Staining

Question 1

How stains can occur

Answer 1

Can occur in 3 ways:
- stains adhering directly to the tooth
- stains contained within plaque and calculus
- stains within structure of the tooth
Normally classified as:
INTRINSIC - occurring within structure of the tooth and cannot be removed by scaling / polishing.
EXTRINSIC - occurring on surface of the teeth and usually remove able.
INTERNALISED - sometimes used , refers to stains that were extrinsic but have entered the dentine via a crack or other tooth defect.

Question 2

Clinical relevance

Answer 2

Tooth staining/ discolouration creates a wide range of cosmetic problems.
General public will often look at ways to improve the appearance of discoloured teeth.
Treatment might just require improvement in OH/ scaling and polishing or may require tooth whitening techniques and sometimes operative techniques such as veneers and crowns needed to camouflage underlying discolouration.

Question 3

Extrinsic stains

Answer 3

Need to look at stains under the following headings:

• clinical appearance
• teeth most commonly involved
• possible causes
• preventive measures
• ease or difficulty of removal

Question 4

Types of extrinsic stains

Answer 4

YELLOW - Associated with presence of plaque. Most likely stained by food and can occur in anyone at any age with poor OH. Easily removed.
GREEN - can be light/ dark and often found embedded in plaque. Can be any age but mostly children. It’s composition is chromogenic bacteria / decomposed haemoglobin and food pigments .it is hard to remove as very adherent to the tooth. Usually an area of decalcification under the stain. Most likely area is anteriors.
BLACK LINE ( metabolic stain) - most common in upper palatal surfaces. Usually seen in a fine line but may cover more. Usually demarkated from gingivae by area of unstained enamel . Think it’s associated with chromogenic bacteria which is capable of producing stain.
TOBACCO - light brown/heavy brown. No distinct pattern. Dictated by how and what they smoke , how they hold it and how good OH is. Ultrasonic removable but it’s tough.
CHLORHEXADINE- brown. Difficult to remove as gets into pits and fissures.
TEA AND COFFEE/red wine - light brown stain.
STANNOUS FLUORIDE - very light brown. Relatively easy to remove.
BETEL NUT - black/ dark brown.
ORANGE AND RED - chromogenic bacteria.
METALLIC - nowadays associated with supplements ie liquid form of iron supplements. Easy to remove.
STAINED PELLICLE - slightly grey/pink with red wine. Removed by brushing.

Question 5

Intrinsic stains

Answer 5

Incorporated into the tooth structure. Either been acquired during tooth development , prior to eruption or may have been acquired post eruption. They are not removable by normal scaling and polishing techniques but need to be able to recognise and identify.

Question 6

Pre eruption intrinsic stains

Answer 6

SYSTEMIC ENAMEL HYPOPLASIA - usually caused by children getting unwell with a high temperature and therefore the smell lasts are affected.
LOCALISED ENAMEL HYPOPLASIA - if localised it may have been caused by trauma to a primary tooth.
AMELOGENESIS IMPERFECTA - genetic and very severe. All teeth affected to some degree. Malformation. 6s usually badly affected. Teeth very rough and sensitive.
DENTAL FLUOROSIS- mild or severe. Caused by ingestion of excessive fluoride ion during development. 1ppm optimum in water. May be caused by swallowing toothpaste.
DENINOGENESIS IMPERFECTA - as dentine is affected so is enamel. Odontoblasts affected by genetic disorder.
TETRACYCLINE - antibiotic. Problem is if it’s taken during tooth development or pregnancy. Completely normally formed teeth but with the staining.