Lesson 2: Changes in Tooth Color

Image: Healthy gingiva with intrinsic stain.

Intrinsic stains cause color changes within the tooth. These include staining from aging, oral disease, trauma, medications, and systemic conditions.

As teeth grow older, the pulp shrinks and dentin becomes thicker, which can cause teeth to look more yellow. Oral diseases, such as exposed root surfaces from gingival recession or restorations, also affect tooth color.

During trauma, vital pulp can die. If trauma does not destroy the tooth, bleeding into tooth structures can occur, causing darkening over time. Enamel defects can result from trauma during tooth formation or inherited dental disorders, such as amelogenesis imperfecta.

Medications taken during tooth formation can result in enamel defects. A common culprit is the antibiotic tetracycline. Fluorosis, or excess fluoride consumption, can also cause mottled and spotted teeth, as shown here.

Dr. Lee to Mary: "In-office whitening can effectively treat both intrinsic and extrinsic stains (extrinsic stain)."

Enamel color is also affected by extrinsic, or external, factors. Extrinsic stains on the tooth’s surface can penetrate into the enamel matrix. Superficial stains are caused most commonly by several extrinsic factors, including coffee, tea, red wine, tobacco, and chromogenic, or color-producing, bacteria.

Dr. Lee to Mary: "Your teeth have superficial stains. The tooth whitening procedures available to you will remove the stains on your teeth, leaving them potentially up to five to ten shades whiter. However, we don’t know exactly how your teeth will respond to treatment. These before and after photos will give you a better idea of the results that you might expect today. Because you are a coffee drinker, you should be aware that whitening will not prevent future staining."

Image: Teeth before and after whitening.