Extrinsic stains in primary teeth: insights and interdiction

Unsightly stains are a common concern prompting patients to seek dental care, particularly in primary dentition. The growing demand for aesthetics has driven the rise of toothpaste and devices presenting dubious claims of “sparkly white” teeth. This paper focuses on staining in primary dentition, and its causes, and summarizes evidence-based treatment modalities to combat extrinsic staining. Extrinsic stains are classified according to their origin, etiology, and appearance. Diet, environmental factors, poor oral hygiene, and medication/antiseptics can cause the development of extrinsic stains. Black stains, which are non-scrapable and commonly observed in primary dentition, result from the activity of bacteria like Prevotella melaninogenica, Actinomyces israelii and Actinomyces naeslundii. These bacteria produce hydrogen sulfide, which reacts with iron in saliva to form ferric sulfide, leading to stains resistant to regular toothbrushing. Brown stains are the result of tannins in food or beverages while mouthwashes containing copper salts may stain the teeth green. The primary course of treatment for extrinsic stains is oral prophylaxis, followed by polishing. The use of toothpaste containing oxidizing agents like peroxide has a good outcome in removing external stains. Fungal proteolytic enzymatic compounds incorporated into toothpastes can reduce extrinsic stains. Ingredients such as papain, alumina, and sodium citrate can serve this task. External bleaching is not recommended for primary teeth due to safety concerns. Clinicians must effectively communicate with the caregivers to convey the etiology and strategies for prevention, dietary modification, and the importance of regular oral hygiene measures for minimizing recurrence.

Black stains; Dental stains; Dentifrices; Extrinsic stains; Green stains; Microabrasion

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