Discoloration of the enamel, dark spots on the surface of the teeth is a common phenomenon. Their shape, size, location vary — and these are the diagnostic criteria by which the dentist can make a diagnosis and prescribe treatment. Why dark spots appear on the teeth, what treatment is needed — MedAboutMe will answer all your questions.
There are quite a few reasons for changes in the color of teeth and enamel: violation of oral hygiene, abuse of coloring drinks and foods, age, and much more. It is possible to single out the most obvious, which are most common — carious or non-carious lesions, poor oral hygiene, etc. There are also less obvious ones, and it cannot be said that they are less common.
External causes: food and bad habits
Many dark-colored foods and drinks contain so-called chromogens. Like tannins, they stain enamel. With regular use of such products, the spots on the enamel become more pronounced and darker. Poor oral hygiene can worsen the situation.
Foods and drinks that are most likely to cause staining of enamel include:
Coffee lovers often have a pronounced and dark plaque on their teeth. Instant coffee is more dangerous in terms of staining. The tea contains tannins, which give the enamel a yellow-brown color. By analogy with instant coffee, tea bags are the most dangerous due to the inclusion of dyes and other artificial components.
Studies show that it is white wine that causes the greatest harm: it contributes to the appearance of microcracks and even erosion of the enamel. Red is recognized as more “useful”, but it contributes to enamel staining due to tannins.
- Sodas and juices
These drinks not only stain the teeth, but also contribute to the leaching of calcium from the structure of the enamel. Some fruit and berry juices are also one of the causes of tooth staining and especially fillings with frequent use.
- Sauces and condiments
Soy sauce and other seasonings that have yellow and brown tints are on the list of foods that stain teeth.
- Sweet desserts
Due to the inclusion of dyes in some of them, the probability of staining the enamel is quite high.
Tobacco smoke contains over 400 compounds, resins that stick to the teeth. In dentistry, there is such a thing as a smoker’s plaque. This is a dense coating of dark, literally black shades, rather sticky and quickly formed. Smoker’s plaque is formed when smoking conventional and electronic cigarettes, chewing tobacco, over time it becomes more and more dense and more difficult to remove.
How nice it would be if precious stones grew on the teeth! But there is no such thing! More than 700 types of microorganisms live in the oral cavity, which constantly mix with saliva and food particles, forming a sticky, transparent film — plaque. Partially, it is removed after brushing the teeth, but only partially.
No toothbrush and paste can provide 100% plaque removal! And over time, it accumulates, hardens and turns into tartar. There are a number of factors that accelerate the formation of tartar and ensure its tight attachment and dark color:
- lack of oral hygiene;
- salivation disorders;
- hormonal changes accompanying puberty, pregnancy, menopause;
- dry mouth caused by various reasons: illness, medication, etc.
The formation of plaque occurs rather slowly, but surely. It is worth remembering that this is one of the causes of tooth decay, gum disease and a number of other problems. You can get rid of plaque only in the dentist’s office using professional tools and techniques.
Tartar removal is a procedure that can improve the color of the enamel by several shades and get rid of dark spots on the enamel, especially in the cervical region.
Perhaps this is the most common cause of dark spots on the teeth of various sizes, configurations and shades. Caries has favorite places of formation — natural depressions, areas where plaque can accumulate:
- fissures of chewing teeth;
- contact surfaces (between teeth);
- cervical region.
Less commonly, caries is formed on the «immune zones» — the mounds of chewing teeth, the cutting edge of the central ones.
Caries is a staged process, and this reflects the size and color of the spot, although they largely depend on the area of formation. For example, staining of fissures does not always indicate caries, but it is necessary to consult a dentist. With the formation of caries in the cervical region, the staining of the tooth occurs quite quickly: a dark spot appears, and as the pathological process develops, the tooth appears gray.
The appearance of dark spots around previously installed fillings is a reason to immediately seek medical help. Such symptoms indicate the formation of recurrent or secondary caries.
Non-carious diseases of the teeth are enamel lesions that are not associated with caries, but may manifest similar symptoms: dark spots, cavities and indentations. In clinical practice, there are several types of non-carious lesions.
Hypoplasia is the underdevelopment of enamel, which is formed even at the time of the development of the teeth, that is, before their eruption. In clinical practice, it is customary to distinguish several forms of the disease, which differ in symptoms and manifestations:
The most common, it is characterized by the appearance of spots from a pale yellow to a dark shade. In this case, the thickness of the enamel does not change.
Indentations are formed on the enamel that resemble cups. The surface of the spots is smooth, the color is predominantly yellow, but of various shades.
Grooves of different depths are formed, at their bottom the enamel is thinned, and the spots become darker.
This is a complex form of hypoplasia. In some areas of the teeth, enamel is completely absent.
Combines the symptoms of different forms of hypoplasia.
There are also less common forms of hypoplasia. For example, Hutchinson’s teeth: in this case, the incisors are affected, they become barrel-shaped, and the edges become crescent-shaped. Fournier teeth: the molars become cone-shaped, and the enamel becomes bumpy. The reason for the appearance of such a pathology is intrauterine infection with syphilis.
An even rarer form of hypoplasia are tetracycline teeth. The pathology is congenital, and the reason is the intake by the future mother of antibiotics from the group of the same name. Clinically, these are teeth with a dark, literally black color.
Fluorosis is a non-carious disease of the teeth that forms during mineralization, that is, even before eruption. And the reason is an excess of fluorine.
The main source of fluoride is drinking water. WHO has set standards for fluoride in drinking water — 0.8-1.2 mg/l. Unfortunately, such dosages are not observed, and in most regions of Russia, the concentration of fluorine in water does not even correspond to the lower limit of the norm. Only in a few regions the concentration is normal and exceeds the norm: in some regions of the Moscow region (Egorievsk, Krasnogorsk), in the Penza, Tver regions (from normal to overestimated), in the Republic of Udmurtia.
Symptoms of fluorosis can vary and depend on the form: in severe cases, fluorosis contributes to persistent dark staining of the teeth, the formation of grooves, pits and stains. The symptoms of fluorosis and caries are similar, but where there is fluorosis, there is no place for caries.
After each meal, the enamel is erased by a few microns. In young people and children, enamel is quickly restored with the help of saliva, which saturates it with minerals. But with age, such processes are not so effective, and the enamel begins to wear off.
It is due to such age-related changes, as well as other factors, that dark, persistent spots begin to appear on the enamel, which are difficult to remove. But it is quite possible to correct the situation: after examination, the dentist can offer several treatment options.
Each of us has his own, individual color of teeth: some are lighter, others are darker. But some genetic anomalies can have a more pronounced effect on tooth color and stain formation. Of course, such pathologies are rare, but they are difficult and require long and complex treatment.
- amelogenesis imperfecta
This is a hereditary disease characterized by impaired mineralization and matrix formation. In clinical practice, it is customary to distinguish 14 types of amelogenesis imperfecta, which are more often inherited in an autosomal dominant manner. Symptoms range from the appearance of slight light spots to severe, which are characterized by extensive damage to the enamel with dark spots.
- Imperfect dentinogenesis
The teeth may have a bluish or brown color, these are not spots, but the full color of the surface of the teeth. Imperfect dentinogenesis is combined with imperfect osteogenesis. Outwardly, the teeth are quickly erased, but at the same time secondary dentin is formed, which protects the tooth pulp. The diagnosis is usually made in childhood.
Long-term use of certain medications is also one of the reasons for the formation of dark spots on the teeth. Among the «dangerous» drugs include tetracycline antibiotics, drugs prescribed in the treatment of diabetes, etc.
Rogova Natalya Mikhailovna, dentist
External staining of enamel may be associated with occupational hazards, namely exposure to metal salts, as well as taking medications that contain them. For example, foundry workers who are constantly in contact with iron supplements can develop dark teeth, literally black, which has been proven by many observations and studies.
Prolonged contact with copper is the cause of the formation of spots with green tints. Contact with other metals, such as potassium permanganate, causes persistent dark purple and black stains.
Even more interesting is a study that links darker teeth staining to the use of chlorhexidine, which is found in mouthwashes. It is quite difficult to establish the exact staining mechanism, because its intensity varies. One theory is that chlorhexidine is broken down in the mouth to form parachloroaniline, fueled by dysbiotic changes in the mouth that increase the concentration of coloring compounds produced by bacteria. But research is ongoing, and their main task is to establish the exact staining mechanism and determine the role of concomitant factors.
What treatment is needed?
Treatment tactics depend on the cause of the discoloration of the enamel. For example, in one case, a change in diet, a rejection of bad habits will be recommended, in others, more complex and lengthy treatment is needed. But in any case, the first thing to start with is professional oral hygiene and teaching the rules of brushing your teeth at home. What treatments can dentists offer?
The main task of whitening is to make a smile radiant and give confidence to its owner. However, there are a number of medical indications for whitening. As a rule, these are non-carious lesions — mild forms of hypoplasia and fluorosis that occur without violating the integrity of the enamel.
Nevertheless, in some cases, whitening is ineffective: tetracycline teeth, aplastic hypoplasia, severe forms of fluorosis.
In more complex cases, when the stains on the teeth are quite pronounced or there are defects in the enamel, whitening alone cannot be enough. It is necessary to close enamel defects, thereby preventing the development of caries and even more tooth decay.
Artistic restorations are tools that will not only restore the enamel and aesthetics of a smile, but also prevent further tooth decay. Nevertheless, even filling in some cases is not an option: “heavy artillery” will be required.
There are several types of prosthetics — the installation of veneers, lumineers (microprosthetics), as well as the installation of crowns and even prostheses (classic prosthetics).
Veneers are thin plates that not only cover the aesthetic defect, but can also correct the shape and size of the tooth. This method of treatment can be recommended even in the case of a pronounced enamel defect, for example, with aplastic hypoplasia or complex forms of fluorosis. But the decision is made individually, because severe fluorosis makes the teeth brittle.
In more complex cases, such as tooth abrasion, amelogenesis imperfecta and dentinogenesis imperfecta, prosthetics are the only treatment option. Only with the help of crowns it is possible to stop the process of enamel erasure and tooth decay, to return to patients the opportunity to fully chew food and smile.
In most cases, discoloration of the teeth and the appearance of stains can be avoided by following certain recommendations. So, the American Dental Association has formed a few simple rules that must be strictly followed:
- brush your teeth twice a day with fluoride toothpaste
- use additional hygiene products: flosses, irrigators, rinses;
- regularly visit the dentist for preventive manipulations: brushing teeth, remineralization of enamel, etc .;
- to refuse from bad habits;
- limit sweets and «fast» carbohydrates, include in the diet fresh vegetables, fruits that require careful chewing.
Natural car enamels, dentine reactions, dentinal fluid and biofilm / Laryssa de Barros Pinto, Maria Luiza Lima Alves Lira, Yuri Wanderley Cavalcanti // british dental journal — February, 2019 — volume 9, Article number 2841
Imperfect amelogenesis — lifelong management. Restorative management of an adult patient / M. Patel , ST McDonnell ,S. Iram // british dental journal — November, 2013 — Volume 215
Tooth discoloration and staining: a review of the literature / A. Watts, M. Addy // british dental journal — March, 2001 — volume 190