Dental Stain

Question 1

What are the three main classifications of tooth discoloration?

Answer 1

1. Intrinsic discoloration
2. Extrinsic discoloration
3. Internalized discoloration

Question 2

Where is intrinsic discoloration located?

Answer 2

Intrinsic discoloration occurs following a change to the structural composition or thickness of the dental hard tissues.

Question 3

Where is extrinsic discoloration located?

Answer 3

Extrinsic discoloration is outside the tooth substance and lies on the tooth surface or in the acquired pellicle.

Question 4

What is internalized discoloration?

Answer 4

Internalized discoloration is 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.

Question 5

List the causes of intrinsic discoloration.

Answer 5

1. Congenital hyperbilirubinemia
2. Amelogenesis imperfecta
3. Dentinogenesis imperfecta
4. Dentinal dysplasia
5. Tetracycline staining
6. Fluorosis
7. Enamel hypoplasia
8. Pulpal hemorrhagic products
9. Root resorption
10. Ageing

Question 6

What color is seen in congenital hyperbilirubinemia?

Answer 6

Yellow-green discoloration due to breakdown products of hemolysis and deposition of bile pigments in calcifying dental hard tissues.

Question 7

What color appearance is seen in amelogenesis imperfecta?

Answer 7

Varies from mild hypomature “snow-capped” enamel to more severe hereditary hypoplasia with thin, hard enamel that has a yellow to yellow-brown appearance.

Question 8

What color is associated with dentinogenesis imperfecta?

Answer 8

Bluish or brown color with opalescence on transillumination.

Question 9

What colors are associated with dentinal dysplasia?

Answer 9

Type I: Amber translucency
Type II: Brown discoloration with thistle-shaped pulp chamber and pulp stones

Question 10

What colors are associated with tetracycline staining?

Answer 10

Yellowish or brown-grey appearance that is worse on eruption and diminishes with time. Different tetracycline analogues produce different colors:
• Chlortetracycline: Slate grey
• Oxy-tetracycline: Creamy discoloration
• All tetracycline-stained teeth fluoresce bright yellow under ultraviolet light

Question 11

What colors are seen in dental fluorosis?

Answer 11

Ranges from chalky white to dark brown/black appearance. The brown/black discoloration is post-eruptive, caused by internalization of extrinsic stain into porous enamel.

Question 12

What color changes are associated with pulpal hemorrhage after trauma?

Answer 12

Initially a pinkish hue that may disappear in 2-3 months if the tooth becomes revascularized. Later turns to dark discoloration (grey to black) due to hemoglobin or other hematin molecules.

Question 13

What color is associated with root resorption?

Answer 13

Pink appearance at the amelo-cemental junction.

Question 14

How does aging affect tooth color?

Answer 14

Gradual darkening of teeth due to the natural laying down of secondary dentine, which affects light-transmitting properties.

Question 15

What are the two categories of extrinsic staining causes?

Answer 15

1. Compounds incorporated into the pellicle that produce stain from their basic color
2. Compounds that lead to staining caused by chemical interaction at the tooth surface

Question 16

What are the two types of extrinsic stains based on origin?

Answer 16

1. Metallic stains
2. Non-metallic stains

Question 17

What are common sources of non-metallic extrinsic stains?

Answer 17

Dietary components, beverages, tobacco, mouth rinses, medicaments, and chromogenic bacteria.

Question 18

What colors are associated with chromogenic bacteria in children?

Answer 18

• Green: Caused by Penicillium and Aspergillus species
  • Orange: Found in children with poor oral hygiene
  • Black/brown: Found in children with good oral hygiene and low caries, caused by Actinomyces species

Question 19

What color is associated with iron exposure?

Answer 19

Black staining

Question 20

What color is associated with copper exposure?

Answer 20

Green staining

Question 21

What color is associated with potassium permanganate when used in mouth rinses?

Answer 21

Violet to black color

Question 22

What color is associated with silver nitrate used in dentistry?

Answer 22

Grey color

Question 23

What color is associated with stannous fluoride?

Answer 23

Golden brown discoloration

Question 24

What color is associated with chlorhexidine?

Answer 24

Brown discoloration

Question 25

What are the two categories of dental defects permitting entry of chromogenic material?

Answer 25

1. Developmental defects 2. Acquired defects

Question 26

What are the types of acquired defects that can lead to internalized staining?

Answer 26

1. Tooth wear and gingival recession 2. Dental caries 3. Restorative materials

Question 27

What color changes are associated with dental caries progression?

Answer 27

- Initial lesion: Opaque, white spot • Hard, arrested lesion: Black (from exogenous stains)

Question 28

What color change is seen in dentine following removal of long-standing amalgam restorations?

Answer 28

Dark grey to black color due to migration of tin into tubules, not mercury as previously thought.

Question 29

What are the main treatment options available to whiten teeth?

Answer 29

1. Diet and habit modification 2. Effective tooth brushing with dentifrice 3. Professional tooth cleaning 4. Bleaching (vital and non-vital techniques)