The terms you are using are those that would be used by academics and not so much by practicing cosmetic dentists. But they are a useful way to categorize teeth stains. Of the terms you mentioned, extrinsic and intrinsic would probably be heard more often clinically among practicing dentists than endogenous and exogenous.
Extrinsic stains would be those that exist on the surface of the teeth. Tobacco creates extrinsic stains. Here’s a picture of some teeth with extrinsic stains.
These are child’s teeth, and children, as their teeth are developing, tend to pick up some of these stains as different naturally-occuring bacteria come to populate their mouths. Peridex mouthwash causes this type of stain. The milder stains of this type can be removed by brushing (e.g. whitening toothpastes). The more stubborn ones will need to be removed by a dental cleaning, or by Supersmile toothpaste.
Intrinsic stains would be those that are absorbed into the actual structure of the teeth. They take a long time to develop. Years of drinking coffee or tea, smoking, or even eating highly pigmented fruits such as raspberries, will cause the teeth to darken. These stains tend to be brownish or yellowish. They cannot be removed by any toothpaste, but they can easily be removed by bleaching. Here are before-and-after photographs of teeth that had these accumulated stains which were treated with the Kör deep bleaching system.
Exogenous stains would be those that are caused by outside agents. All of the stains mentioned above would be exogenous. All can be removed by either a surface cleaning of the teeth or by bleaching.
Endogenous stains are those that were acquired during the development of a tooth. Tetracycline stains would be in this category. If the antibiotic tetracycline is taken during the development of permanent teeth (between birth and twelve years old) it binds to the dentin of the tooth and becomes a deeply embedded stain. Fluorosis stains are more superficial but they are also developmental—they are caused by the consumption of too much fluoride while teeth are forming. From the point of view of a cosmetic dentist, you could also call a dark natural pigmentation in the teeth to be an endogenous stain. Some people’s teeth are just naturally dark.
The treatment of these endogenous stains is different. Tetracycline stains respond somewhat to bleaching, but are best treated by porcelain veneers. Fluorosis stains should not be treated by bleaching because they occur in splotches. However, the natural pigmentation of teeth can be treated effectively by bleaching. With persistent bleaching treatments, people can get their teeth whiter than they were when they first erupted into their mouths.
I hope this is helpful. Good luck in your schooling.
– Dr. Hall
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I appreciate your help. Last year I began getting mysterious brown staining on my teeth that my dentist cannot remove. He did not tell me it could be fluoride. A natural health practitioner told me it is from excess fluoride. I am 63 years old. I have not used fluoride toothpaste in years, but my township has fluoride added to the water. I have been drinking Poland Spring water which also has fluoride. I do not drink wine or coffee. Last year I started drinking a cup or two of green tea daily which I just found out has plenty of fluoride, so this must be what pushed me to fluoride overload and brown staining. I only drink plain water now. Do you know which bottled water brands do not contain fluoride? Which type of whole house water filtration system removes fluoride?
Which cosmetic dentists in New York City would you recommend for bonding? I have had some previous bonding in NJ and was not happy with the color matching.
– Linda in New Jersey
Dental fluorosis is a mottling of the enamel caused by excessive intake of fluoride while teeth are forming. In its mild form it is manifest by white spots. When it is more severe the spotting or mottling can be brown.
Once your teeth are formed, they will not be stained by fluoride. So if this is a stain that is new, it has nothing to do with fluoride.
I’m a little puzzled by your statement that this is a stain that your dentist can’t remove. Once your teeth are fully formed, any stain that they pick up should be able to be removed. Let me explain the two different ways to do this, depending on the stain.
There are only two types of stain that you would be getting on your teeth at age 63. One type would be external staining – something that attaches itself to the surface of your teeth. Any stain of this character should be able to be polished off. Supersmile toothpaste also works very well for removing these types of stains. It enzymatically removes the protein pellicle on your teeth, and it is that pellicle to which the stains adhere.
The other type of stain would be internal staining. Your teeth can absorb pigments from food and drinks. Tea is an excellent source of this stain, and, from the clues you are giving me, that seems to be the top candidate for this stain. I would know better if I could see it myself. Internal stains get absorbed into the enamel of the teeth and can only be removed with bleaching. Internal staining would be manifested by a general darkening of the color of the teeth. External staining would probably concentrate around the gumline of the tooth and the spaces between the teeth and would be irregular in appearance. Internal staining would be evenly distributed throughout.
I would not recommend bonding for this type of staining, if that’s what you have. Bleaching works better, is much less expensive, and doesn’t require anything artificial to be attached to your teeth, so it will look nice perpetually. Bonding would also require an expert cosmetic dentist, which limits you to about 1-2% of dentists. Any of the expert cosmetic dentists we recommend on our site would do an excellent job with bonding. But you don’t need an expert cosmetic dentist for bleaching – many dentists can do that well.
If you do need bonding work, however, and you are in New Jersey, you shouldn’t need to go to New York. Dr. Allyson Hurley, in Bedminster, does a fine job with bonding. She is AACD accredited. Google her and you will find her website. Dr. Jeff Golub-Evans, in Manhattan, is internationally renowned for his bonding skills, and sees many fashion models and movie stars, if you need that level of care.
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