These stains typically present as black or brown lines along the cervical third of the teeth, particularly on the lingual and buccal surfaces.
Although striking in appearance, they are benign, do not cause tooth destruction, and are not directly associated with dental caries.
Etiology and Microbial Origin
Chromogenic stains result from the activity of chromogenic bacteria, particularly species capable of producing iron-rich compounds that bind to the dental biofilm.
When these bacteria metabolize nutrients in the oral cavity, they generate dark pigments that deposit on the enamel surface.
This condition is more common in children due to differences in the composition of the oral microbiome, salivary characteristics, and dietary habits.
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Clinical Characteristics
Patients typically present with:
✔ Dark brown to black staining following the contour of the gingival margin
✔ Stains that are firmly attached to the enamel and resistant to regular brushing
✔ Absence of enamel defects or associated cavitated lesions
✔ Good overall oral hygiene in many cases, which often surprises parents
Despite their appearance, these stains are not an indicator of poor oral hygiene, nor are they pathologic.
However, they may have a strong esthetic impact, prompting families to seek professional care.
Diagnosis and Differential Considerations
The clinical presentation is usually sufficient for diagnosis. It is important to differentiate chromogenic stains from:
✔ Extrinsic stains caused by diet (tea, coffee, spices)
✔ Tobacco-related pigmentation
✔ Dental caries, especially early childhood caries
✔ Metallic stains from iron supplements or medication
A thorough clinical examination ensures proper identification and appropriate treatment planning.
Management and Treatment
Treatment is simple and highly effective:
✔ Professional prophylaxis using low-abrasion pastes and rubber cups
✔ Ultrasonic scaling when necessary to lift more resistant deposits
✔ Patient and parent education to explain the harmless nature of the condition
✔ Periodic monitoring, as recurrence is common due to the persistence of chromogenic bacteria in the oral flora
In selected cases, adjunctive antimicrobial guidance may help reduce recurrence, but should only be used under professional criteria.
Prevention and Maintenance
While prevention cannot be guaranteed, recurrence can be reduced by:
✔ Optimizing daily plaque control
✔ Using fluoridated toothpaste
✔ Maintaining regular dental check-ups
✔ Monitoring dietary patterns that may support bacterial proliferation
Clinical Relevance
Chromogenic stains are a benign yet esthetically bothersome condition.
Understanding their origin and proper management allows clinicians to reassure families and provide effective, minimally invasive treatment.
The rapid transformation seen after prophylaxis—such as in the clinical case shown—reinforces the value of routine dental care in pediatric patients.
