Dental Stains and Their Characteristics

Dental Staining and Its Removal

• Images of stained teeth are shown to grab attention

• Learning outcomes for the presentation are listed. These include various numbers, for example, 1.1, 1.1.1, 1.1.8, 1.2.1, 1.2.2, 1.2.4, 1.5.3, 1.5.5, 1.7.3, 1.7.7, 1.7.8, 1.9.1, 1.10.2, 1.10.3, 1.10.4, 1.10.5, 1.10.6, 5.2.

• Formative assessment involves completing a workbook.

• Different types of dental stains exist. Some are directly on the hard or soft deposits; others are within the tooth itself.

• Learning outcomes for the session include the definition of methods for stain adherence, causative factors for intrinsic and extrinsic stains, and methods of removing extrinsic stains and reducing intrinsic stains.

• Extrinsic stains are on the tooth's outer surface, caused by topical or external agents. These stains can be removed.

• N1-type of dental stain is a direct stain where a chromogen binds to tooth surface via ion exchange, similar to bacterial adhesion on pellicle. Examples are tea, coffee, metals, and wine.

• N2-type is also a direct stain where the chromogen changes colour after binding to the tooth. Example is aging food.

• N3-type is an indirect stain, where colorless material/pre-chromogens react chemically within the tooth to cause staining, examples include browning of carbs, sugars, cooking oils, baked goods, and fruit.

• Predisposing factors for dental staining include enamel defects, poor salivary function, poor oral hygiene, microscopic pits and fissures, and certain bacteria.

• Agents causing extrinsic stains can include coffee and tea.

• Stain removal is important for aesthetic reasons and to prevent plaque retention. Poor oral hygiene can be a cause for stain.

• Stain types and description:

  • Yellow stain: dull yellow where plaque is retained. Common to all ages, indicative of poor oral hygiene.
  • Green stain: yellowish to dark green, caused by chromogenic bacteria and fungi. Usually found in children and some adults.
  • Brown stain: light to dark brown stains, can become intrinsic, caused by tobacco, corsdyl/chlorexine, tea.
  • Orange stain: caused by chromogenic bacteria, less common than green stains, found on buccal surfaces of anterior teeth.
  • Black stain: brown pigment from smokeless tobacco, paan, and betel nut. Increased by elevated plaque levels. Can become severe.
  • Metallic stain: from metal exposure (factory dust, vitamins/iron tablets), may become intrinsic.
  • Black line stain: black or dark brown stains, continuous or interrupted, follows tooth contours, may be caused by chromogenic bacteria.

• Intrinsic stains are located inside the tooth structure due to internal factors, and cannot be removed. Exogenous types from outside sources become incorporated into the tooth structure. Endogenous types originate within the tooth structure

  • Grey stain: in pulpless teeth, yellowish brown to slate grey, billiverdin gets released.
  • Pink stain: Created by haemorrhage into the pulp chamber
  • Decalcification: Results after orthodontic treatment.
  • Restorative/Metallic stain: grey black in color from amalgam, which migrates into tooth structure. Composite materials can discolour with age.
  • Disturbances in tooth development include localised enamel hypoplasia, systemic enamel hypoplasia, amelogenesis imperfecta, and tetracycline stain. Also include dental fluorosis, and dentinogenesis imperfecta.

• Methods for extrinsic stain removal include good oral hygiene, various polishing techniques, debridement, power-driven scaler/air polishing, and bleaching/whitening.

• Methods for intrinsic stain removal: vital bleaching, cosmetic dentistry/veneers, microabrasion, non-vital bleaching, and composite resin restorations.

• Images demonstrating before and after staining removal procedures are included

• Techniques for stain removal are shown.

• Stain removal is important for aesthetics, plaque retention prevention, and detecting oral hygiene issues. It is unsightly, rough, and may cover underlying calculus.

• Further reading is suggested for a more in-depth understanding of intrinsic discolouration treatment in children and adolescents, including links to online resources.

• A thanks-you message closes the presentation.

This quiz focuses on the types of dental stains, their characteristics, and causes. Explore the differences between extrinsic and intrinsic stains, their predispositions, and the reasons for their removal. Test your knowledge on dental hygiene and the factors influencing tooth discoloration.