Types of tooth stains in children (with pics!) & what you can do about them

Most of the time, staining on a toddler’s teeth bothers  the parent far more than it bothers the child but, if the stains are severe, they may lead to your child being teased at pre-school or affect their self esteem.

There are a number of different causes of tooth stains in children and my advice to any parent is to take their toddler for regular dental and hygiene visits as soon as they are able to comply – from around 2 years of age.

Why are my child’s permanent teeth darker than their milk/baby teeth?

Often parents ask why the newly-erupted permanent teeth are quite a bit darker than the primary (milk/baby) teeth. This is completely normal because the primary teeth are more calcified than the permanent teeth. The permanent also contain more dentine (inner layer of the tooth) than the primary teeth and the dentine is darker than the enamel (outer layer).

What causes stains on a child or toddler’s teeth?

Stains on a child or toddler’s teeth can range from white spots/marks to brown, black, blue, green, gray, orange, pink, red and yellow and there are a number of different causes.

It’s important to distinguish between extrinsic and intrinsic stains on teeth. Extrinsic stains are due to external factors such as food, drink, medicine, bacteria etc. It is possible to remove these stains, but your child will need a professional cleaning from the hygienist or the dentist. Most of the time, intrinsic stains are not removable, but your dentist or hygienist will be able to advise you as to what can be done to make the tooth more aesthetically pleasing.

Not brushing properly

Remember that children, just like adults, also need a professional dental cleaning every 6 months, or more often if recommended by the dental hygienist or dentist. Just like in adults, plaque will form, and if not removed properly, it will calcify. The soft plaque or hard calcified plaque (tartar/calculus) will then become stained from food and drinks and this can kind of stain can range from yellow to orange or brown.

Tooth stains caused by not brushing properly

Medication

Supplemental vitamins containing iron might form a dark brown to black stain on the teeth. This can also be the case with iron-fortified rice cereal or formula where the infant may exceed the daily requirement for iron.

Tooth stains caused by medication

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Tooth injury

A single blue-gray tooth (although sometimes this can be seen in two teeth next to each other) can be the result of bleeding within the tooth due to dental trauma like a fall or a hard bump.

Tooth stains caused by injury

Weak enamel

A child may have a genetic problem with enamel formation that can  later lead to discolored primary teeth.

Tooth stains caused by weak enamel

Excessive fluoride

In rare cases, which is mostly seen in children from rural areas where drinking water has an excessive fluoride concentration, white to brown and even dark brown marks can be seen on the teeth.

While fluoride is an excellent way of remineralising the teeth to protect them against acid forming bacteria that cause tooth decay, adequate intake of fluoride from all sources should be around 0.05mg/kg of body weight per day in order to reduce the risk of dental decay without causing unwanted side effects.

The desired level of fluoride in drinking water for optimal oral health is 0.7ppm. At the moment, the amount of fluoride naturally occurring in Rand Water is 0.161 ppm. To put it into perspective – in some rural areas where evidence of fluorosis can be seen, the fluoride levels are 1.5 ppm or more.

So please do not be alarmed when the dental hygienist or dentist advises a fluoride treatment every 6 months when you take your child for a dental cleaning. And if your child has demineralised areas (start of decay), topical fluoride application might be advised more often than 6 monthly.

Tooth stains caused by excess fluoride

Demineralisation

White marks, especially those close to the gum line, can be caused by poor oral hygiene. Often plaque close to the gum line is not completely removed and, if left there, it will cause demineralisation of the tooth and is the start of decay. With remineralisation from fluoride for instance, these lesions might harden enough to stop the decay proceeding, but the white mark will remain.

Demineralisation (decay) stains

Read next: 7 ways to make brushing your child’s teeth easier

Illness

Primary teeth might develop with a green or yellow hue if the child is born with a condition in which there is too much bilirubin in the blood (known as hyperbilirubinemia). It’s very rare, but serious illnesses like recurring infections, jaundice, heart disease or even blood or liver diseases can have a visible effect on the teeth.

Tooth stains caused by childhood illness

Early childhood decay

A combination of poor oral hygiene and food and drink high in sugar can lead to tooth decay, especially if the baby is put to sleep with a bottle containing liquid high in sugar. When florescent bacteria and/or fungi are responsible for the decay, the stain might be gray-green. If chromogenic bacteria are responsible for decay, a red-orange stain might form.

Early childhood decay yellow

Early childhood decay green/grey

Internal resorption

Resorption is the inflammation and loss of the tooth’s dentine (inner tissue) or cementum (covering the root) due to trauma. Extreme heat, chemicals or bacterial invasion of the nerve of the tooth can also cause resorption. Internal resorption can often be identified by a pinkish-red stain.

Internal resorption stain

Idiopathic stains

A condition called ‘Black stain’ affects between 2,4 and 21% of children aged 2 to 3 years old, but it has been seen on permanent teeth as well. The cause of these stains is unknown but they typically form on the gum line. It is a form of plaque, but cannot be removed by brushing – even with professional cleaning, it is difficult to remove. It is, however, related to a lower frequency of decay.

Idiopathic black stains

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How can you prevent your child or toddler’s teeth from becoming stained?

• Clean your toddler’s teeth well to eliminate poor dental hygiene and cavities.
• Prevent early baby bottle decay by not letting your baby go to sleep with a bottle unless it only contains water.
• Don’t share anything that was in your mouth with your child – this can spread cavity causing bacteria.
• Take your toddler for regular visits to the dental hygienist or dentist to discuss
  your child’s dental health. Your dentist and dental hygienist will be able to
  give you advice on treatment options and possibilities regarding conditions out
  of your control. There are ways and treatment options to make some of the
  intrinsic stains less visible.