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Stained Teeth. Causes, Prevention, and Treatment Options


If you're part of the 18% of the general population with stained teeth, the expression "say cheese!" is not one that elicits joy. Once teeth have become discolored, are there any products or treatments to make them brighter again?

Stained teeth is a condition in which the color of the teeth changes from their natural color. Patients have reported negative psycho-social impacts due to changes in their tooth color. Various factors and lifestyle habits can affect the severity of stained teeth.

Enamel is the outermost layer of the teeth and contains several minerals, including calcium. In young children, the enamel is opaque, giving their teeth a whiter appearance. In healthy adults, the enamel is semi-translucent and gives a yellowish appearance due to an underlying layer called dentin.

Causes of stained teeth

In general, intrinsic and extrinsic factors, or a combination of the two, cause stained teeth.

  • Intrinsic factors that cause stained teeth are abnormalities in physiological or metabolic factors that affect teeth during their formation. For instance, an inherited metabolic disorder, known as alkaptonuria, causes acid to form. This acid causes permanent discoloration, resulting in the browning of teeth.
  • Extrinsic factors can cause teeth staining as they interact chemically on the tooth surface. Examples include smoking or chewing tobacco. Tobacco causes yellowish-brown to black discoloration on the lingual and cervical parts of the teeth. Organic stains and chromogens from tobacco, coffee, and tea penetrate tooth enamel to cause stained teeth.

Another intrinsic factor is metabolic errors such as congenital erythropoietic porphyria which can cause an accumulation of an organic compound called porphyrin in red blood cells, feces, urine, bone marrow, and teeth. This accumulation of porphyrins will change the color of the teeth to a brownish-red color and produce a red fluorescence under ultraviolet light.

Impaired tooth enamel formation can also cause stained teeth. A condition disrupting the mineralization process and the formation of the enamel matrix, called amelogenesis imperfecta, eventually causes the enamel to thin out. It changes the color of the teeth from yellow to yellow-brown.

The most common intrinsic factor is tetracycline staining. Systemic administration of an antibiotic called tetracycline at an early age may cause enamel and tooth tissue to discolor. Tetracyclines form chemical complexes with calcium ions on the surface of a tooth's mineral, causing discoloration. Administration of tetracycline in children may cause the appearance of teeth to be yellowish or gray-brown.

Other extrinsic factors causing stained teeth include poor dental health and hygiene. Chromogenic bacteria can cause deposits on teeth different from usual dental plaque. These deposits can cause tooth discoloration to black or even green and orange in children with poor oral hygiene.

Preventing stained teeth

Preventing stained teeth is possible with a good care plan based on a dentist's recommendation.

To maintain dental health and hygiene:

  • Reduce the presence of tea or coffee in the mouth by rinsing the mouth after drinking tea or coffee.
  • Stop smoking and chewing tobacco.
  • Brush your teeth after eating foods that can cause discoloration of the teeth. Brush your teeth at least twice a day.
  • Limit consumption of drinks and foods that contain dyes. For instance, red wine can also stain teeth. Talk to your dentist about using an over-the-counter whitening product two-three times a week.
  • Eat a healthy diet. Consuming rough leafy vegetables such as kale or spinach can help reduce stains on the surface of the teeth. A study showed that adding milk to a cup of tea can prevent extrinsic tooth staining caused by tea. The ability of tea to stain teeth is significantly reduced by the presence of casein in cow's milk. Casein can bind to the polyphenol content in tea, so it doesn't stain tooth enamel.

Treatments

Several treatment types can be performed to restore stained teeth based on the type and severity of the tooth staining. All treatment should be based on the patient’s history and diagnosis of the dentist.

  • Bleaching: One of the most commonly prescribed treatments, bleaching is a tooth whitening procedure that acts on the chromophores in teeth.
  • Hydrogen peroxide: Using hydrogen peroxide as a tooth whitening agent will interact with organic chromophores in the tooth structure, so it can convert molecular chains into simpler units. This procedure results in a lower molecular weight product and changes its optical properties, enabling stains to be removed from the tooth surface. The concentration of hydrogen peroxide commonly used is about 15 to 38%. Carbamide peroxide, chlorine dioxide, and sodium perborate are also used as teeth whitening agents.
  • Enamel microabrasion: It is a superficial treatment used to remove mild to moderate stains. A low concentration of hydrochloric acid with silicon carbide microparticles cleans the teeth through a micro-abrasive mechanism carried out in less than 30 seconds. Microabrasion procedures can be combined with teeth whitening agents, such as carbamide peroxide, to remove residual stains and improve teeth color.

Staining due to intrinsic factors requires a more aggressive approach. Porcelain laminate veneers or crowns can be applied to treat stained teeth. It is a minimally invasive restorative approach to improve tooth color and shape.

The most widely used materials for this restorative action are feldspathic porcelain and lithium disilicate. The risk of post-treatment sensitivity can be reduced using veneers that are conservative and remain dominant in tooth enamel. Reports indicate a high success rate and longevity after the restoration procedure.

Stained teeth can cause low self-esteem and other psycho-social issues. Consult your dentist regularly to maintain oral hygiene and prevent teeth stains.

References:

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D’arcangelo, C., De Angelis, F., Vadini, M., & D’Amario, M. (2012). Clinical evaluation on porcelain laminate veneers bonded with light-cured composite: results up to 7 years. Clinical oral investigations.

Eimar, H., Siciliano, R., Abdallah, M. N., Abi Nader, S., Amin, W. M., Martinez, P. P., ... & Tamimi, F. (2012). Hydrogen peroxide whitens teeth by oxidizing the organic structure. Journal of Dentistry.

Fayle, S. A., & Pollard, M. A. (1994). Congenital erythropoietic porphyria--oral manifestations and dental treatment in childhood: a case report. Quintessence International.

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