Dental Staining and its Removal: Types and Methods

• Correct identification aids the determination of aetiology and removal or prevention techniques
• Julie Watson is the author of this text: Dental Staining and its Removal

Learning Outcomes

• Describe how to remove extrinsic stain and reduce intrinsic stain
• Define the methods by which stain adheres to the tooth structure
• Define and discuss potential causative factors for intrinsic and extrinsic stains
• Aim to be able to do the above at the end of this session

Classification

• Extrinsic stains originate from an outside source
• Intrinsic stains originate from an internal source

Extrinsic Stains

• Extrinsic stains are located on the outer surface of the tooth structure and caused by topical or extrinsic agents
• These stains can be removed

Extrinsic Staining Process

• N1-type dental stain (direct dental stain) has a chromogen that binds to the tooth surface
• With N1 stain, the chromogen interacts with the tooth surface via an ion exchange mechanism, the color is similar to the stain
• Examples of N1 stains include bacterial adhesion to pellicle, tea, coffee, metals and wine
• With the N2-type dental stain (direct dental stain), the chromogen changes color after binding to the tooth, for example, food that has aged
• With the N3-type dental stain (indirect dental stain), colorless material or pre-chromogen binds to the tooth
• Chemical reaction of the N3-type dental stain causes staining, for example, browning of foods with high carbohydrates and sugars, cooking oils, baked products and fruit

Predisposing Factors

• Enamel defects can be a predisposing factor for dental staining
• Poor oral hygiene can be a predisposing factor for dental staining
• Certain bacteria can be a predisposing factor for dental staining
• Microscopic pits and fissures can be a predisposing factor for dental staining
• Salivary dysfunction can be a predisposing factor for dental staining

Why Remove Stains?

• Rough and thick stains can become a nidus for plaque retention
• Stain removal is an aesthetic benefit to the patient
• Poor oral hygiene is the most common cause of stain

Yellow Stain

• Dull yellow stain is where plaque is retained
• Yellow stain is common to all ages
• Yellow stain is an indicator of poor oral hygiene

Green Stain

• Green stain ranges from yellowish-green to dark green
• Chromogenic bacteria and fungi cause green stain
• Green stain organisms grow only in light
• Green stain primarily affects children, but also some adults

Brown Stain

• Brown stains range from light to dark brown
• Brown stains can become intrinsic

Orange Stain

• Orange stain is caused by chromogenic bacteria
• Orange stain is less common than green staining
• Orange stains appear on buccal surfaces of anterior teeth

Black Stain

• Black stain occurs from brown pigment from smokeless tobacco, paan & betel nut
• High plaque levels increases black stain
• Black stain can be severe

Metallic Stain

• Metallic stain occurs from metal or factory dust exposure
• Metal from vitamins oral iron tablets causes metallic staining
• Metallic stain may become intrinsic

Black Line Stain

• Black line stain ranges from black to very dark brown, can be continuous or interrupted
• Black line stains follow the contour of the tooth.

Intrinsic Stains

• Intrinsic stains are located within the tooth structure and caused by internal or intrinsic agents
• Intrinsic stains cannot be removed

Intrinsic Stain Types

• Exogenous intrinsic stains originate from a source outside of the tooth but has become incorporated into the tooth structure
• Endogenous intrinsic stains originate from within the tooth structure

Causative Agents of Intrinsic Staining

• Development issue such as excessive Fluoride or Tetracycline can cause intrinsic staining
• Restorative procedures such as Endodontics or Amalgam migration can cause intrinsic staining
• Extrinsic stains may become intrinsic over time

Grey Stains

• Pulpless teeth can grey
• Yellowish brown to slate grey teeth indicates intrinsic staining
• Release of billiverdin can appear grey teeth

Pink Tooth

• Haemorrhage into pulp chamber can cause pink teeth

Decalcification

• Decalcification post orthodontic treatment

Restorative/Metallic Intrinsic Stain

• Metal ions from amalgam migrate into the tooth structure
• Composite materials discolour with age
• Restorative/Metallic discolouration appears as grey/black colour

Tooth Development Disturbances

• Localised Enamel Hypoplasia
• Systemic Enamel Hypoplasia
• Amelogenesis Imperfecta
• Dental Fluorosis
• Dentine is opalescent in Dentinogenesis Imperfecta
• Odontoblastic disturbance causes Dentinogenesis Imperfecta
• Tetracycline Stain causes disturbances in tooth development
• Teeth can appear translucent to bluish grey to brown in Dentinogenesis Imperfecta
• Hypomineralisation resulting from an intake of more than 2ppm causes Dental Fluorosis

Extrinsic Stain Removal Techniques

• Good oral hygiene
• Air polishing/Power driven scaler
• Bleaching/Whitening
• Polishing
• Debridement/PMPR

Intrinsic Stain Removal Techniques

• Vital bleaching
• Cosmetic dentistry/veneers
• Composite resin restorations
• Microabrasion
• Non-vital bleaching

Why Remove Stains?

• Stain is unsightly
• Stain is rough and therefore plaque retentive
• Stain may be covering calculus