Skipping tooth brushing is a common habit, and because of this, the biofilm, or plaque biofilm—made up of bacteria present in our mouth along with saliva and food—adheres to the tooth surface. It's said that even after tooth brushing, this biofilm can reform within hours. What does this biofilm do? It remains on the tooth surface and gradually hardens over time, forming tartar. This tartar attracts stains, causing teeth to become yellow and dull in color. That's why dentists always recommend thoroughly rinsing the mouth after every meal and brushing teeth at least twice a day, with particular emphasis on brushing at night before sleeping.

Poor brushing technique or brushing too hard is commonly observed due to a lack of awareness about the correct brushing technique. Many people believe that aggressive brushing back and forth removes plaque and tartar effectively. However, this often results in more damage as it wears down the tooth enamel and affects the gums due to excessive pressure. Enamel, the outer layer of the tooth, serves as a protective layer, but even with excessive pressure and hard brushing, it tends to wear down, exposing the underlying dentin, which appears yellowish because dentin is naturally yellow in color. Using a back-and-forth motion with heavy or hard bristles can further degrade enamel. Ideally, brushing should involve soft bristles directed at a 45-degree angle to the tooth and used in a circular motion. It's recommended to brush twice a day for at least 2 minutes each time.

Maintaining interdental health is equally as important as brushing twice a day. Interdental food lodgment can lead to plaque and tartar accumulation, resulting in stains and yellowish discoloration, ultimately leading to cavity formation. Therefore, interdental cleaning with flossing, water flossers, and interdental brushes is crucial. It is recommended to incorporate interdental cleaning into your daily routine, alongside tooth brushing, at least once a day, with proper care to avoid harming the gums, applying gentle pressure to ensure gum safety.

Food and beverages can also cause discoloration or yellowing of teeth. Beverages such as coffee, tea, red wine, and cola can lead to discoloration. Similarly, foods containing higher amounts of turmeric, soy sauce, and balsamic vinegar can also cause discoloration. These foods and beverages contain chromogens, which are the pigments responsible for tooth discoloration. Additionally, the enamel absorbs these pigments, causing staining. Furthermore, foods like citrus fruits and soda, due to their acidity, can degrade and wear down the enamel, leading to tooth erosion and a dull, yellowish appearance. Completely avoiding these foods and beverages may be impractical. However, consuming them in moderation and regularly rinsing the mouth and flossing can help. Professional cleaning by a dentist can also aid in reducing tooth discoloration.

Tobacco, whether in smoking or smokeless forms, can cause tooth staining due to its content of tar and nicotine. Tar, a sticky residue formed after burning tobacco, adheres to the enamel surface of teeth, causing pigmentation. Nicotine, the highly addictive component, can constrict gum vessels, reducing the gum's response to inflammation. Additionally, tobacco use reduces saliva flow, hindering saliva's natural cleansing action, and leading to tooth staining. Alkaloids and additives present in tobacco can also contribute to pigmentation. Smokeless tobacco, involving grinding, wears down enamel, causing pigments to stain teeth and result in discoloration. Moreover, natural pigments in tobacco leaves further contribute to pigmentation. Therefore, individuals with tobacco habits should undergo professional cleaning to eliminate discoloration.

Biting on hard objects, such as using your teeth to open bottles or cut tape, can have detrimental effects on your teeth. It can lead to cracks in the enamel, wearing it down and exposing the underlying dentin, as well as causing chipping or cracking. This can result in staining and increased sensitivity. Additionally, the rough surfaces created by these practices can allow food and bacteria to penetrate, leading to further staining. Despite enamel being extremely hard, these actions can still lead to enamel damage.

Water is an essential part of our lives for very valid reasons. It's not just crucial for overall health; hydration also helps maintain oral health. Water acts as a natural cleanser, washing away food particles and bacteria. Additionally, it dilutes acids in the mouth that can lead to enamel erosion and tooth decay. Water can remove pigments from stain-causing foods and beverages, promoting saliva production. Therefore, inadequate water intake can contribute to tooth discoloration and yellowing. Hence, keeping ourselves hydrated is crucial.

Not following dental advice is a common mistake, especially for individuals with the following issues:

• Amylogenesis imperfecta leads to yellowish discoloration due to defects in enamel, including inadequate deposition, insufficient mineralization, and incomplete maturation.

• Traumatic injuries can also cause tooth chipping, exposing the underlying dentin and resulting in yellowish or yellow-brown discoloration.

• Medications such as tetracycline, oxytetracycline, and ciprofloxacin can cause yellowish tooth discoloration, although they often fade over time.

• Medical conditions like erythroblastosis, ketosis, polycythemia, and thalassemia can lead to yellow teeth due to the incorporation of bilirubin or blood pigments within dentin grooves.

• Endodontic treatment, particularly the use of intracanal medicaments like iodine, potassium iodide, or iodoform-based products, may cause yellow or yellow-brown staining of the teeth.

To conclude, in this article, I have discussed how skipping tooth brushing, which is common, can cause plaque, plaque biofilm, and bacteria accumulation, leading to tooth staining. Improper brushing techniques, such as not being aware of how to use the brush correctly or brushing back and forth, can result in tooth erosion and staining. Additionally, neglecting interdental health by not flossing or using interdental brushes can contribute to tooth staining. Not using mouthwash can lead to plaque buildup and tooth discoloration. Consuming excessive amounts of foods and beverages known to cause discoloration, as well as using tobacco in smoking or smokeless forms, can stain the teeth. Biting on hard objects, not drinking enough water, or not following advice for certain conditions like amylogenesis imperfecta, traumatic injuries, or medications such as oxytetracycline and tetracycline can also cause staining. Furthermore, medical conditions like thalassemia, atheroblastosis, and endodontic treatment involving intracanal medicaments can contribute to tooth staining.

References

1. Mortazavi, H., Baharvand, M., & Khodadoustan, A. (Year of publication). Colors in Tooth Discoloration: A New Classification and Literature Review. International Journal of Clinical Dentistry, Volume number(1), Page range. Nova Science Publishers, Inc. ISSN: 1939-5833.

2. https://emedicine.medscape.com/article/1076389-overview?form=fpf

3. https://www.colgate.com/en-in/oral-health/teeth-whitening/what-causes-green-tooth-and-other-tooth-discoloration#:~:text=Dental%20professionals%20note%20that%20various,colours%20can%20indicate%20different%20things.&text=Tobacco%20use%20remains%20a%20significant,a%20role%20in%20brown%20discolouration.

(By Manav Chaturvedi)

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