Extrinsic discolouration

Extrinsic stains that appears on the tooth surfaces can become internalised through enamel defects or cracks or as a result of dentine becoming exposed but most extrinsic stains appear to be deposited on or in the dental pellicle layer on the enamel surface.


Causes of extrinsic staining include

  • Dental plaque : although usually virtually invisible on the tooth surface, plaque may become stained by chromogenic bacterial species, such as Actinomyces .
  • Calculus : neglected plaque will eventually calcify, and lead to the formation of a hard deposit on the teeth, especially around the gum line. The color of calculus varies, and may be grey, yellow, black or brown
  • Tobacco : Tar content in smoke from tobacco products tends to form a yellow-brown-black stain around the necks of the teeth above the gum line
  • Betel nut chewing causes red to brown discoloration of the tooth enamel.
  • Certain foods & drinks  :   food products and vegetables rich with carotenoids or xanthonoids. Ingesting colored liquids like sports drinks, cola, coffee, tea, and red wine can discoloration of your teeth.
  • Certain topical medications  : Mouth wash containing –  Chlorhexidine (antiseptic mouthwash) binds to tannins, meaning that prolonged use in persons who consume coffee, tea or red wine is associated with extrinsic staining (i.e. removable staining) of teeth.
  • Metallic compounds  : Exposure to such metallic compounds may be in the form of medication or other environmental exposure. examples include iron (black stain), iodine (black), copper (green), nickel (green), cadmium (yellow-brown).


Intrinsic discolouration

Changes in the thickness of the dental hard tissues would result in intrinsic discolouration. There are a few causative factors that may act locally or systematically, affecting only a single tooth or all teeth and cause discolouration as a result.

Several diseases that are known to affect the developing dentition especially during enamel and dentine formation can lead to discolouration as well.


Causes of intrinsic staining include

  • Dental caries  Dental Caries — (tooth decay).
  • Dental Trauma  — which may cause staining either as a result of necrosis of the pulp tissue, as a result the tooth may become darker without pulp necrosis.
  • Eanmel Hypoplasia.
  • Hyperemia
  • Fluorosis.
  • Dentinogenesis Imperfecta.
  • Tetracyclin or Minocycline — Tetracycline is a broad spectrum antibiotic and its derivative minocycline is common in the treatment of acne. The drug is able to chelate calcium ions and is incorporated into teeth, cartilage and bone. Ingestion during the years of tooth development causes yellow-green discoloration of dentin visible through the enamel which is fluorescent under ultraviolet light. Later, the tetracycline is oxidized and the staining becomes more brown and no longer fluoresces under UV light.
  • Prophyria
  • Hemolytic disease of the newborn.
  • Root resorption.
  • Alkaptonuria ( a Metabolic disorder ) — which promotes the accumulation of homogentic acid in the body and may cause brown colour pigmentation in the teeth, gums and buccal mucosa.


Causes of extrinsic and intrinsic staining include

  • Age   :: The tooth enamel becomes thinner over time, which allows the dentin to shine through – thus teeth look a bit yellow as we grow older.
  • Bruxism  :: (clenching and grinding of the teeth) can lead to micro-cracking of the incisal edges of the teeth. Extrinsic stains may settle more readily into these cracks, and a thin layer of enamel can be left. This thin enamel layer is partially transparent, allowing the dark background of the mouth to shine through, affording a darker appearance of the incisal edge.


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