Vchat stain1/26/2024 ![]() Medical history for both children was unremarkable, with no history of previous childhood illness or medications. The other child was reported to have never experienced staining of this nature. The black staining was noted by the parents to have been present since the teeth first erupted in the child with the staining, with no sign of its severity decreasing. The flowchart cannot be fully evidence-based, given the small volume of research in this area and so it is based on the authors' experience.īlack stain seen on teeth of only one of two monozygotic twins (left) The authors suggest a treatment flowchart ( Fig. Black staining can unfortunately commonly reoccur despite complete removal and patients should be advised this is a normal occurrence. Patients can be further reassured that its position close to the gingival margin means it is often concealed by the lip when at rest. 10 Overuse of the ultrasonic scaler should be avoided as this may lead to undesired loss of enamel. If stains are difficult to remove, a tissue can be used to 'blot' out the excess water from the pumice paste and the tooth dried to concentrate and take further advantage of its abrasive particles. Black staining deposited on the pitted grooved areas can often prove extremely difficult to remove. A combination of a simple scale and polishing with pumice paste is often sufficient to remove the stain. Particular advice should include instruction to avoid 'over scrubbing' the teeth when brushing, as this is unlikely to remove the stain and may cause abrasion cavities. ![]() Patients are often reassured, knowing the staining is not permanent and is in fact a common occurrence in the developing dentition. The holistic treatment of black staining initially includes explaining the cause of the staining to both patient and guardian. ![]() The characteristic dotted line, localised in a linear fashion to the gingival margin, aids in the differentiation between caries and black staining. Caries, however, is an irreversible decalcification of the enamel or dentine. Black staining is a deposit on the intact surface of the tooth and can therefore be removed through instrumentation or polishing. It is important to differentiate between caries and black staining. 13 Internal staining is unlikely to be mistaken for black stain. Examples includeamelogenesis imperfecta, dentinogenesis imperfecta and tetracycline staining. Intrinsic discolouration arises following a change to the internal structural composition or thickness of the enamel or dentine. 12 In particular, the causes of similar discolourations include staining from tea or coffee (usually of a brown/black colour), 12 suboptimal oral hygiene (a yellow, brown or green colour) 12 and polyvalent metal salts and cationic antiseptics such chlorohexidine (often black or brown in colour). 12 Black staining, as well as stains caused by the consumption of tea, coffee, smoking, poor oral hygiene and pharmaceuticals (such as a chlorohexidine mouth rinses and iron supplements) are all examples of a form of extrinsic staining. These can be subcategorised into extrinsic origin and intrinsic origin.Įxternal tooth discolouration arises when chromogens (a term which refers to a colourless chemical compound that can be converted by chemical reaction into a compound which can be described as coloured) are deposited on the external surface of the tooth or its pellicle. When diagnosing black staining, a dentist must consider the other possibilities of tooth discolouration. ![]() 4, 5ĭental discolouration is a relatively common finding and its aetiology can be varied. 2 Further studies suggest a prevalence range within these figures 3 and there is no apparent sex predilection. A prevalence as high as 19.9% has been reported for school children from Switzerland (aged 7-15 years) 1 and as low as 2.5% for Brazilian children (aged 3-5 years). There is no consensus in the literature as to the prevalence of chromogenic staining, with studies suggesting a prevalence of between 2-20%. Often found in paediatric patients, its perceived unsightly appearance can have a negative effect on a child's self-esteem. Other names that have been used to describe black staining include: chromogenic or paediatric staining and exogenous tooth discolouration. Its characteristic appearance is of a black pigmentation which occurs along the cervical third of the buccal and/or lingual surfaces of teeth. A particular poorly understood yet common type of extrinsic staining is known as black stain. Tooth discolouration is a common problem affecting patients, often causing aesthetic concerns. ![]()
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