Tooth discoloration can be caused by many different factors. Some influence the formation of the enamel, while others cause the staining of enamel. Discoloration may be uniform or may appear as spots or lines in the enamel. Discolored areas may also have a different density and porosity than normal enamel.

Factors influencing tooth color include genetic, congenital, metabolic, chemical, infectious and environmental. Inherited diseases may influence the thickness of enamel or the calcium or protein content of the enamel. Metabolic diseases may cause both abnormalities of color and shape.

Drugs and medications either taken by the mother while pregnant or by the child during the time of tooth development can cause changes in both the color and hardness of the enamel.

• High fever at an age when tooth formation is taking place
• Poor dental hygiene; poor care and cleanliness of the mouth and teeth
• The antibiotic tetracycline given before the age of 8 years
• Excessive fluoride either from environmental sources (natural high water fluoride levels) or from excessive administration (fluoride applications, rinses, toothpaste, and fluoride supplements taken by mouth)
• Severe neonatal jaundice caused by poor liver function as a newborn
• Porphyria, a disease characterized by an excessive production of pigmentation in the body
• Amelogenesis and dentinogenesis imperfecta, genetic defects which affect the enamel of both primary and permanent dentition
• Eating or drinking foods (or fluids) that temporarily stain the teeth, like tea or coffee

Good oral hygiene will help if the teeth are staining from a food or fluid, or if the abnormal color is the result of poor hygiene.

It is appropriate to consult your dentist for abnormally colored teeth. However, if the color seems to be related to a medical condition, your regular health care provider should also be consulted.

• the teeth appear to be an abnormal color without ready explanation.
• the abnormal tooth color lasts even after good oral hygiene has been maintained.
• other symptoms are also present.

The medical history will be obtained and a physical examination performed.

Medical history questions documenting abnormal tooth color in detail may include the following:

• Time pattern
  • Have the teeth been abnormally colored since they erupted, or did they change color over time?
  • When was this first noticed?
  • How long has it been present?
  • Is the abnormal color temporary or permanent?
  • Does it improve when good oral hygiene is maintained?
• Quality
  • What is the discoloration (what color)?
  • What is the pattern of the discoloration (uniformly discolored, or spots or lines)?
• Dietary history
  • What is the diet like?
  • What foods and drinks are consumed frequently?
  • Does the person drink coffee or tea?
  • How much milk and dairy products are consumed?
• Medication history
  • What medications are being taken?
  • What medications have been taken in the past (particularly, did the child ever take tetracycline)?
  • What medications did the mother take when pregnant?
• Health history and family history
  • Do other members of the family have teeth that are abnormally colored?
  • How has the general health been?
  • Was the child jaundiced as a baby?
• Fluoride exposure
  • Is the water fluoridated where the person lives or visits frequently?
  • Is a fluoride supplement being taken?
• Oral hygiene habits
  • Are there frequent problems with the teeth, such as cavities or gingivitis,(inflamation of the gums)?
  • What are the dental habits?
  • How often are the teeth brushed and flossed?
  • What kind of toothpaste, mouthwash, or similar substances are used?
• What other symptoms are also present?

Diagnostic testing may not be necessary in many cases. However, if the coloration may be related to a medical condition, testing may be necessary to confirm the diagnosis. Dental X-rays may be performed.