What Is It?
Tooth discoloration may be caused by
superficial stains or by changes in the
underlying tooth material. Dentists divide
discoloration into three main categories:
▪ Extrinsic discoloration — This
occurs when the outer layer of the tooth
(the enamel) is stained by coffee, wine,
cola or other foods or drinks. Smoking also
causes extrinsic stains.
▪ Intrinsic discoloration — This may
occur when the inner structure of the tooth
(the dentin) darkens or gets a yellow tint.
Other causes include excessive exposure to
fluoride during early childhood, the
maternal use of tetracycline antibiotics
during the second half of pregnancy or the
use of tetracycline antibiotics in children
8 years old or younger.
▪ Age-related discoloration — This is
a combination of extrinsic and intrinsic
factors. In addition to stains caused by
foods or smoking, the dentin naturally
yellows over time. The enamel that covers
the teeth gets thinner with age, which
allows the dentin to show through. Chips or
other injuries to a tooth can also cause
discoloration, especially when the pulp has
In rare cases, children with a congenital
condition called "dentinogenesis imperfecta"
are born with gray, amber or purple
Symptoms include discoloration of the enamel
or a yellow tint in the underlying dentin.
Tooth discoloration can be diagnosed with a
Some tooth discoloration may be removed
with professional cleaning, but many stains
are permanent unless the teeth are treated
(whitened) with a bleaching gel.
Brushing your teeth after every
meal will help prevent some stains. Dentists
recommend that you rinse your mouth with
water after having wine, coffee or other
potentially staining foods. Regular
cleanings by a dental hygienist also will
help prevent extrinsic stains.
Intrinsic stains that are caused by damage
to a nerve or blood vessel in the inner part
(the pulp) of a tooth sometimes can be
prevented by having a root canal, which
removes organic material before it has a
chance to decay and darken. However, teeth
that undergo root canal treatment may darken
anyway. To prevent intrinsic stains in
children, avoid water that contains a high
fluoride concentration. You can check the
concentration of fluoride in your drinking
water supply by calling the public health
department. Then consult your dentist.
Discoloration often can be removed by
applying a bleaching agent to the enamel of
the teeth. With a technique called "power
bleaching," the dentist applies a
light-activated bleaching gel that causes
the teeth to get significantly whiter in
about 30 to 45 minutes. Several follow-up
treatments may be needed.
It's also possible to remove discoloration
with an at-home bleaching gel and a mouth
guard given to you by your dentist. The
bleaching gels designed for use at home
aren't as strong as those applied by your
dentist at the office, so the process takes
longer — usually two to four weeks.
Whitening toothpastes may remove minor
stains, but they aren't very effective in
If you've had a root canal and the tooth has
darkened, your dentist may apply a bleaching
material to the inside of the tooth.
When a tooth has been chipped or badly
damaged, or when stains don't respond to
bleaching, your dentist may recommend
covering the discolored areas. This can be
done with a composite bonding material
that's color-matched to the surrounding
tooth. Another option is to get veneers,
which are thin shells of ceramic that cover
the outer surfaces of the teeth.
When To Call A Professional
Tooth discoloration is mainly a cosmetic
problem. Call a dentist if you're unhappy
with the appearance of your teeth. Any
change in a child's normal tooth color
should be evaluated by a dentist.
The prognosis is very good for extrinsic
stains. Intrinsic stains may be more
difficult or take longer to remove.
American Academy of Cosmetic Dentistry
2810 Walton Commons West - Suite 200
Madison, WI 53718
Phone: (608) 222-8583
Toll-Free: (800) 543-9220
Fax: (608) 222-9540
American Dental Association
211 E. Chicago Ave.
Chicago, IL 60611
Phone: (312) 440-2500
Fax: (312) 440-2800
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