloration may result
pumice. from subsurface hypo-mineralization causing
2. Discoloration may be brown, black, green, dental fluorosis.
grey, orange, and yellow. Intrinsic
discoloration cannot be removed by scratch High fevers associated with early childhood
test. Also they may be red or pink. illness, and other types of trauma
3. Intrinsic stains are caused by deeper internal
stains or enamel defects. Staining may be 1. Trauma to un-erupted teeth can disturb
located in enamel or in dentin. Stain enamel formation and may result in enamel
distribution varies from localized (i.e. 1 or 2 hypoplasia.
teeth) to a regional or generalized 2. Trauma that occurs to erupted teeth may also
involvement of primary or secondary teeth. cause discoloration this type of discoloration
4. This type of stains is caused due to: occurs in teeth having fully formed roots and
have sustained irreversible pulpal injury
Hereditary disorders and genetic defects caused by avulsions, intrusions, or fractures
involving the pulp chamber.
1. The hereditary diseases in enamel or dentin 3. Due to intrapulpal haemorrhagic and FeS 2
formation are like amelogenesis imperfecta, deposition along the dentinal tubules bluish
dentinogenesis imperfect, dental dysplasia black colour may occur.
causing intrinsic tooth discoloration.

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Dental material Internalised stains
1. Dental restorations such as amalgam It is the incorporation of extrinsic stain
restorations may produce corrosion products within the tooth following dental development it
producing grey black colour in the tooth. mainly occurs in enamel defects and in porous
2. Composites, acrylic restorations, and glass surface of exposed dentine. Dental defects which
ionomer can give grey colour to the tooth allow chromogenic material are classified into:
adjacent to the material.
3. Several other dental materials are like Developmental defects
eugenol, root canal sealers and poly anti-
1. These defects create their own changes which
microbial paste.
are caused by influences on light
Infections transmission through dentine and enamel.
2. These defects are either caused by increased
1. Infections like maternal rubella or enamel porosity or presence of enamel
cytomegalovirus and toxaemia of pregnancy defects, such examples would include
can lead to tooth discoloration. fluorosis and other enamel conditions which
2. Some postnatal infections such as measles, result in enamel hypoplasia or hypo-
chicken pox, scarlet fever, streptococcal calcification
infection can also cause enamel hypoplasia. 3. Alternatively development defects may
expose dentine directly or may later cause
Excess fluoride dentinogenesis imperfecta, chromogens then
enters dentine directly or by the tubule
Nutritional deficiencies system.
Intrinsic factors Characteristics
Dentinogenesis Yellow or grey Acquired defects
imperfecta brown
Amelogenesis Yellow-brown
Tooth wear and gingival recession
imperfecta 1. The progressive loss of enamel and dentine
Dental fluorosis Opaque white to due to erosion, abrasion and attrition is
yellow brown
termed tooth wear.
patches
Sulphur drugs Black staining 2. With the thinning of the enamel teeth
Tetracycline: becomes darker and dentine colour becomes
Chlortetracycline Grey- brown more apparent.
Oxytetracycline Brown yellow to 3. As the dentine is exposed the potential
Tetracycline HCL yellow chromogens enters the tooth body.
Dimethyl Brown yellow to 4. If any physical trauma occurs in teeth it can
chlortetracycline yellow result in a bulk loss of enamel or enamel
Minocycline Brown yellow to cracks which may cause internalisation of
doxycycline yellow extrinsic stains.
Blue-grey to grey 5. Exposure of dentine is more likely to be
No change
caused by gingival recession as wear of
Dental trauma Transiently red
through to black tooth mainly occurs in cervical area where
Hyperbillirubinemia Yellow-green to enamel is very thin.
blue brown and
grey Dental caries
Erithropoietic porphyria Red or brown
1. The various stages of tooth damage can be
Ochronosis Brown
easily recognized by change in colour as the
disease progresses.
2. The initial stage of injury shows an opaque
white spot, the white spot lesion differ in

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 colour from adjacent enamel because of its 4. Miller L. Organising colour in dentistry. J
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S, Arisue M. Bilirubin pigmentation of
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169.
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