Civitali Dental and Prosthetic Center srl

Alteration of the normal color of teeth.


Teeth abnormal colors.

A change in the color of the teeth may be determined by exogenous or endogenous factors.

Changes in teeth color (Barone et al, 1995) may look as stains or affect all the tooth exposed surface. Color may change from yellow to brown or from blue-green to red. Sometimes they may show as discoloration of the surrounding enamel. According to the Arens, Nonato and Colura classification, endogenous and exogenous factors may be distinguished:

1.Changes in color caused by exogenous factors:

Causes may be:

food (coffee, tea, nicotine chewing-gums, licorice, artificial colorants)

chemical compounds (nicotine, chlorhexidin, silver nitrate, tin fluoride)

bacteria (pigment-producing bacteria)

When stains origin from these causes, colored substances lay down on the tooth surface and may be removed easily with cleaning mechanical actions: ultrasound, brushes, rubber cups and prophylaxis paste. Sodium bicarbonate with proper pulsing applicators may be used for more resistant alterations.

2.Changes in color caused by endogenous factors:

Causes may be:

congenital or hereditary diseases (hereditary amelogenesis imperfecta, dentinogenesis imperfecta, enamel hypoplasia, hereditary congenital porphyria, sclerosis tuberosa, hereditary epidermolysis bullosa, ectodermal dysplasia, jaundice, incontinentia pigmenti achromians, congenital heart malformations)

toxicological or pharmacological causes (fluorosis, tetracycline effects)

trauma (abrasions, wear, direct trauma to the tooth)

iatrogenic causes (restoration materials, pulpar or para-pulpar pins, endodontic procedures, endodontic canal filling materials)

other causes (caries, Turner’s tooth, melanodontia, physiologic modifications due to aging, obliterations of the pulp chamber, pink spots, occupational diseases, physical agents as electrocautery, laser, ionizing radiations).

Once the cause is diagnosed, if  abnormal coloration origins from exogenous causes, cleaning is performed with ultrasounds, brushes, rubber cups  with abrasive paste, or even sodium bicarbonate and proper pulsing applicators. These hygiene treatments are preliminary to all other treatments to approach color changes and often lead to complete elimination of stains. If causes are endogenous, cleaning is not enough and whitening becomes necessary. This can be achieved with many different methods, varying if teeth are vital or not.