Articles Written by Stephen Friedman, D.D.S., P.A.

"How can I prevent stain?" is a common question we hear from oral hygiene patients.  There are a number of ways teeth pick up stains or darken. 1) From stain producing substances that go into our mouths from the foods we eat and the use of tobacco, 2) From stain producing bacteria that produce stains as a metabolic byproduct 3) From intrinsic discoloration of a tooth, say from a dead nerve or certain systemic medications, and 4) From color changes in and around old fillings.  These last two factors we can do very little to prevent.  But the first two factors we have some control over.  The most common cause of staining is from tobacco use.  Since smoking is on the decline, we see much more staining in our patients from common stain producing foods such as coffee, tea, candies with food dyes like licorice, and colored berries.   So be sure to brush thoroughly after eating these food types.  Also, if plaque control is good, patients don't have to worry about stain producing bacteria.  So, floss regularly and use an electric toothbrush. Using an electric brush has been shown to be more effective than manual tooth brushing. Remember bacterial plaque forms first in between the teeth and around the gum line and then it moves out to cover the smooth surfaces. So remember when tooth cleaning, in order to be most effective, begin with good flossing between the teeth and then on to brushing around the gum line and on the smooth surfaces. 

“What’s the best toothpaste to use?” is a little tougher to answer.  There are some toothpastes for food stain and smoking, but they are more highly abrasive than our normal dentifrices.  My advice is to use a fluoride containing toothpaste and use a technique that scrubs each surface for five to ten seconds front, back and in between.  That's a long time in the mouth; because most people have finished brushing their entire mouth in the same amount of time I'm telling you to brush one tooth.  Some of the whitening pastes which contain hydrogen or carbamyl peroxides will also lift stains, but they have to be used for several days before the results are evident and they're a little more expensive and may cause sensitivity. If sensitivity occurs you must stop using these pastes or they can cause tooth damage.  Also, be careful of using highly abrasive pastes.  These types of pastes can cause rapid abrasion at the gum line of natural teeth and can scuff the shine off of porcelain crowns already in place in the mouth.  The American Dental Association, the ADA, places its seal of approval on the tooth care products that are safe with regard to abrasiveness.  There are other toothpastes for moisturizing patients with dry mouths, and we recommend them for patients who are on medications that cause drying. These may be worth giving a try also for stain control because the dry mouth condition will cause plaque to precipitate onto the tooth surface, which may in turn contribute to stains.  Toothpastes vary in costs depending on what's in the paste in terms of the amount of whitening agent, types of flavoring, and amount of fluoride.  The bottom line is that how well you scrub the tooth surface is going to be the biggest factor in removing the stain, not the magic chemicals added.

One final note is that recently there has been some new research that shows that decreasing acid levels in the mouth can have an indirect effect of reducing stain because it decreases demineralization.  Demineralization is the leaching out of calcium and other minerals. This allows other stain producing substances to move into the chemical composition of the tooth structure and become a permanent part of the surface color.  So keep the acid levels in the mouth as low as possible.  This can be accomplished by eating the right foods, cleaning the surfaces as described above, and by chewing non-sugar, xylitol containing gum for a short time after every meal.

Once the stain becomes part of the intrinsic composition of the tooth it is much more difficult to deal with, but in many cases it can be reversed.  Ask the staff here at the office if you have a question about discoloration or staining.

This article is a general guide for choosing toothpaste and for what to do to reduce and reverse tooth staining, furthering the goal of keeping your oral structures healthy throughout your lifetime.