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Teeth Staining Prevention and Treatment: If the teeth are healthy on the outside as well as on the inside, pearly white teeth are attainable.

Teeth staining, or discoloration is a huge concern among people who are invested in pearly white teeth. Even celebrities with beautiful white teeth have to deal with staining at times. When patients come to you with concerns, you can use the following information to both educate and help them avoid and mitigate stains.

Teeth staining varies in terms of what causes yellow, black, or even brown discoloration. In order to determine the cause of teeth staining, it's important to understand extrinsic and intrinsic staining. By learning these two concepts, we can then distinguish the real reason behind yellow or discolored teeth and find a resolution such as whitening gel or hydrogen peroxide without damaging the teeth and their anatomy.

Extrinsic Stains

The good news is that extrinsic teeth staining can be corrected because it is outside of the teeth. In other words, the stains are on the enamel surface of the tooth, which is the first anatomical layer of the tooth. Certain foods and drinks, as well as smoking, can lead to extrinsic staining. However, if excessive smoking continues, it can become intrinsic and harder to remove with a toothbrush or at a dental clinic by a dentist or a hygienist. Certain foods and drinks that can cause extrinsic staining include wine (both red and white), coffee, chocolate, black or green tea, candies, juices, or even certain vegetables, such as beets and turmeric. Some dental fillings can also catch stains on the outside of the enamel because of the abrasiveness of the fillings. A hygienist or a dentist can polish the fillings during dental visits, or good home care will also do the trick.

So, how can patients avoid extrinsic discoloration, while still enjoy a nice cup of hot chocolate, coffee, or tea? By consuming these things in moderation, as well as brushing or flossing within 30 minutes after eating so that the acid from the foods and drinks does not penetrate any further. Even using water or antibacterial mouthwash right away could help remove the bacterial plaque. Drinking juices, such as cranberryjuice, with a straw is a good choice because it limits the liquid's contact with the teeth. Chewing sugarless gum can help with neutralizing the acid in the mouth, as saliva plays a role as a cleaning buffer.

Using whitening gel or strips can help to whiten teeth, but should be used with caution because they are very abrasive; the pH of hydrogen peroxide is about 4.5 and can be bad for the mouth, which has a normal pH of about 7.5. The main ingredient in whitening gel is carbamide peroxide and when it touches the saliva in the mouth, it breaks down and becomes hydrogen peroxide. Because hydrogen peroxide is considered abrasive--almost like bleach--if teeth have large enough cavities, the hydrogen peroxide can cause a very rare anomaly called internal resorption, or loss of tooth structure within the root. It can also cause further decay of the tooth or corrode tooth structure. It's important for patients to discuss the percentage of hydrogen peroxide with a dentist when deciding to whiten extrinsic teeth staining or determine how sensitive their teeth are, as well as fill any cavities prior to whitening treatment. A whitening toothpaste may also be recommended depending on the severity of the discoloration.

Intrinsic Stains

Intrinsic staining is a bit more complicated, because the staining is on the inside of the tooth, or where the dentin is exposed, and does not usually go away. Among the intrinsic staining culprits are tetracycline antibiotics used by the mother, which might affect the child in utero during teeth development. The tetracycline discoloration can vary, but most of the time it is brown or greyish in pigmentation. Trauma to the tooth can also cause staining, as well as internal bleeding causing red or brownish discoloration of a deciduous or permanent tooth, requiring an emergency visit to the dentist. A child (particularly before age 8) could be exposed to too much fluoride, called fluorosis, which can leave teeth mottled and brownish inside the enamel and dentin. Another rare but serious teeth condition is dentinogenesis imperfecta, which is a congenital tooth development disorder in which the teeth are discolored from blue-grey to brownish color, effecting the dentin.

To permanently remove intrinsic staining, a crown or veneers can be suggested by the dentist, as it provides a cosmetic option for the discoloration. For teeth that are damaged due to a fall or injury of the nerve, a root canal is the most appropriate, although a brown stain may still be visible. The best option to prevent intrinsic staining in children is to avoid too much fluoride and tetracycline antibiotics for the mother.

Clearly, multiple factors can influence teeth staining. Some of the additional factors are head and neck radiation, which can make teeth more yellowish, and genetics as some people can have more of a yellow tone than others. Other factors may be dental materials-some fillings, such as amalgam, can cause intrinsic staining of grey-black color--and aging. As we age, the enamel gets more brittle and wears away, and because dentin is naturally yellow or grey in color, it becomes more exposed.

Your patients' best choice for managing both extrinsic and intrinsic staining is to discuss options with the dentist to determine the best treatment and course of action. As a first step, you might suggest meticulous home care and regular dental checkups. Caution patients against brushing the teeth too hard because this practice can wear away the enamel, exposing more of a yellow dentin; using an electrical toothbrush may be more appropriate.

Pearly white teeth aren't hard to obtain. Many options are available, as long as the teeth are healthy on the outside as well as on the inside.

By Albina Babakhanov, BS, RDA

Albina Babakhanov, RDA, based in Boston, MA, first received her dental assistant certificate in 2005 at Bryman Institute, as well as her associate degree in science concentration at Bunker Hill Community College. She has worked in various dental offices, and has more than 10 years of dental experience. She recently earned her B.S. degree in health studies and public health at University of Massachusetts, Amherst. She enjoys learning about science and has passion to further explore the field of dentistry.

Resources

1 .Teeth Stains: Causes, Types, and How to Remove Teeth Stains, (n.d.). Retrieved from https://crest.com/en-us/oral-health/conditions/teeth-stains/teeth-stains-causes-types-how-remove-teeth-stains

2.10 Signs You Need to See Your Dentist, (n.d.). Retrieved from https://www.activebeat.com/your-health/10-signs-you-need-to-see-your-dentist/2/

3. How Does Dental Whitening Gel Work? (n.d.). Retrieved from https://www.colgate.com/en-us/oral-health/cosmetic-dentistry/teeth-whitening/how-does-dental-whitening-gel-work-0914
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Author:Babakhanov, Albina
Publication:The Dental Assistant
Geographic Code:1USA
Date:Jan 1, 2019
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