Discolored Teeth

Content Reviewed by AEDIT Medical Advisory Board

Overview

Today’s society is concerned with appearances and youthfulness. Discolored teeth take away from physical attractiveness, and thereby cause many people to feel awkward in public and engage in less socialization.

Resultantly, people have been developing ways to correct stained teeth for many centuries. Today, teeth discoloration correction has evolved into a very sophisticated scientific discipline. Dentists and dental hygienists use various techniques and professional products to create attractive smiles for their patients.

Further, the teeth are important for much more than contributing to physical attractiveness. According to Medscape, they are needed for nutrient intake, communication, and defending ourselves from various microbes that could cause us illness.

This article reviews the types and causes of tooth discoloration, as well as how to prevent and treat it when possible. Learn more about professional dental treatments, at-home teeth whitening kits and over-the-counter teeth bleaching products, as well as some effective and affordable natural products that work against teeth stains and improve oral health.

Terminology & Definitions

In order to understand the causes of and possible treatments for tooth discoloration, it is helpful to have an understanding of the terminology used to describe it. Following are some of the most common tooth anatomy terms:

Canine (cuspid): Pointed teeth used to tear food. 2 upper and 2 lower. Crown: The visible portion and top of a tooth. Dentin: Bony, yellow tissue under the enamel that forms the bulk of a tooth. Enamel: The outer layer of a tooth and the hardest, most mineral-rich tissue in the body. Incisor: Chisel-type front teeth used to cuts foods. 4 upper and 4 lower. Molar: Back teeth with several cusps used for grinding food. 6 upper and 6 lower. Premolars (bicuspids): Double-cusped teeth used for crushing food. 4 upper and 4 lower. Pulp: Soft tissue in all teeth where blood vessels and nerves are found. Root: The lower ⅔ of teeth that are embedded in the jaw bones.

Different Colors of Teeth Stains

While yellow stained teeth may be the most common color, there are various other stain colors that occur. Teeth discoloration can be white, grey, yellow, orange, red, purple, brown, black, and green. The hue of discoloration, and how to best correct or manage it, depends on the cause.

Types of Teeth Stains

Teeth discoloration can occur just on the surface of the tooth enamel, or deeper into the teeth in the dentin, or both on the enamel and in the dentin.

There are a few different types of teeth stains recognized by dental professionals. They are intrinsic stains, extrinsic stains, and age-related stains.

Intrinsic Teeth Stains As the name suggests, intrinsic tooth discoloration occurs inside of a tooth, underneath the enamel. It happens when stain-causing substances make their way through the enamel, and then, into the inner region of the tooth called the dentin.

This type of tooth staining typically causes a yellow or grey tint to show through the translucent enamel. Excessive fluoride exposure is a primary cause, particularly in children.

Extrinsic Teeth Stains Extrinsic tooth discoloration occurs on the exterior of a tooth, on the surface of the enamel. Enamel stains can be white streaks, brown pits or spots, and yellow tints. It occurs when pigmented substances accumulate on the protein-based film that coats the enamel.

Extrinsic staining is commonly caused by the consumption of certain foods and beverages and using tobacco products.

Age-Related Teeth Stains Age-related tooth discoloration typically presents as a combination of extrinsic and intrinsic staining. It occurs progressively with age as the dentin naturally darkens and the enamel gets thinner.

Teeth Discoloration in Kids Relatedly, intrinsic tooth discoloration in children can result from the maternal use of tetracycline antibiotics during the 2nd and 3rd trimester of pregnancy.

Children may also develop stained teeth from using either doxycycline or tetracycline antibiotics during their teeth are fully developed, which normally occurs by age 8.

The Mayo Clinic reports that tooth discoloration in babies and children is most commonly caused by:

• Poor dental hygiene
• Physical trauma that causes tooth injury
• Using fluoridated water to mix infant formula
• Use of pediatric medications that contain high levels of iron
• Maternal use of tetracycline antibiotics during pregnancy or breastfeeding
• Hyperbilirubinemia, an illness marked by high levels of bilirubin in the blood

Ensuring adequate oral hygiene and a healthy low-sugar diet are two excellent ways to prevent extrinsic tooth discoloration in young children. Intrinsic stains most often require professional whitening services or dental restorations like crowns and veneers.

Teeth Stain Causes

There are various causes of teeth stains, including some food and beverages, medications, diseases, environmental pollutants, genetics, root canal treatments and other sources of dental trauma, aging, and poor oral hygiene.

Foods and Beverages Certain foods and drinks can stain teeth and affect tooth color. Some of the ones to avoid in order to prevent surface stains and keep your white teeth white are:

• Balsamic vinegar
• Tomato sauce
• Sports drinks
• Dark berries
• Soy sauce
• Popsicles
• Red wine
• Potatoes
• Cherries
• Coffee
• Beets
• Cola
• Tea

Tobacco Products Smoking, chewing, or other uses of tobacco products stain the teeth. Further, these products are all associated with various possible health risks, including cancer and heart disease.

Nicotine, tar, and other staining compounds in tobacco penetrate into the millions of tiny pores in the teeth. Chronic use of tobacco can stain the teeth deeper than the enamel, into the dentin underneath.

Nicotine is a colorless compound. However, it turns yellow when combined with oxygen. As oxygenated nicotine accumulates on the enamel, it causes yellow/brown stains to appear.

Chewing tobacco causes heavy enamel staining as the dark liquid produced by tobacco juice and saliva mixed together saturates the teeth.

Tobacco stains are some of the most difficult to remove because, in many cases, the user has gone on for decades before stain correction is pursued.

Dental Treatments

Some dental procedures can cause the teeth to become discolored. For instance, the placement of silver amalgam fillings of other restorations can produce a grey/black hue in the teeth. Procedures such as a root canal is a dental procedure used to replace infected tooth pulp with an inert material. It causes deep tooth trauma and can damage or kill nerves inside the tooth. Root canal treatments also commonly cause grey or brown tooth discoloration.

Further, previous dental restorations that are failing or have failed can cause yellow, green, black, brown, and grey stains on the teeth.

Over the counter teeth, whitening products are not typically effective for correcting discoloration in failed dental restorations. In such cases, a dentist may recommend professional whitening services and/or the application of new dental restorations.

Prescription Medicines Various drugs can cause tooth discoloration. Some examples include:

• High blood pressure drugs like diuretics, ACE inhibitors, and calcium channel blockers
• Antihistamines like Dimetane®, Zyrtec®, Claritin®, Allegra®, Alavert®, and Benadryl®
• Antidepressants like Zoloft®, Prozac®, Celexa®, Luvox®, Paxil®, and Lexapro®
• Broad-spectrum antibiotics like amoxicillin, ampicillin, and augmentin
• Chemotherapy drugs like Taxol®, Nipent®, Alimta®, and Cisplatin®
• Head and neck radiation treatments

Fluoride Fluoride is a salt with a fluorine base. Fluorine is an elemental gas. It is pale yellow and poisonous. Like chlorine, bromine, iodine, and astatine, fluorine is a halogen. It is highly reactive and causes severe burning if it comes in contact with living tissues.

We all are exposed to minute amounts of fluoride from various environmental sources. Some of these include fluoridated water, foods grown in fluoridated soil, toothpaste, mouth rinses, and oral supplements that contain it.

Fluorosis is typically developed during the tooth-forming years. It commonly causes the teeth to develop brown and/or white spots and/or lines.

In the US, fluoride is added to the public water supply in an effort to keep tooth decay rates low. However, there has not been enough research to determine if fluoride really helps to counteract tooth decay.

Concerning fluorosis prevalence, the CDC reports, “Less than one-quarter of persons aged 6-49 in the United States had some form of dental fluorosis.” However, this statistic was based on data from 1999-2004.

According to 2017 research from the University of Washington, “A growing number of parents are refusing topical fluoride for their children during preventive dental and medical visits.”

While there are some possible health benefits associated with fluoride, it is also linked to various possible adverse health effects, including its capacity to discolor teeth. Overexposure to fluoride can cause a chronic condition called fluorosis, which is marked in part by mottled (spotted) teeth.

Talk with a dental professional about the safety of fluoride, and about ways to limit your exposure to it without increasing your risk of dental caries.

Aging Process As we age, our enamel is slowly worn thinner. This allows the yellow-pigmented dentin underneath the enamel to show through the enamel, causing the appearance of a yellow stain. Aging also exposes us to greater amounts of teeth-staining foods, beverages, and other substances that contribute to discoloration and darkening.

Correcting Teeth Stains: Treatments, Remedies, and Other Options

Colgate® reports that success in correcting teeth stains depends on the type and severity of the stain, and the treatment method used. A dental hygienist or dentist can help to develop the best plan to combat discoloration.

An evaluation of the patient’s oral health is required, and then, common dental problems like gum disease and gingivitis will need to be treated before beginning to address teeth discoloration.

In many cases, extrinsic stains, like those caused by coffee and tobacco products, can be effectively treated with whitening toothpaste, gels, or strips. More stubborn extrinsic stains often respond well to laser teeth cleaning, pharmaceutical-grade hydrogen peroxide treatments, or in-office whitening services.

Intrinsic teeth stains are typically more challenging to correct because they have penetrated past the enamel into the dentin. In some cases, intrinsic stains can be treated with whitening strips or other at-home products. However, in many cases, this type of inner tooth discoloration requires professional dental services, possibly including the placement of dental veneers.

Professional In-Office Teeth Bleaching reports that many extrinsic and some intrinsic teeth stains can be removed or significantly reduced by the application of a hydrogen peroxide bleaching gel to the surface of the enamel. This is performed by a licensed dental hygienist or dentist, takes about an hour, and costs up to $700.

Note that this type of stain correction is not for everyone. Depending on the condition of the patient’s teeth, composite bonding, dental veneers, or dental crowns may be better options.

In-office teeth whitening may is not typically effective for removing discoloration caused by fluorosis, the use of tetracycline antibiotics, tooth nerve damage or other facial trauma.

Teeth whitening isn't permanent. It can last from a few months to up to 3 years, but this varies from person to person. Generally, the whitening effect won't last as long if you smoke or drink red wine, tea or coffee, which can all stain your teeth.

Laser Teeth Whitening This cosmetic dentistry procedure is much like regular in-office bleaching. A concentrated hydrogen peroxide gel is individually applied to each tooth in the esthetic zone, and then, a laser is used to generate heat and cause the gel to activate more effectively.

Although the price will depend on your dentist and the discoloration of your teeth, you can expect to pay around $1,000 for the procedure. Being a cosmetic treatment, it is not covered by most insurance plans.

Dentist-Dispensed At-Home Bleaching Kits While in-office teeth bleaching and laser teeth whitening treatments produce fast, effective results for reducing tooth discoloration, dentist-dispensed bleaching kits for home use may be more effective for the long term.

A dentist or dental hygienist can fit you for a custom mouth tray. This can be used without supervision, at home, to reduce teeth stains and keep them from redeveloping.

Generally the kits provide enough gel for one two-week treatment per year, plus one- or two-day touch-ups every four to six months.

Dental Crowns, Bonding, and Veneers Extremely discolored teeth may not respond to either professional or at-home whitening kits. This degree of tooth staining is most commonly caused by fluorosis, the use of antibiotics and other drugs, and root canal procedures. Instead of bleaching, some people need:

• Composite Bonding (color-matched plastic resin)
• Dental Veneers (thin coatings of composite resin or porcelain)
• Dental Crowns (“caps” for teeth made from porcelain, ceramic, or metal)

Veneers, crowns, and bonding are very useful in cases of facial trauma that damage the oral region. They effectively improve the appearance and strength of cracked, chipped, or gapped teeth as well as covering up existing teeth stains.

Over-the-Counter Teeth Stain Treatments

Various types of OTC teeth stain removal products are available including whitening strips, toothpaste, mouth rinse, paint-on liquids, chewing gum, and dental floss. They use bleaching agents that are not as potent as in-office and dentist-dispense whitening kits, some with as low as 1% concentration.

Over-the-counter teeth bleaching products are not commonly effective for intrinsic teeth stains, or severe extrinsic stains. They are best used for superficial extrinsic stains like those caused by foods and tobacco. They may also be helpful for mild cases of medication-induced staining or fluorosis.

These products are widely available in stores, require no prescriptions or professional supervision, can be used at home, and are affordable for most people with pricing from $4 to $100.

Natural Treatments for Teeth Discoloration

There are various natural products that are purportedly effective both for improving oral health and removing stubborn teeth stains. You should ask your dentist or hygienist if they are safe for you before beginning to use any of them.

Some of the best natural teeth stain removers are:

• Organic Coconut Oil
• Apple Cider Vinegar
• Activated Charcoal
• Baking Soda

Organic Coconut Oil Pulling Oil pulling has been used by millions of people over thousands of years. It simply involves placing a couple of tablespoons of healthy oil (coconut, olive, almond, jojoba, etc) into your mouth, and then, swishing it around in the mouth and “pulling” it through the teeth.

Coconut oil is largely preferred for pulling to increase oral health because it has been shown in research to have multiple beneficial properties, including:

• Antimicrobial (destroys pathogenic bacteria, viruses, and fungi)
• Anti-inflammatory (reduces redness and swelling)
• Antioxidant (fights free radical damage)

Those effects alone would make coconut oil pulling a worthwhile habit for most people. Coconut oil has also shown anticancer, cardioprotective, lipid-balancing, appetite-suppressing, antiseizure, procognitive, and fat-burning properties.

Further, the Journal of Clinical Periodontology reports that coconut oil works against the two primary strains of bacteria linked to microbial plaque buildup and subsequent gum disease: Streptococcus sanguis and Fusobacterium naviforme.

Many people report that coconut oil pulling helps to reduce oral inflammation and pain, reduce tooth discoloration, and improve overall long-term oral health.

Sodium Bicarbonate (Baking Soda) Mixing one part baking soda (sodium bicarbonate) into two parts consumer-grade hydrogen peroxide (H2O2) makes an effective stain removing the toothpaste. When brushed and left on discolored teeth for 1-2 minutes, the paste releases oxygenated molecules that break down stains on the enamel.

Rinse your teeth and mouth thoroughly after using this type of toothpaste, and limit usage to 2-3 times weekly. Overuse can cause enamel breakdown and increase tooth discoloration.

Apple Cider Vinegar Organic apple cider vinegar is effective for removing common teeth stains like those from foods and tobacco use. ACV is naturally acidic, so it helps to break down tough stains on the enamel. It is also a natural antibiotic and probiotic, meaning it helps to decrease bacteria that cause gingivitis, and increase bacteria that foster oral health.

You can brush the teeth with ACV alone, or mix in some baking soda to enhance the stain-removing effects. Do not overuse this method because acidic substances like ACV can break down the enamel. With moderate use and thorough rinsing afterward, this method produces noticeable smile whitening effects in many people.

Activated Charcoal Some people claim that activated charcoal whitens the teeth as effectively as a professional cleaning treatment. Activated charcoal is made from heating substances like coconut fiber or hardwood to a point where its absorbency is optimized.

Activated charcoal can be applied to stained teeth with a wet toothbrush. It is black and many people think that it will stain their teeth or sinks. However, it rinses away completely and produces significant teeth whitening effects in many users. It’s safe to use this method 2-3 times a week as necessary to brighten your smile.

Activated charcoal is also very effective for trapping toxins of all types inside the body. It is a standard substance used for drug overdose and other types of poisoning in hospitals is affordable and has numerous benefits aside from whitening teeth when taken internally.

How to Prevent Teeth Stains

It is possible to prevent teeth stains from occurring in many cases. Two of the most common causes of tooth discoloration are eating stain-causing foods and using tobacco products. So, avoiding those foods and not smoking or chewing tobacco are some of the best ways to prevent discoloration in the first place.

Some other ways to prevent teeth stains include:

• Avoid overexposure to fluoridated water, toothpaste, and other products
• Use broad-spectrum antibiotics only when absolutely necessary
• Eat a healthy diet to provide nutrients that facilitate oral health
• Rinse your mouth after every meal or beverage break
• Avoid root canals unless medically imperative
• Use an ultrasonic toothbrush