[Oral Health #13] Tooth Discoloration or Staining...Why is your Tooth Discolored?

Dear Fellow Steemians!!!

Aesthetics in the Present Time is a Trending Hot Topic (more precisely new drug on the streets) that has emerged from past few years now. Be it physical build, shape, face, Smile, etc. Almost billions of dollars are spent annually for the making a person aesthetically better. From Celebrities to the General Population, Well Everybody wants to look aesthetically better (i am not judging coz Everybody deserves to be).

Do you have a HOLLYWOOD PERFECT SMILE?

Smile is a unique ornament of a person. It has the ability to increase or decrease the confidence and self-esteem of a person. Teeth as well as lips, can affect your smile. In order to get that "HOLLYWOOD PERFECT SMILE" and ofcourse Natural smile, a good portion of fortune is spent by people of almost every section of society.

So why does a person needs Smile makeover or Teeth makeover (restrict our topic to teeth only). Why are Teeth of different shades (colours) and what shade is the natural and perfect shade for a tooth? Why does the colour of Tooth Changes? To answer them all, lets begin our Voyage of Tooth and its discoloration.

Tooth Discoloration or Tooth Staining

It is the Aesthetic problem in which the Tooth loses its natural color (whole or partial), hue, chroma or translucency. It is an embarrassing condition which leads to loss of self-esteem and confidence. It can be External discoloration or Internal Discoloration. A number of factors are responsible for the tooth discoloration, and as always bad oral hygiene being one of them. As it is always said;

Dentistry isn't Expensive, Neglect is.

What is the color of Natural Tooth?

The color of tooth and its perception by the eye and brain depends on many factors like opacity of the tooth material, translucency, light, etc.
The tooth is grossly made of enamel, dentin and pulp. The enamel is white in color and is thin compared to Dentin which is Yellowish Brown, forms bulk of tooth. Pulp tissue which is red or pink in color isn't visible from outside except some conditions like internal resorption.
A normal tooth shade has been changing with community and geography. There is no specific guideline of perfect normal tooth shade. However, It is seen that the most common type of tooth shade ranged from A1 to A3 on VITA tooth guide which ranges from A1 to D4.

The agents that impart the discoloration on the tooth are called as Chromogens. The discoloration of Tooth can be in the form of pin-point stain or involving whole crown of the tooth. Sometimes a tooth is discolored due to some systemic condition and not by some local factor.

Like Face is the index of mind, Teeth or Oral Cavity is the Index of Body.

Types of Tooth Discoloration

• Extrinsic:
  It occurs due to the stains present on ouyer surface of tooth. This can occur due to coffee, tea, smoking, tobacco chewing, wine, carbonated drinks, etc. The stains are generally dark brown or black or yellow or even red in color.
  Source

• Intrinsic:
  It occurs due to the discoloration in the internal structure of the tooth. Sometimes the dentin loses its color due to some problems (discussed later) and being in bulk this discoloration is reflected outside. This discoloration when present, many a times involves almost all the crown portion of tooth or even root sometimes. E.g, Tetracycline discoloration, Trauma.
  Source

• Internalized:
  Sometimes the Extrinsic Stains gets incorporated deep into the internal structure of the tooth i.e. dentin due to some tooth defects like fracture or cracks in the tooth.

• Age Related:
  This is also a conbination of both Extrinsic and Intrinsic Stains in which Dentin becomes dull in color, while Extrinsic factors precipitate stains on the Tooth causing discoloration.

NATHOO has classified these Extrinsic Stains into 3 Classes; N1. N2, and N3.

• N1:- The Chromogen imparts its color to the tooth on binding with it.

• N2:- The Chromogen binds with tooth and the color imparted is different than the chromogen color.

• N3:- The colorless preChromogen binds chemically with the tooth and imparts the color.

Causes of Tooth Discoloration

There are Various Causes that cause Intrinsic as well as Extrinsic Stains. Most of them include:
Source

• Food/Drinks:
  These include Tea, Coffee, Cold Beverages, certian fruits and foods, wine etc. The discoloration is mainly due to deposition of tannins found in these drinks which are generally deposited on the lingual side of the tooth and on the cervical area.

• Smoking/Tobacco:
  Smoking doesn't just stain your teeth but also your gums and blacken your lips as well. The stains are tenacious dark brown or black stains that cover cervical 3rd of tooth.
  Chewing Pan will impart Reddish-black stains on the teeth and even gums.
  Source

• Poor Dental Hygiene:
  This leads to accumulation of plaque and calculus which are rich in Bacteria, some of which have chromogenic property. The Bacterias like Actinomyces cause black staining while Orange Brown color of stains are imparted by Flavobacterium. Aspergillus sp. impart Green color to the stains.

• Diseases:
  The developmental diseases of Enamel or Dentin can cause the Discoloration of the tooth.
  Periodontal diseases also cause the dark yellow to brown discoloration of teeth.
  Treatment of certain diseases by Chemotherapy and Radiotherapy also causes the discoloration of teeth.
  Any infection in Pregnant mother can also cause discoloration of infant teeth due to developmental defects of tooth.
  Source

• Medication:
  Antibiotics like Tetracycline or doxycycline can discolor the tooth to grey to red-brown if the tooth is still developing. Tetracycline don't cause discoloration if the tooth formation has completed, however doxycycline does cause.

Mouth Rinses like Chlorhexidine when used continuously for few weeks causes brown staining of teeth and gums.

Source
Antihistamines, Antipsychotic drugs or drugs for Blood Pressure can also cause the tooth staining.
Potassium permanganate can cause violet-black staining.

• Dental Materials:
  Dental Materials used in restoration and Endodontic Purposes can also cause discoloration (intrinsic) of tooth.
  Amalgam can cause dark black color of tooth over time.
  
  Certian Composites, Glass Ionomer cause greyish hue inside the tooth.
  Some of the Endodontic sealers are also thought to cause discoloration of the tooth.
  Eugenol, formocresol also add to the list of the dental materials which impart color to the tooth.

Dental fluorosis is caused by the excessive ingestion of fluoride which causes hypomaturation of enamel causing discoloration which may be White mottled (mild) to Dark brown (Severe).

Source

• Dental Caries and Conditions
  Dental Caries Stain the tooth depending upon the severity of the caries. It can be light brown to dark brown to completely black in color.
  Dental Conditions like Attrition, Abrasion, Erosion can lead to the Dull yellowish discoloration of the tooth.

• Trauma
  Trauma to the tooth that involves pulp leads to the bluish-black discoloration of tooth over time due to pulpal haemorrhage.
  Trauma during the development of tooth can cause developmental defects like hypoplastic enamel.

• Genetics

Developmental defects of tooth which are hereditary in nature like Amelogenesis imperfecta, Dentinogenesis imperfecta and Dentinal Dysplasia cause the intrinsic tooth discoloration which can range from yellow to dark brown to blue discoloration.

• Advancing Age
  With age, the enamel wears off leading to the yellowish appearance of dentin in tooth more prominent.

• Nutritional Deficiency
  Vit. C and D, Calcium and phosphate deficiencies can lead to enamel hypoplasia and thus discoloration.

Psychosocial Aspect of Tooth Discoloration

Smile has a great impact on the society in terms of confidence and self-esteem. When the smile is diminished by the disease, it often leads to damage of physical and mental health.
Tooth discoloration can impact the greater portion of society especially when present in the anterior region of teeth and The adolescents are largely affected by this problem. Anterior Tooth discoloration is the main reason behind any dental aesthetic treatment.
It has been studied that Tooth discoloration can cause profound embarrassment and psychological distress. Fear, anxiety, depression, antisocial behaviour are commonly seen in these individuals which can affect the general health of the person.

Signs and Symptoms

• Stains on the outer tooth surface.

• Stains don't rub off even after brushing.

• Flaking of Tooth.

• Dentin Visibility due to worn Enamel.

• Pain due to Carious tooth.

Tooth Discoloration is a cumulative Process.

Diagnosis is made by the dentist Clinically. No special tests for generally required.

Prevention

• Brushing and Flossing Regularly.
• Rinsing your mouth after Every Meal or Any Beverages or Drinks.
• Routine Dental Check ups.
• Some intrinsic stains can be prevented by proper consultation with your dentist, like fluoride consumption.
• Good Oral Hygiene
• Oral Prophylaxis.
• Stop Smoking or Tobacco Chewing.

Treatment

• Many Extrinsic Stains can be removed by proper Brushing, Flossing and rinsing after meals.

• Bleaching Method
  These are whitening agents that are used to remove the discoloration of tooth. The time required by the procedure generally varies from 30 - 45 min (Power bleaching done in the dental clinic) to overnight (Home Bleaching done at home using mouth guards).
  Source

• Veneers
  These are the recent advances in which the facial enamel of the tooth in anterior region is replaced by prosthetic ceramic shells.
  Source

• Bonding
  Composite bonding materials are present in different shades and a proper and desired shade can be matched and used on the individual.
  Source

Prognosis

The Extrinsic Stains have a Good Prognosis while the Intrinsic Stains have Fair Prognosis at most of the times.

Refrences

1. Webmd
2. Medscape
3. 1-800-Dentist
4. NCBI
5. Wikipedia

HAVE YOU READ MY LAST POST:

1. TEETH GRINDING OR BRUXISM

2. HOW DO YOU KNOW YOUR TOOTH NEEDS A ROOT CANAL

So this is it for now...
Till next time.

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