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com
• Tooth discolouration may be
extrinsic or intrinsic in nature.
• Extrinsic stains are superficial &
occur after tooth eruption.
• Intrinsic discolouration may result
from developmental defect of enamel
or internal staining of the tooth.
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 Causes of tooth discolouration

Extrinsic staining Intrinsic discolouration

Green/orange stains Generalized intrinsic staining
of teeth

Black stains
Localized staining of one or
several teeth
Yellow stains

Chronological staining of
Brown stains dentition
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 Extrinsic Staining
Agents responsible are deposited in
enamel defects or become attached to
the enamel without bringing out a
change in its surfaces.
Aetiological agents causing extrinsic
stains are :
* Beverages / food
* Smoking
* Poor oral hygiene
* Drugs
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Iron Supplements
1. Green / orange stain

Poor oral hygiene

Chromogenic bacteria

Usually in cervical & gingival areas of

tooth
More common in mouth – breathers &
young persons www.fourthmolar.com
2. Black stains

Tobacco
Drugs
Iron
supplements

Minocyclin
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e
The stain may be seen as a line
following the gingival contour or it
may be apparent in a more
generalized pattern on the clinical
crown.

If it collects in pitted areas, it is

difficult to remove.

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3. Yellow stains

 Caused by
beverages / foods

 Due to bile
pigments from
gingival www.fourthmolar.com

crevicular fluid
4. Brown stains

Arrested caries

Chromogenic bacteria

Discolouration is due to sub-

surface decalcification
with intactwww.fourthmolar.com
surface which has
 Intrinsic discolouration
Factors causing these
conditions include blood-
borne pigments, blood
decomposition within the
pulp, and drugs used in
procedures such as root canal
therapy.
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a. Generalized intrinsic staining of teeth:

i. Yellow brown to dark

yellow

 Due to Amelogenesis Imperfecta

 Both dentitions affected
 The term A.I. is applied to inherited
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 Amelogenesis Imperfecta
Hypoplastic A.I.

Types Hypomineralized A.I.

Hypocalcified A.I.

 Enamel may be rough, smooth or

randomly pitted
 Enamel is thin & yellow to brown
in colour www.fourthmolar.com
ii. Blue brown (Opalescent)

Dentinogenesis Imperfecta

 All teeth are uniformly

affected
 Often associated with
osteogenesis imperfecta
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 Dentinogenesis Imperfecta

 D.I. is an inherited disorder of

dentin
 Dental manifestations are –
* Amber, bluish-brown
discolouration or opalescence
* Pulpal obliteration
* Relatively bulbous crowns
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iii. Reddish brown

Congenital erythropoietin porphyria

 The porphyrias are inherited & acquired

disorders in which the activities of the
enzymes of the haeme biosynthetic pathway
are
partially or almost completely deficient
 Discolouration is due to deposition
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iv. White

Fluorosis / non-fluorotic
 The mildest form of fluorosis
is manifest as
hypomineralization of the
enamel, leading to opacities.
 Opacities range from tiny
white flecks to confluent
opacities throughout the
enamel, making the crown
totally lacking in
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translucency
v. Green - blue

Hyperbilirunaemia

Seen in children with end

stage liver
disease and premature
infants

Common disorders that

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cause this
 Erythroblastosis Fetalis

Leads to Rh-incompatibility

Causes anaemia & Jaundice due to red cell

destruction

Which in turn leads to Hyperbilirunaemia

Persistent Jaundice during the

neonatal period,
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b. Localized staining of one or several
teeth
i) Pink

Internal
Seen
resorption
before
exfoliation of
primary tooth after
trauma (Pink tooth
of mummery)
Pink colour is seen
when vascular
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ii) Grey – black

Amalgam staining
 Leakage of old amalgam restoration
causing discolouration around the
restoration
 Mostly occurs in younger patients who have
open dentinal
tubules
 Large class II proximal restorations of
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posterior teeth & deep
iii) Yellow brown / White

Developmental defects

Subsurface decalcification Turner's hypoplasia

in permanent teeth after
Enamel defects seen in
trauma or infection
permanent teeth are
caused by periapical
inflammatory disease of
the overlying deciduous
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tooth. The altered tooth
iv. Greyish brown

Non-vitality

 Usually after trauma

 This discolouration is due to severe

pulpal damage i.e.
pulpal degeneration followed by
necrosis (pulpal
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c. Chronological staining of dentition
i) TETRACYCLINES

Yellow Yellow to Orange to

Grey to
bright yellow Grey brown
blue brown

Tetracycline Oxytetracycline
unoxidized erupted teeth, oxidized
Chlortetracycline
Dimethyl chlortetra fluorophore odour also
fluorophore seen in www.fourthmolar.com
hydrochloride cycline
newly erupted teeth depends on the type of
 Discolouration is noticed in children
who have received
tetracycline therapy during the
period of calcification of primary or
permanent teeth.
 Tetracyclines chelate calcium salts &
so, are incorporated into bones &
teeth during calcification.
 Tetracyclines administered during
pregnancy can be transferred
through the placenta, & cause
discolouration. www.fourthmolar.com
ii) SYSTEMIC ILLNESS

Yellow / brown
Vitamin D
deficiency
Developmental defects of
enamel affecting all teeth
forming during illness
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Severe
 TREATMENT

a) Extrinsic stains :

* Can be removed from the

surface of
the teeth by polishing
with a rubber cup & an
abrasive material ( flour
pumice )
* Improvingwww.fourthmolar.com
the oral
b) Intrinsic stains:
* Vital bleaching & laboratory laminate
veneers must be
considered state-of-the-art treatment for
aesthetic dentistry
* Bleaching & enamel microabrasion may be
used in
combination for certain types of
discolouration
* Direct resin veneers or laboratory laminate
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veneers are often
 References:
1. Welbury RR. Paediatric dentistry 2 edn , Oxford
university Press, 2001: 204- 5
2. McDonald RE, Avery DR, Dean JA. Dentistry for the
child and adolescent 8th edn, Mosby, 2004 :133-5, 447-8
3. Neville BW, Damm DD, Allen CM, Buoquot JE. Oral and
maxillofacial pathology, 2nd edn Saunders, 2005: 53-4,
59-66
4. Cameron AC, Widmer RP. Handbook of pediatric
dentistry 2nd edn, Mosby, 2003: 209-12

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