IMAGINE how difficult it would be to live a life where you have to conceal your teeth whenever you want to smile?
You instantly extend your arm in an attempt to hide your teeth whenever you do anything that exposes them to the public.
Insecurity about one’s oral health is common, particularly when it comes to tooth discolouration as it can be both aesthetically unappealing and psychologically traumatising.
It can erode the sparkle from a smile.
Most people, who have discoloured teeth are constantly anxious and shun elaborate conversations in new social situations.
This thwarts their self-esteem and reduces chances of reaching their full potential as individuals.
The sooner we develop strategies to prevent and treat this widespread issue, the better.
People often believe that poor oral hygiene, tooth decay or plaque accumulation are the only causes of tooth discolouration.
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This misconception stems from lack of dental literacy.
Therefore, in this particular submission, we will unpack the intricacies of tooth discolouration.
Where does tooth discolouration come from or how does it come about?
Although the causes of tooth discolouration are numerous and intricate, they are typically categorised as internalised, extrinsic or intrinsic.
The cause distinguishes internal stains from intrinsic discolouration.
When chromogens — the coloured molecules or architects of discolouration — are deposited in the tooth’s bulk, typically in the dentine (second layer), intrinsic discolouration results.
These colourings frequently originate from the pulp of the tooth.
This type of discolouration can emanate from a variety of endogenous or exogenous causes, including changes that occur during or after tooth development (odontogenesis).
During odontogenesis, teeth may become discoloured due to changes in the quantity or quality of enamel or dentin, or from the incorporation of a discolouring agent into hard tissues.
It could also be due to lack of a nutritious diet during pregnancy.
Intrinsic causes may include:
Metabolic factors: Alkaptonuria, an inborn metabolic error that causes brown discolouration and red or purple discolouration;
Hereditary factors: Amelogenesis imperfecta, a condition that disrupts the mineralisation or enamel formation; the colour is typically yellow to brown to dark yellow and affects both primary and permanent dentitions;
Latrogenic factors: These are effects inadvertently caused by a doctor, surgeon, medical treatment or diagnostic procedures; for instance tetracycline staining is the result of systemic drug administration and its subsequent chelation to form complexes with calcium ions on the tooth surface.
Children below the age of 12, expecting and nursing mothers should refrain from taking tetracycline to prevent discolouration of developing teeth.
Tetracycline affected teeth have a band-like appearance on the enamel and might vary in colour from yellow to grey.
Fluoride in mouthwashes, pills or toothpastes as a supplement or naturally existing water sources can cause fluorosis.
This kind of staining is typically limited to the enamel and can take the form of chalky white, dark brown/black, or widespread opaque mottling with flecking patches.
This only happens during tooth eruption phase, be it primary or permanent teeth in children under the age of eight.
In adults, dental fluorosis cannot occur since their enamel is fully developed.
For children under six, parents should exercise caution while using fluoride toothpaste (children under three should use a rice grain-sized amount and those aged three to six should use a pea-sized amount).
Additionally, keep an eye on the fluoride level of the water children drink, whether it comes from a well or in bottled.
On the other hand, “stain internalisation” encompasses situations in which extrinsic stain penetrates the tooth via structural flaws (extrinsic stain internalisation).
These external stains are absorbed into the tooth’s enamel or dentine as a result of trauma or a developmental abnormality.
Teeth that have more of the yellow dentine visible due to dentine exposure or enamel loss appear darker.
Cracks caused by gingival recession, which occurs when the gums and exposed dentine make teeth more susceptible to internalisation of extrinsic stains or damage to the enamel.
For example, when the tooth structure has been weakened, such as after a dental filling or other treatment, or when there is tooth decay.
Causes of discolouration associated with ageing
Teeth naturally become dark and yellowish as people age, and their light-transmission characteristics change.
The enamel thins as a result of tooth decay and because the dentine is darker than the enamel, the dentine colour becomes more noticeable when the enamel becomes weak and transparent.
Topical or extrinsic substances can induce extrinsic discolouration, which is characterised as darkening on the outside of the tooth structure.
This can be direct or indirect topical discolouration.
Direct staining results from substances that are integrated into the pellicle layer, which is the outermost layer of teeth and is caused by the chromogen’s basic colour.
With chromogens originating from either diet or items routinely placed in the mouth, direct staining has a multifactorial cause.
On the other hand, a chemical reaction on the tooth surface results in indirect staining.
It is typically linked to excessive use of metal salts and cationic antiseptics (chlorhexidine, which becomes brown to black).
These substances either have no colour or have a colour that differs from the stain that is created on the tooth’s surface.
Conventionally, extrinsic tooth discolouration can also be categorised as metallic or non-metallic based on where it originated.
Tea, coffee, tobacco, mouthwashes, chlorhexidine, and some medication can produce non-metallic extrinsic stains that are absorbed onto the tooth surface by integrating into the plaque or acquired pellicle.
In youngsters poor dental hygiene, chromogenic bacteria have also been linked to extrinsic staining (orange and green stains).
Management of coffee-induced discolouration
Since coffee is a staple beverage for most people, it is advised to drink water after consuming it.
Even a small sip of water may make a big difference.
You should brush your teeth before drinking coffee rather than after.
Tooth discolouration can be treated by either professional teeth whitening or individual teeth whitening at home.
For individual teeth whitening, the patient is recommended to use whitening toothpaste or tooth whitening strips.
Tooth-whitening strips should only be used once or twice a day for 15 minutes over the course of two weeks.
Internal and external stains can be removed much more effectively with tooth-whitening strips than with whitening toothpaste.
Whitening toothpaste works exclusively on external stains and should be used for no more than two months; once the stains have disappeared, the use of such toothpaste should be ceased.
Excessive use of these whitening techniques may cause gum inflammation and tooth hypersensitivity.
Professional teeth whitening is primarily required for intrinsic discolouration; however, professional oral hygiene may be very beneficial for extrinsic discolouration.
- Patience Matambo is a final year BSc Dental Surgery student at the People’s Friendship University of Russia. She can be reached at patiencedental2024@gmail.com
