Understanding Brown Spots On Teeth

Introduction

Tooth staining and discolouration have become a cause for concern in dental health. Without a deeper understanding of the cause behind tooth discolouration, self-treating to sustain healthy-looking teeth may be a futile effort. Dentists play a big role in making the correct diagnosis and planning the treatment of teeth discolouration. It is very important to determine the cause of brown spots for effective management, which could range from a change in lifestyle to addressing a more serious underlying dental condition. In this article, we will explore the causes, symptoms, diagnosis, management, and prevention of brown spots on teeth.²

Causes

• Metabolic disorder

Alkaptonuria is an inborn error of metabolism that causes brown discolouration on permanent teeth due to incomplete metabolism of certain protein building blocks.⁵

• Developmental defects of teeth and dental cavities

Brown spots on teeth may be caused by enamel hypoplasia, which can result from injury or infection during the formation of a baby tooth. This condition can affect one or multiple teeth.⁵ Dental cavities initially start off as brown spots on teeth and need to be treated by dentists.

Tobacco use (smoking or chewing) can cause stains on teeth, as can certain drinks like wine, tea and coffee. The colour of the tooth comes from chemicals in food called polyphenols, which give colour to food.⁵

• Poor oral hygiene 

External tooth discolouration can result from poor oral hygiene, the use of iron supplements, and colour-producing bacteria. These bacteria can cause black/brown (most common), green, orange or blue discolourations on the tooth surfaces of children.⁵

Tartar and plaque deposits easily stain teeth and appear as brown-black spots, mostly near the gum area.⁵

• Ageing

As people age, the white enamel which is the outermost covering of teeth, slowly degrades, leading to yellowing to a brownish appearance of teeth. This process can occur in all teeth and is a natural part of the ageing process.⁵

• Genetics

Brown spots on teeth can also be caused by genetic conditions which are inherited. Amelogenesis imperfecta, Dentinogenesis imperfecta are conditions where tooth formation is affected. Congenital erythropoietic porphyria is a rare condition, where pigments are deposited in teeth. Affected teeth will appear red to brown in colour and glow red under UV light. The type of amelogenesis imperfecta can determine how the teeth look, with some types causing a white layer on top with others causing yellow to brown discolouration and thinning of the enamel.⁵

Symptoms

Spots on teeth range in colours from yellow-brown to brown-black. Brown spots on teeth vary in size, shape and location on the teeth. They may appear as irregular, blotchy patches to brown lines. If accompanied by tooth pain, sensitivity, or bad breath, you should see a dentist. In people with celiac disease, oral symptoms may include dry mouth, canker sores, or mouth ulcers. Enamel hypoplasia may cause rough or pitted areas on teeth and should also be addressed by a dentist to avoid further complications.^3,5

Diagnosis

A regular dental check-up can help prevent problems and address existing oral health conditions that may go unnoticed. Early diagnosis also contributes to up-to-date dental health records; helps avoid costly procedures; and improves overall dental health.^3,4

Examination by a dentist

An ideal dental examination occurs at least once or twice per year. However, the frequency of a dental check-up depends on the state of the teeth, gums, and jaw. 

X-rays and other imaging tests

It is necessary to have a proper clinical examination and dental x-ray to make a proper diagnosis and treatment plan in most cases. Before discussing bleaching and teeth fillings, it is vital to get a thorough clinical and x-ray assessment.^3,4

Treatment

Dentists are often treating stained teeth. Sometimes, scaling and polishing the teeth helps, but other times, more treatment is needed. Options include bleaching or teeth whitening, microabrasion, veneers, and crowns. Sometimes, multiple treatments are done to ensure better results.^3,4,5

Dental cleaning and polishing

Dentists or a hygienist can perform a scale and polish procedure for the discoloured teeth. During the first stage, any deposits of plaque and tartar are removed using an ultrasound scraper and specialised instruments. The second step is to polish the teeth, which not only removes stains but also smoothens out minor imperfections and rough textures on the teeth. This helps protect against future plaque build-up and keeps your teeth healthy and shiny.³

Tooth coloured fillings

It is more common for people to get tooth-coloured fillings than silver-coloured ones. Although tooth-coloured fillings can match the colour of your teeth, they tend to cost more than most silver-coloured fillings.³

Crowns or veneers

If you have brown spots on your teeth and don't want to bleach them, there are alternative options such as direct composite veneers, porcelain veneers, and crowns. Porcelain veneers are thin ceramic layers that can be customised to fit over your teeth and cover up brown spots, crooked teeth, or decayed teeth. Another solution to brown spots on teeth is cosmetic bonding, which involves fusing the resin to the enamel of the tooth to alter its shape and colour. Ceramic veneers tend to have better outcomes than indirect composite veneers and glass-ceramic crowns as it typically lasts 11-13 years. Direct composite resin veneers can be the alternative option which is cheaper and less invasive, however, their colour can fade over time.⁴

Teeth whitening

Tooth whitening products help make teeth look whiter by changing their colour or removing stains on the surface of the teeth. Some products use hydrogen peroxide or carbamide peroxide in gels, which can be applied directly or with strips or mouth guards. The peroxide is applied to the teeth and making the teeth whiter. There are also kinds of toothpaste with chemicals that can make teeth look less yellow. Extrinsic stains can be removed by polishing teeth at the dentist and controlled with regular brushing with good toothpaste. Whitening toothpaste has extra cleaning ingredients like abrasives, peroxides, salts, and enzymes to remove and prevent stains.²

Prevention

The best way to avoid black or brown spots on your teeth is through dietary changes, regular dental checkups and good oral hygiene. 

Good oral hygiene practices

To achieve this, it is important to practice good oral hygiene, such as brushing your teeth twice a day using fluoride toothpaste and flossing at least once daily. It is recommended to rinse your mouth, brush your teeth or drink water after eating or drinking if possible.⁴

Limiting exposure to staining agents

The connection between tooth discolouration and tobacco smoking is widely recognised. Studies have shown that tobacco contaminants stain the tooth. The amount and duration of smoking have a positive impact on this staining effect.⁴

Regular dental check ups

Regular dental check-ups can help identify oral conditions early and avoid unexpected expensive procedures. 

Complications

Dental complications may occur when brown spots on the tooth are left untreated. It is best to see a dentist as soon as possible if you experience any of these symptoms.⁶

Tooth loss & gum disease

Brown spots on teeth near the gums that bleed may be an early sign of a cavity, which could lead to periodontal disease, a type of gum disease. Periodontal disease occurs when bacteria-laden plaque builds up on teeth due to inadequate brushing and flossing. This can lead to swollen, bleeding, and painful gums when chewing. In severe cases, gum disease can even cause tooth loss or require the removal of affected teeth.⁶

Summary

Brown spots on teeth can be caused by a variety of factors, including inborn errors of metabolism, enamel hypoplasia, tobacco and certain drinks, poor oral hygiene, iron preparations, chromogenic bacteria, natural ageing, and genetic conditions such as congenital erythropoietic porphyria and amelogenesis imperfecta. These conditions can result in discolouration ranging from brown to red, with some causing thinning of the enamel.

Regular dental check-ups are crucial to detect the possibility of oral health issues associated with the discolouration of the tooth. Assessments which are done during checkups to examine damaged fillings, cavities, and root fillings are recommended before bleaching. Treatments such as teeth whitening, microabrasion, veneers, cosmetic bonding and crowns aim to improve tooth colour, while other treatments like polish can remove plaque and tartar to prevent further complications that may be associated with tooth discolouration. 

Toothing whitening products; good oral hygiene like regular brushing; and avoidance of staining agents like tobacco are ways to prevent stains from the tooth. Brown spots near the gums can be a sign of a cavity leading to periodontal disease when left untreated. Swollen or bleeding gums are symptoms that should be reported to dentists to avoid tooth loss.