Tooth discoloration may be a simple cosmetic problem, or it may be a symptom of disease or a side effect of medication. It might be part of normal aging or the result of a trauma to the tooth or teeth involved. It may be a superficial problem or a sign of changes inside a tooth. Let’s look at the types of tooth discoloration, and at some of its more common causes.
The first type of discoloration is extrinsic, that is, it only effects the tooth’s surface. This includes staining from foods such as coffee, wine, blueberries, tea or from smoking. It might also be a sign of poor dental hygiene. This type of discoloration can be prevented by stopping or reducing smoking or consumption of foods that stain, as well as brushing teeth after eating or drinking. This is the kind of discoloration that professional or over-the-counter whitening products can remedy.
Another cause of extrinsic discoloration can be excessive consumption of fluoride.
The Department of Health and Human Services (HHS) adjusted the recommended level of fluoride in drinking water in January, 2011, and the commendation is presently open for public comment. The new recommendation is a level of 0.7 mg per liter of water, which is the lower end of the previous recommended level of 0.7 to 1.2 mg. The reason for this adjustment is the availability of fluoride in other sources, such as toothpaste, mouth rinse, application by a dentist. The result of too much fluoride is fluorosis, and in the United States it is usually found in milder forms . This results in lacy white markings on the enamel, either lacy or in spots. In its more severe state, it can lead to pitting and darker discoloration.
The next type of tooth discoloration is due to natural aging. As we age, the dentin layer just under the enamel yellows and the enamel layer becomes thinner.
The next type of discoloration is intrinsic, meaning that it is caused by changes inside the tooth. These changes can be due to certain filling materials that show dark under the tooth enamel, especially silver fillings, or to internal damage to the tooth by trauma or from a procedure like a root canal. A crown may be needed in such cases.
Intrinsic discoloration can also be caused by certain diseases or medications. Certain infections in pregnancy may affect the teeth of the fetus, as can treatment with tetracycline taken during the second half of the pregnancy. Injury to a tooth while the enamel is still forming (up to age 8) or injury to an adult tooth even in adulthood can cause discoloration. Radiation treatment to the head or neck or chemotherapy can affect the color of the teeth. Tetracycline or doxycycline antibiotics taken before age 8 can affect the growth of the enamel.
Tooth discoloration can also be a symptom or a complication of a more serious disease, like diabetes or celiac disease. If it is one of several symptoms, and good hygiene does not affect it, see a doctor.
Intrinsic discoloration is more difficult to treat, and capping may be the only way to whiten the teeth if whitening is desired.