FACT SHEET:
For New Zealand Cosmetic Teeth Whitening Association
Registered Teeth Whitening Practitioners
Authorised by the New Zealand Cosmetic Teeth Whitening Association [NZCTWA] with the professional support of the
Dentists, Chemists, Local Authorised Trainers and Global Teeth Whitening experts of NZCTWA Member Vendors including
the World's foremost Teeth Whitening authority Beyond Dental and Health and its Dentist Founder Dr. Jenny Shen DDS, and
Research Director Tara Erickson
A GUIDE TO TEETH STAINING & CAUSES
General Staining:
Coffee and Tea: It stains teeth destroying your naturally white smile. The heat from the
coffee can also cause small fractures in your tooth's surfaces. Try drinking cooler coffee
and use a straw or brush your teeth after drinking coffee or tea
Smoking will cause a build up on teeth that can cause a yellow to orange colour staining.
These stains can take longer to lighten.
Sugar Drinks: Sugar Drinks can be your teeth's worse enemy. The acid in pop can "eat"
your tooth's enamel to cause cavities. If you must drink pop try sugar free or use a straw.
A straw allows less sugary, tooth staining liquids to reach you front teeth.
Red Wine: Red wine can also discolour teeth over time
Types of Stains
EXtrinsic stains are stains on the EXterior of the tooth surface or, at most, penetrating
micro cracks and fissures, and can usually be removed by dental polishing.
Many extrinsic stains are pigments embedded in the calculus or plaque that has become
coloured from interaction with food debris, tobacco smoke, wine or other sources.
It should be emphasized that, although coffee, tea, wine, fruit juice, and tobacco are all
well known for their ability to cause staining, the colour that develops is from a chemical
reactions occurring in the plaque and does not necessarily imply anything about the colour
of the food itself.
Most common are yellow-brown to dark brown stains that probably caused by an
accumulation of dental plaque, food stain and poor oral hygiene.
Aging or inherit discoloration usually occurs in 9 out of 10 people. These stains usually
bleach quite readily as due yellowish discoloration, whether due to aging or tobacco
smoke, likewise responds well to bleaching.
INTRINSIC STAINING
INtrinsic stains are stains on the INterior of the tooth surface
Staining from aging takes our 1-hour to whiten.
Nicotine staining usually takes our 1-hour to whitening although better results are
achieved by having two cycles of 2-20minute treatments 1- day apart
Tetracycline Staining
Tetracyclines are a group of broad-spectrum antibiotics
Use of tetracycline (antibiotics) during the period of tooth
formation leads to its incorporation into the tooth structure.
The resulting appearance depends both on intensity of use
and the type of tetracycline employed.
Tetracycline stains are difficult to bleach, but will usually respond to prolonged
treatment.
When only part of the tooth is affected, patients can be
disappointed with the initial results: While the tooth is
lightened overall, the difference in shade between the
stained and unstained regions can be more noticeable, the
difference never entirely disappears.
Tetracycline stained Teeth may initially look worse because their more normal enamel
lightens more quickly than the discoloured areas.
Be patient when whitening these teeth, because good results will take some time and
make take several treatments.
Minocycline Staining
Minocycline is a semi-synthetic derivative of tetracycline often prescribed for the
treatment of acne or rheumatoid arthritis. Unlike tetracycline, however, it can stain teeth
even after tooth eruption.
Predicted whitening results are similar to those for tetracycline: Prolonged bleaching is
usually successful, but may be less than satisfactory when banding is severe.
Aging teeth develop secondary dentin over time, (usually beyond 50-years) which also
makes the teeth appear darker.
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FLUOROSIS due to Ingestion of fluoride
Ingestion of excessive amounts of fluoride during tooth
formation can lead to areas of lighter appearing enamel. This
is called FLUOROSIS
FLUOROSIS can appear as chalky white spots or patches in
the teeth of children given fluoride tablets during the ages of
5-15 as their adult teeth are erupting (growing and forming)
These spots are chalky white in appearance and, obviously,
cannot be bleached to match the surrounding enamel.
After eruption these teeth may fluoresce under UV light, but
this is a property that is generally lost with age and exposure.
The discoloration may be generalized or limited to a specific
part of the individual teeth that were developing.
It is sometimes referred to as 'mottled or marbled enamel'.
Cosmetic Teeth Whitening does NOT remove the white spots but lightens background so
they are less noticeable.
Secondary stains that occur around these white areas are readily bleached to produce an
appearance that, while not normal, may be less noticeable.
Sometimes fluorosis is accompanied by pitting and other surface defects that may
suggest veneering or bonding, perhaps following an initial bleach.
Occasionally, clients present with both Fluorosis AND Tetracycline staining
See Picture…
• Chalky White areas = Fluorosis
• Brown tooth base = Tetracycline Staining
Important Note: Sometimes when a client with quite
stained teeth presents for cosmetic teeth whitening, FLUORORIS can be hard to see
because the staining can mask it. Hence, it is important to discuss the risk that pre-existing
FLUOROSIS (and Tetracycline – see previous page) conditions may be discovered during
the cosmetic whitening procedure and cause their teeth to look mottled or marbled
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Treating Fluorosis Cases
Pre-treatment consultations are extremely important, especially when treating fluorosis
cases. The examination will allow an opportunity to check for possible fluoride spots and
inform patients ahead of the treatment that the tooth enamel will not be entirely even in
colour immediately following the treatment.
Uninformed clients will be surprised by the mottled appearance of the enamel
immediately following the treatment, and may be unhappy with the results.
In less severe cases, mottling may be limited to one or two white spots. However in
moderate to severe fluorosis cases, mottling can be more noticeable.
The white spots will become less noticeable within the 24-48 hour immediately following
the treatment as the post-treatment colour settles. Clients should be informed of this
before the treatment.
Treatment schedules should be designed based on the severity of fluorosis. Mild to
moderate discolorations can be treated during a single, in-office visit.
Severe cases should be treated with multiple, in-office visits
Ie:
Week 1: Three cycles, 20 minutes each cycle;
Week 2: Two to three cycles, 20 minutes each cycle
Natural Tooth Colour Variation
In addition to acquired discolouration, teeth naturally vary in colour.
Enamel is more or less translucent, allowing the underlying dentin colour to show through.
Normal variations in dentin structure can result in more or less light being reflected.
Variations in dentin structure can also, to a small extent, affect the colour of the reflected
light, as can materials that may be incorporated into the tooth structure.
These natural variations can make teeth look old. The teeth may yellow over time due to
pulp recession.
Trauma
Perhaps the most common cause of post-eruptive intrinsic staining is trauma.
Dentists sometimes refer to this staining as a ‘dead tooth’, which may not be entirely
correct.
Trauma is usually accompanied by haemorrhage, producing a rise in pressure within the
pulp cavity that forces the extravasated blood into the dentinal tubules. Such tooth
trauma can be caused by a knock or dentist practise during some filling types or root canal
work
This will initially produce a pink colour. As the haemoglobin breaks down, however, it is
converted to black iron sulphide. Even though this is an inorganic pigment, it responds
well to bleaching.
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Trauma may also produce necrosis of the pulp, with or without accompanying
haemorrhage. Various by-products of protein degradation will migrate into the tubules,
producing a greyish-brown colour that is less intense than that due to haemorrhage. The
stain will be lighter when the necrotic material is removed promptly.
This stain will usually respond well to non-vital bleaching techniques. Note however that
not all pulpless teeth will discolour.
Black line stain, most frequently found on the lingual surfaces (The surface of a tooth that
faces the tongue) one millimetre above the gingival (gum) margin. It is a metabolic stain
and is frequently found in clean mouths.
Metallic stains can be absorbed into plaque by inhaling the fumes of metallic salts.
The colour varies from green to bluish-green to brown according to the metal the
individual was exposed to. Green stains can also be the result of decomposed
haemoglobin and inorganic elements like calcium, potassium, sodium, silicon, magnesium,
phosphorous and other elements in small amounts. This type of stain often overlies
demineralised tooth structure.
Once extrinsic stains are removed, oral hygiene techniques will be reinforced to minimize
extrinsic stain reoccurrence.
Tongue Piercing.
Cheap tongue piercing can create metallic stains in teeth.
This presents as a ‘grey teeth’ and is almost impossible to
remove
Latrogenic discoloration.
Latrogenic means “as a result of treatment” is this case
previous dental treatment
Dental materials can also result in tooth discoloration. Sometimes this can be as simple as
the colour of the restorative material showing through the translucent enamel.
It is possible for restorations to discolour adjacent tooth surfaces as they deteriorate and
release various metal ions. The presence of recurrent decay beneath the old or leaking
restoration can also result in a darkening of the tooth.
Once the defective restorations are replaced, any remaining stains should respond well to
bleaching.
Various other materials used in dentistry, such as…
• Amalgam (grey/black);
• Silver nitrates (black stain),
• Iodine (brown);
• Essential oils (yellow/brown);
• Aureomycin (Tetracycline) (yellow/brown),
• And silver-containing root canal sealer (black) can also cause stains under some
circumstances.
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