Trauma

Trauma to developing, yet unerupted, teeth can disturb enamel formation ( amelogenesis) and may result in enamel defects, which are seen as stained, grooved or otherwise mal-formed teeth. Unerupted permanent front teeth are commonly are affected after the baby teeth are bumped, pushing the root of the baby tooth into the developing permanent tooth when young children fall on their faces.

Trauma that occurs to erupted teeth also causes discoloration. This discoloration frequently occurs in teeth that have fully formed roots and have sustained irreversible nerve. Trauma can cause the blood vessels to break inside the tooth and iron sulfide gets deposited inside the tooth, producing a bluish black hue over time.

Medications

Since the 1950s, drugs from the tetracycline family have been associated with internal tooth discoloration. Once in the bloodstream, tetracycline can be incorporated in the calcification process of developing teeth.

Minocycline is a second-generation derivative of tetracycline. Minocycline can lead to a green-gray or blue-gray intrinsic staining of teeth. Unlike with other tetracycline, staining occurs during and after the complete formation of eruption of teeth.. Minocycline is prescribed for long-term acne therapy in adolescents and adults, although it is being replaced by medications such as Clindamycine and isotretinoin that do not cause tooth discoloration.

Dental fluorosis is characterized by brown or white staining due to over-exposure to fluoride during the early enamel formation. This is not common anymore because most communities, parents and dentists monitor all the sources of fluoride that small children get. For instance, if your child is a toothpaste swallower, perhaps you don't need to give them the fluoride tablets until they grow out of that habit. Also, consider sources of flouride like daycare water supplies, and school water. It's important to consider all this with us before your kids take a fluoride tablet daily, so we can determine the proper dose.

Fluorosis affects primary and secondary dentitions with a broad range of clinical findings. In its mildest form, fluorosis appears as faint while lines or streaks on the enamel. Moderate fluorosis has more obvious opaque regions referred to as enamel mottling, whereas severe fluorosis appears with extensive mottling that readily chips and stains and leads to pitting and brown discoloration.

Fluoride sources are numerous and include naturally or artificially fluoridated drinking water, commercially available beverages, food prepared in fluoridated water, chewable vitamins, oral healthcare products (e.g. Toothpastes, mouth rinses, oral fluoride supplements), and professional fluoride products prescribed by dentists. The fluoride concentration of naturally fluoridated waters varies depending on geographic locations. For example, in some areas of Africa, the concentration may be as high as 10 parts per million, whereas many other regions have a concentration of zero ppm. Artificially fluoridated water supplies usually have a fluoride concentration of one ppm (warren, 1999).

Similar to tetracycline exposure, the dose and duration of fluoride exposure in developing teeth is correlated with the extent and severity of the clinical findings. Several clinical indices have been developed to measure fluorosis (Rosier, 1994)

Infection

Infections of the baby teeth can disrupt normal enamel formation in the developing permanent teeth still under the gums. Crown formation begins in utero so therefore, the potential for discoloration of the developing teeth may be present throughout pregnancy.

Although rare, maternal rubella or cytomegalovirus infection and toxemia of pregnancy can lead to tooth discoloration, which generally manifests as a focal opaque band of enamel hypoplasia that is confined to the primary teeth forming enamel at the time of maternal infection.

Crown formation of the secondary dentition occurs until the child is aged approximately 8 years old. Systemic postnatal infection (e.g. measles, chicken pox, streptococcal infections, scarlet fever) can cause enamel hypoplasia. The band like discoloration on the tooth are visualized where the enamel layer has variable thickness and becomes extrinsically stained after tooth eruption.

Braces

Patients with orthodontic brackets are at great risk for cavities and permanent white spots on their teeth if they do not brush well while the braces are on. As the bacteria gather around the bracket, they produce an acid that slowly degrades the enamel and a cavity progresses into the dentin. The translucent enamel will look very white in spots tht have been de-mineralized, but if things go too far, it reveals the color of the underlying caries and appears yellowish brown, to dark brown or almost black.