Teeth Stains and Discoloration: Causes & treatments

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Many patients come to the clinic with the complaint of stained or discolored teeth. There can be many reasons for this, and not every patient is the same. The first thing to establish is whether the stain is inside or outside the tooth surface.

Surface stains

If the stain is extrinsic this means the stain or deposits that are causing the discoloration are sitting on the outside of the tooth surface and are caused by external factors such as:

  • Food
  • Drink (Coffee, red wine)
  • Tobacco
  • Medications

There are some antimicrobial mouthwashes that contain an ingredient called chlorhexidine. This causes dark brown staining on the teeth. This mouthwash is considered to be the gold standard of mouth washes when it comes to treating acute gum problems so should only be used for this purpose and only for specified periods of time according to their concentration so that they do not become ineffective.

Internal discoloration

If the stain is intrinsic, the internal color of the tooth cannot be removed by home oral hygiene and even professional dental cleaning. This type of stain needs to be assessed by a dental care professional to ascertain the best course of treatment.

The cause of internal stain or tooth color can be down to a number of reasons:

  • Aging – most common cause of natural internal color change over our lifetime.
  • Tooth decay or demineralization of enamel – wearing of the tooth substances such as erosion, grinding or receding gums expose the layers under the enamel surface which is naturally darker in color. All these changes need to be assessed and treated by the dentist.
  • Fluorosis – too much fluoride, which results to bright white chalky spots on the teeth to dark brown stains and spots.
  • Tetracycline (antibiotic) – if taken during pregnancy or by a child under the age of 12 whilst the teeth are developing can cause different color bands on the teeth and this can vary in severity. This is called tetracycline stain. Both these conditions need to be assessed as more severe cases are not suitable for procedures such as whitening.
  • Pulp necrosis – refers to when nerve dies inside the tooth and this can cause the tooth to be discolored ranging from grey through to purple. Similarly when a tooth has had a root canal treatment it can also discolor as it is no longer alive.
DIY teeth whitening: is it safe?

The subject of over-the-counter products for whitening your teeth can be very confusing and hard to know if it is effective. Professional tooth whitening can only be carried out by fully-qualified and trained dental care professionals. The reason for this is to ensure the patients safety and well-being for such a procedure.

It is extremely important that the clinician has carried out a full examination to ensure that the patient is suitable for whitening and that they expect to achieve the result they are hoping for. The reason for this is existing fillings, crowns and veneers will not change color during the whitening procedure, plus certain internal stains as mentioned early may require a longer term plan or alternative treatments.

Certain products available to buy over-the-counter can cause more damage than expected such as some whitening toothpaste and polishes. Many rely on an abrasive agent to buffer off the stain which means they can cause abrasion to the enamel. Every tooth paste has relative dentin abrasivity (RDA) score. This tells you how abrasive it is and anything with a score above 100 is highly abrasive and 150 is above harmful limits. Surprisingly there are some very familiar brands with an RDA above 100. Online searches are easily available. These toothpastes will also only remove stains on the outside of the teeth and cannot change the internal color.

There are many kits available to buy in shops and online which claim to change the internal color of teeth but the effectiveness of these is extremely questionable. The trays supplied with these kits are universally made to fit anyone so do not provide a good fit hence the product that usually accompanies the trays is of a low concentration due to safety guidelines, which means they don’t really provide any whitening benefits.

Also if a stronger product is obtained and used the risk of burning gums and soft tissues irritation is extremely high, along with severe sensitivity. Some products contain sodium chlorite. If this chemical comes into contact with acid causes a weakening of enamel which leads to easier wearing of the tooth.

Best advice: Get professional treatment

The safest way to change the color of your teeth is to visit the dentist and hygienist to seek professional advice on ways to improve your smile.

You can expect to receive reliable and expert advice in regards to what’s causing the discoloration and the best way to correct this. The dentist will carry out an examination and take radiographs to check for cavities. They can then advise on the best way to treat any problems.

This could be as simple as having a comprehensive cleaning with the experienced dental hygienist and advice on which home care products to use, along with professional whitening tailored to suit the patient either in clinic or from the convenience of the patient’s home.

Dental Hygienist, UK
Umm Suqeim Clinic, Dubai



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