Article Data

  • Views 428
  • Dowloads 154

Original Research

Open Access

Evaluation of pediatric dentists' knowledge and approaches to tooth discoloration

  • Dilara Demirkol1
  • Seçkin Aksu2,*,
  • Seçil Çalışkan3
  • Nuray Tüloğlu1

1Private Dentist, 26050 Eskişehir, Turkey

2Department of Pediatric Dentistry, Faculty of Dentistry, Mersin University, 33020 Mersin, Turkey

3Department of Pediatric Dentistry, Faculty of Dentistry, Eskişehir Osmangazi University, 26050 Eskişehir, Turkey

DOI: 10.22514/jocpd.2023.075

Submitted: 04 July 2023 Accepted: 24 August 2023

Online publish date: 01 November 2023

*Corresponding Author(s): Seçkin Aksu E-mail:


In recent years, esthetic expectations have come to the fore in pediatric dentistry, as in every field of dentistry. Therefore, to better meet patients’ expectations, the steps taken to determine and improve the current level of knowledge of pediatric dentists on tooth discoloration gain importance. This study aims to measure the knowledge levels of pediatric dentists regarding tooth discoloration. A 33-questioned survey created online was emailed to pediatric dentists between March and December 2021. The first part included four multiple-choice and two open-ended questions regarding demographic characteristics. The second part was to measure the participants’ knowledge of tooth discoloration. The last part was to evaluate the clinical approaches of the participants. Participants who agreed to answer all of the questions were included in the study (n = 129). The knowledge levels of the participants were scored according to the accuracy of their answers. The data were statistically analyzed using descriptive statistics and chi-square tests. Of the pediatric dentists who participated in this study, 16.3% had high knowledge, 79.8% had medium knowledge, and 3.9% had insufficient understanding of tooth discoloration. There was no correlation between time since dental school graduation and time spent practicing as a pediatric dentist (p > 0.05). The group with the highest average level of knowledge was the group most frequently encountered with tooth discoloration in the clinic (p ≤ 0.05). On average, pediatric dentists had moderate knowledge of tooth discoloration. The group with the highest average expertise in this field was the group that most frequently encountered and treated tooth discoloration. Information on tooth discoloration due to systemic factors was insufficient. To increase the knowledge level of pediatric dentists about the causes and treatments of tooth discoloration, it may be beneficial to establish training programs during and after specialization education.


Pediatric dentist; Knowledge; Questionnaire; Tooth discoloration

Cite and Share

Dilara Demirkol,Seçkin Aksu,Seçil Çalışkan,Nuray Tüloğlu. Evaluation of pediatric dentists' knowledge and approaches to tooth discoloration. Journal of Clinical Pediatric Dentistry. 2023.doi:10.22514/jocpd.2023.075.


[1] Al Khayyal M, Al Halabi M, Hussein I, Salami A, Rodd H, Hassan A, et al. How do schoolchildren view other children who have discolored teeth? Journal of International Society of Preventive and Community Dentistry. 2021; 11: 340–347.

[2] Bryan RA, Welbury RR. Treatment of aesthetic problems in paediatric dentistry. Dental Update. 2003; 30: 307–313.

[3] Moslemi F, Yasaie AM, Shojaiepour R. Is the metallic color of stainless steel crown satisfying for cooperative children and their parents? A preliminary study. Journal of Dentistry. 2022; 23: 480–488.

[4] Rocha AO, Anjos LMD, Vitali FC, Santos PS, Bolan M, Santana CM, et al. Tooth bleaching: a bibliometric analysis of the top 100 most-cited papers. Brazilian Dental Journal. 2023; 34: 41–55.

[5] Hekmatfar S, Babaei N, Molaei T, Belyad S. Relationship of pH and the viscosity of five different iron supplements with the absorption of iron ions and enamel discoloration in the anterior primary teeth (an in vitro study). Dental Research Journal. 2021; 18: 7.

[6] Feigin K, Bell C, Shope B, Henzel S, Snyder C. Analysis and assessment of pulp vitality of 102 intrinsically stained teeth in dogs. Journal of Veterinary Dentistry. 2022; 39: 21–33.

[7] Dhar S, Gupta D, Ghosh A. An unusual case of green teeth secondary to neonatal hyperbilirubinemia. Indian Journal of Dermatology. 2022; 67: 74–75.

[8] Erwin AL, Desnick RJ. Congenital erythropoietic porphyria: recent advances. Molecular Genetics and Metabolism. 2019; 128: 288–297.

[9] Geetha Priya PR, John JB, Elango I. Turner’s hypoplasia and non-vitality: a case report of sequelae in permanent tooth. Contemporary Clinical Dentistry. 2010; 1: 251–254.

[10] van Meijeren-van Lunteren AW, Voortman T, Wolvius EB, Kragt L. Adherence to dietary guidelines and dental caries among children: a longitudinal cohort study. European Journal of Public Health. 2023; 33: 653–658.

[11] Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. European Archives of Paediatric Dentistry. 2022; 23: 3–21.

[12] Gadhia K, McDonald S, Arkutu N, Malik K. Amelogenesis imperfecta: an introduction. British Dental Journal. 2012; 212: 377–379.

[13] Kim YJ, Lee Y, Zhang H, Seymen F, Koruyucu M, Bayrak S, et al. Translated mutant DSPP mRNA expression level impacts the severity of dentin defects. Journal of Personalized Medicine. 2022; 12: 1002.

[14] Wang J, Zou D, Li Y, Liu P, Guo C. Drug-induced tooth discoloration: an analysis of the US food and drug administration adverse event reporting system. Frontiers in Pharmacology. 2023; 14: 1161728.

[15] Ng C, Almaz E, Simon J, Fried D, Darling C. Near-infrared imaging of demineralization on the occlusal surfaces of teeth without the interference of stains. Journal of Biomedical Optics. 2019; 24: 1–8.

[16] Fallahinejad Ghajari M, Shamsaei M, Sadeghpour Galouyak M, Basandeh K. Evaluation of Abrasion and whitening effect of toothpastes containing charcoal on primary teeth. Frontiers in Dentistry. 2022; 19: 22.

[17] Meyfarth S, Abreu MGL, Fernandes TO, Milani AJ, Antunes LS, Antunes LAA. Dental trauma in primary dentition and the importance of its preservation until the eruption of permanent successor: a 6-year follow-up case report. International Journal of Burns and Trauma. 2021; 11: 424–429.

[18] Petel R, Fuks A. Pink spot—literature review and case report. Journal of Clinical Pediatric Dentistry. 2016; 40: 353–355.

[19] Al-Hiyasat AS, Ahmad DM, Khader YS. The effect of different calcium silicate-based pulp capping materials on tooth discoloration: an in vitro study. BMC Oral Health. 2021; 21: 330.

[20] Mandava J, Pamidimukkala S, Karumuri S, Ravi R, Borugadda R, Afraaz A. Microtensile bond strength evaluation of composite resin to discolored dentin after amalgam removal. Cureus. 2020; 12: e7536.

[21] Yaghmoor RB, Platt JA, Spolnik KJ, Chu TMG, Yassen GH. Effect of hydrogel-based antibiotic intracanal medicaments on crown discoloration. Restorative Dentistry and Endodontics. 2021; 46: e52.

[22] Ashfaq NM, Grindrod M, Barry S. A discoloured anterior tooth: enamel microabrasion. British Dental Journal. 2019; 226: 486–489.

[23] Benbachir N, Ardu S, Krejci I. Indications and limits of the microabrasion technique. Quintessence International. 2007; 38: 811–815.

[24] Borges AB, Caneppele TM, Masterson D, Maia LC. Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? A systematic review. Journal of Dentistry. 2017; 56: 11–18.

[25] Walls AW, Steele JG, Wassell RW. Crowns and other extra-coronal restorations: porcelain laminate veneers. British Dental Journal. 2002; 193: 73–82.

[26] Ludovichetti FS, Stellini E, Signoriello AG, DI Fiore A, Gracco A, Mazzoleni S. Zirconia vs. stainless steel pediatric crowns: a literature review. Minerva Dental and Oral Science. 2021; 70: 112–118.

[27] Bevans KB, Moon J, Becker BD, Carle A, Forrest CB. Development of patient‐reported outcome measures of children’s oral health aesthetics. Community Dentistry and Oral Epidemiology. 2020; 48: 423–432.

[28] Cachia Mintoff JM, Riddington M, Parekh S. Oral health-related quality of life in children with osteogenesis imperfecta. European Archives of Paediatric Dentistry. 2022; 23: 261–270.

[29] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Journal of Clinical Epidemiology. 2008; 61: 344–349.

[30] Monteiro J, Ashley PF, Parekh S. Vital bleaching for children with dental anomalies: EAPD members’ survey. European Archives of Paediatric Dentistry. 2020; 21: 565–571.

[31] Wood AJ, Gaid GG. Pediatric dentistry academic workforce survey. Pediatric Dentistry. 2018; 40: 340–345.

[32] Garcia-Lopez M, Martinez-Blanco M, Martinez-Mir I, Palop V. Amoxycillin-clavulanic acid-related tooth discoloration in children. Pediatrics. 2001; 108: 819.

[33] Lumbiganon P, Pengsaa K, Sookpranee T. Ciprofloxacin in neonates and its possible adverse effect on the teeth. The Pediatric Infectious Disease Journal. 1991; 10: 619–620.

[34] Al-Samadani KH. The effect of preventive agents (mouthwashes/gels) on the color stability of dental resin-based composite materials. Dentistry Journal. 2017; 5: 18.

[35] Alsagob E, Sawan N, Aladhyan S, Alsalem N, Alshami A, Albluwi S. Silver diamine fluoride with delayed restoration reduces tooth discoloration. Saudi Journal of Biological Sciences. 2022; 29: 1434–1438.

[36] Wajahat M, Abbas B, Tariq K, Imran E, Aslam S, Khurshid Z. Parental perception of silver diamine fluoride for the management of dental caries. Journal of Taibah University Medical Sciences. 2022; 17: 408–414.

[37] Nordbö H, Eriksen HM, Rölla G, Attramadal A, Solheim H. Iron staining of the acquired enamel pellicle after exposure to tannic acid or chlorhexidine: preliminary report. Scandinavian Journal of Dental Research. 1982; 90: 117–123.

[38] Topal BG, Kırzıoğlu Z. The role of chromogenic bacteria in external tooth discoloration in children. Acta Odontologica Turcica. 2016; 33: 161–165.

[39] Gasmi Benahmed A, Gasmi A, Menzel A, Hrynovets I, Chirumbolo S, Shanaida M, et al. A review on natural teeth whitening. Journal of Oral Biosciences. 2022; 64: 49–58.

[40] Haywood VB, Cordero R, Wright K, Gedreau L, Rupp R, Kotler M, et al. Brushing with a potassium nitrate dentifrice to reduce bleaching sensitivity. The Journal of clinical dentistry. 2005; 16: 17–22.

[41] Cortez TV, Ziotti IR, Scatolin RS, Corona SAM, Souza-Gabriel AE. Protocols for sodium ascorbate application on intracoronary dentin bleached with high-concentrated agent. Journal of Conservative Dentistry. 2018; 21: 26–31.

[42] Alqahtani MQ. Tooth-bleaching procedures and their controversial effects: a literature review. The Saudi Dental Journal. 2014; 26: 33–46.

[43] Carrasco LD, Zanello Guerisoli DM, Pécora JD, Fröner IC. Evaluation of dentin permeability after light activated internal dental bleaching. Dental Traumatology. 2007; 23: 30–34.

[44] Hanks CT, Fat JC, Wataha JC, Corcoran JF. Cytotoxicity and dentin permeability of carbamide peroxide and hydrogen peroxide vital bleaching materials, in vitro. Journal of Dental Research. 1993; 72: 931–938.

[45] A Ghazi RF, Khalifa FA. Sub-clinical cervical root resorption: a case report. Cureus. 2022; 35: e27334.

[46] De Moor RJ, Verheyen J, Verheyen P, Diachuk A, Meire MA, De Coster PJ, et al. Laser teeth bleaching: evaluation of eventual side effects on enamel and the pulp and the efficiency in vitro and in vivo. The Scientific World Journal. 2015; 2015: 835405.

[47] Wood K, Lyne A, O’Donnell K, Brown CJ, Parekh S, Monteiro J. Patient-reported outcome measures for children and adolescents having dental bleaching in the UK. European Archives of Paediatric Dentistry. 2022; 23: 579–586.

[48] Greenwall-Cohen J, Greenwall L, Haywood V, Harley K. Tooth whitening for the under-18-year-old patient. British Dental Journal. 2018; 225: 19–26.

[49] Gupta T, Sadana G, Rai HK. Effect of esthetic defects in anterior teeth on the emotional and social well-being of children: a survey. International Journal of Clinical Pediatric Dentistry. 2019; 12: 229–232.

[50] Fernandez-Riera Y, Gutmann JL. Historical reflections on the use of internal bleaching to manage discolored teeth. Journal of the History of Dentistry. 2022; 70: 119–127.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time