Dental Stains: Causes, Treatments, and Concerns

Follow-up Inquiry #185329

Dear Dr.
Lin,
Thank you very much for your response and guidance in the inquiry consultation #185329.
I have greatly benefited from it.
I would like to ask you the following questions:
Q1.
Regarding your reply: "The new and old fillings cannot completely seal...
thus the junction between the new and old materials will also stain and turn black!" Do you mean that if I directly grind away the black line (gap) on the outer side of my upper left second molar using dental instruments, I will still need to fill it with new material (such as resin)? Can't I just grind away the black line (gap) and then polish it?
Q2.
Regarding your reply: "The staining of resin is usually caused by external factors, such as tobacco, tea, coffee stains, etc., while the staining of silver powder is due to the material itself depositing into the dentin!" I have observed that the darkening below my upper left second molar appears to be "inside the tooth," resembling a "bruise" color.
I was initially concerned that it might be due to nerve damage, but the dentist said it is likely caused by pigment deposition.
Dr.
Lin, since my condition shows darkening "inside the tooth," could this indeed be due to the deposition of silver powder material? Additionally, since I have a long-term habit of drinking tea, could the color from tea potentially penetrate into the tooth or cause the resin filling to stain and darken?
Q3.
Regarding your reply: "If you are very concerned about the color appearance, it is recommended to directly inform the dentist that you want to have it refilled..." I would like to clarify that I am mainly concerned about the darkening of the tooth due to pigment deposition.
Does this condition have any adverse effects or cause harm to the tooth? As for the color appearance, I am not very concerned about that.
Therefore, I would like to ask Dr.
Lin again, does the darkening of the tooth due to pigment deposition have any negative effects or harm to the tooth?
Q4.
Recently, I have noticed that on the inner cusp of my upper right second premolar, there is a small section that is particularly white at the tip.
Dr.
Lin, what could this condition or issue at the tip of the tooth indicate? Also, could this condition or issue cause any adverse effects or harm to that tooth?
Thank you, Dr.
Lin.

Axiang, 40~49 year old female. Ask Date: 2022/08/16

Dr. Lin Jiayong reply Dentistry

1.
In theory, it is feasible, but in practice, if the grinding exceeds a depth of 1mm, it is impossible to maintain the integrity of the surface with polishing alone.
Therefore, it is essential to confirm that the depth of the black line is within 1mm.
However, clinically, it is not possible to determine the depth of the black line, and it is even more impractical to inform the patient afterward that polishing cannot be performed due to excessive depth.
2.
It is indeed possible for discoloration of the tooth structure to occur due to pulp necrosis, but if X-rays have been taken to confirm the condition of the pulp, there is no need for excessive concern.
Amalgam tattoo caused by silver particles does not require special removal unless there are specific reasons, as this would result in the loss of too much tooth structure.
3.
No, it is recommended to take an X-ray every six months to monitor the condition.
4.
It is advisable to have the examining dentist assess the actual cause of the white areas.

Reply Date: 2022/08/16

More Info

Dear Patient,
Thank you for your detailed inquiry regarding dental stains and their implications. I appreciate your trust in seeking clarity on these matters. Let’s address your questions one by one.

Q1: Regarding the black line on your tooth.
The black line you observe on your upper left second molar is likely due to the interface between old and new filling materials. When there is a gap or imperfection in the seal between these materials, it can lead to staining. Simply grinding down the black line may not be sufficient, as it does not address the underlying issue of the seal. After smoothing the surface, it is advisable to apply a new filling material, such as composite resin, to ensure a proper seal and prevent further staining. This will also help restore the aesthetics of the tooth.

Q2: Concerning the internal discoloration of your tooth.
The dark coloration resembling a bruise that you describe is indeed concerning. If your dentist has ruled out nerve damage, it is plausible that this discoloration is due to silver amalgam materials leaching into the dentin or due to external staining from substances like tea. Silver fillings can sometimes cause a grayish hue as they age and interact with the tooth structure. Additionally, your habit of drinking tea can contribute to external staining, which may penetrate the surface of the resin fillings or even the enamel itself. It is essential to maintain good oral hygiene and consider professional cleanings to mitigate these effects.

Q3: Impact of color changes on dental health.
While the aesthetic aspect of tooth discoloration is often a concern for many, the primary question is whether this staining poses any health risks. Generally, external staining from food and beverages does not harm the tooth structure itself. However, if the staining is due to decay or if it indicates a failure in the filling material, it could lead to more severe issues, such as cavities or infections. If you are not concerned about the appearance but are worried about the health implications, it would be prudent to have your dentist evaluate the integrity of the tooth and the filling. Regular check-ups can help catch any potential problems early.

Q4: The white spot on your upper right second premolar.
The white spot you’ve noticed on the cusp of your upper right second premolar could indicate several conditions. It might be an early sign of demineralization, which can lead to cavities if not addressed. Alternatively, it could be a result of enamel hypoplasia, which is a developmental defect that results in a thinner enamel layer. This condition can make the tooth more susceptible to decay and sensitivity. It is crucial to have this evaluated by your dentist, as they can provide appropriate treatment options, such as fluoride treatments or sealants, to protect the tooth.

In summary, while stains and discoloration can be concerning, they often do not pose immediate health risks unless associated with decay or structural integrity issues. Regular dental visits and good oral hygiene practices are essential in managing these conditions. If you have further concerns or if the situation changes, please do not hesitate to reach out to your dentist for a thorough examination and tailored advice.

Best wishes for your dental health!
Sincerely,
Doctor Q&A Teams
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