Monthly Archive December 2014

How to Avoid Extrinsic Dental Stains

teeth-stained-by-nicotineStains located on the outer surface of the tooth structure and caused by external agents. Mouth is subjected to many exogenous and endogenous substances that stains the teeth. Also the oral flora contains many type of color producing deposits which also causes stains. Discoloration include brown, black, gray, green, orange and yellow. Teeth especially, the front teeth appear while talking and smiling. If your teeth are white in color without any stains then you can talk or smile confidently.

The external stains are caused by predisposing factors and other factors.

Predisposing factors are

Poor oral hygiene

Enamel defects

Salivary dysfunction

Saliva plays major role in removal of debris from the outer and interdental surfaces. Diminished saliva production leads to accumulation of stain producing food, beverages, tobacco and other topical agents in the pits ,fissures and defects in the outer surface of enamel. These accumulated food particles or topical agents produce black or brown stains on the tooth surface

Other factors

  • Plaque and calculus
  • Food and beverages
  • Color producing bacteria
  • Tobacco
  • Metallic compounds
  • Topical medications

Plaque and calculus:

Most common cause bof extrinsic stains is poor oral hygiene. Dental plaque and calculus produce brown /black discoloration of tooth surface and interdental area.

Food and beverages:

Accumulation of stain producing foods and beverages leads to brown discoloration of tooth. Tannins are present in the Tea, coffee, other beverages. Accumulation of these tanins on the tooth surface gives brown stains.


Tobacco stains cover the cervical one third to one half of the tooth. Tobacco stains are dark brown and black in color. ex:

  • Cigarettes
  • Cigars
  • Chewing tobacco

Pan chewing produces red black stains on the teeth, gingiva and oral mucosa.

Chromogenic bacteria:

Actinomyces species  action on plaque produce  H2S(hydrogen sulphide).hydrogen sulphide reacts with iron in the saliva and gingival exudate and produce ferric sulphide which is black in color. Pencillium, aspergellus species produce Green stains, Flavobacterium lutenscens produce orange color.

Topical medication:

  • Chlorhexidine mouthwash-After several weeks of use it stains the teeth in brown color.
  • Fe containing solutions used to treat iron deficiency anemia produce black stains.
  • Potassium permanganate mouthwash-violet black strains
  • Silver nitrate-black stains
  • Stannous fluoride-brown stains
  • Some systemic medication such as Minocycline, Doxycycline

Metallic compounds:

Iron, manganese, silver reacts with plaque and produce black stains on the tooth surface. Mercury produces blue green stains.


There has been a recent increase in interest in the treatment of tooth staining and discoloration.

  • Scaling
  • Ultrasonic cleaning, air-jet polishing with an abrasive powder
  • Cessation of habits such as smoking, pan chewing.
  • Bleaching
  • Salivary dysfunction should be treated

Bleaching (tooth whitening):-

The technique involved in the bleaching process is oxidation. With proper patient selection, bleaching is safe, easy and inexpensive modality that is used to treat many types of tooth fiscoloration. Usually bleaching is not indicated for the primary teeth. Two types of bleaching methods are is vital bleaching and the other is non -vital bleaching.


  • Use a straw: sipping beverages through a straw is believed to help keep teeth staining beverages away from the teeth, the front teeth in use straw for cola and juices.
  • Don’t retain things in your mouth for long period of time
  • Swish with water: its not6 always convenient to brush your teeth after having food or drink. Enamel is highly vulnerable to abrasion from tooth brushing for up to 30 minutes after the consumption of an acidic food or it’s safer simply to swish with water and brush later , once the enamel has had a chance to reharden or chew sugarless gum after eating or drinking.
  • Daily twice brushing
  • Regular flossing
  • Avoid over consumption of tea, coffee and other beverages
  • Avoid color producing food
  • Avoid smoking, pan chewing
  • Regular dental visits

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Know About Vitamin A Benefits & Overcome Deficiencies

Vitamin A plays a vital role in maintaining healthy eyes. Vitamin A keeps our Vision Keen. Not only Eyes, Vitamin A helps in bone growth, maintaining immunity and also useful as Powerful Antiixidant, Vitamin A maintains a vigorous reproductive system of the body.

Vitamin A is a fat soluble vitamin. Actually, it is the name of a group of fat soluble retinoid, including Retinol, Retinoic acid, Retinyl Esters. Two forms of vitamin A are available in the human diet.

  1. Preformed Vitamin A (retinal and its esterified form, Retinyl ester)
  2. Provitamin A carotenoids

The most important provitamin A carotenoid is beta carotene. Other carotenoids are Alfa carotene and beta cryptoxanthin. The body converts these plant pigments into vitamin A. the active forms of vitamin A are retinol and retinoic acid.

 Vitamin A Benefits :

  • Vitamin A plays critical role in the formation of rhodopsin, the eye pigment responsible for sensing low light situations.
  • Helps in forming and maintaining healthy skin, teeth, skeletal and soft tissue, and mucous membrane.
  • Involved in immune function, reproduction, cellular communication.
  • Vitamin A also supports cell growth and differentiation, playing a critical role in the normal formation and maintenance of the heart, lungs, kidneys and other organs

Vitamin-AVitamin A sources:-

Vitamin A comes from animal sources such as

  • Eggs
  • Meat
  • Fortified milk
  • Cheese
  • Cream
  • Chicken Liver, Kidney, Cod
  • Halibut fish oil

Beta carotene sources are

  • Bright yellow and orange fruits such as pink grapefruit, apricots, cantaloupe,mangoes
  • Vegetables- carrot, sweet potato, pumpkin
  • Other sources are broccoli, spinach, dark green leafy vegetables.

The more intense the color of a fruit or vegetable, the higher the beta carotene content. Vegetable sources are fat and cholesterol free.

Vitamin A deficiency:-

Vitamin A deficiency is common in many developing countries. Vitamin A deficiency typically begins during infancy, when infants do not receive adequate supplies of colostrum or breast milk. Chronic diarrhea also leads to excessive loss of vitamin A in young children, and vitamin A deficiency increases the risk of diarrhea.

  1. The most common symptom of vitamin A deficiency in young children and pregnant women is is a medical condition in which the eye fails to produce tears. The conjunctiva becomes dry, thick and wrinkled. If untreated, it can lead to corneal ulceration and ultimately to blindness as a result of corneal damage
  2. Night blindness-one of the early sign of is the difficulty for the eyes to adjust to dim light. Cannot see the images in low levels of illumination. Poor vision in the darkness but see normally when adequate light is present.
  3. Keratomalacia-vitamin A is required to maintain specialized epithelia such as in the cornea and conjunctiva. Lack of vitamin A leads to atrophic changes to normal mucosal surface, with loss of goblet cells, and replacement of normal epithelium by an inappropriate keratinized epithelium. Due to this cornea break down and liquefies resulting keratomalacia.The resulting cornea become totally opaque. This is one of the most common reason for blindness around the world
  4. Preterm infants with vitamin A deficiency have an increased risk of eye, chronic lung and gastrointestinal diseases.
  5. Bitot’s spots-collections of keratin in the conjunctiva
  6. Diminishes the ability to fight infections
  7. Decreased growth rate and slow bone development
  8. Most people with cystic fibrosis have pancreatic insufficiency, increasing their risk of vitamin A deficiency due to difficulty in absorbing fat. Vitamin A supplements can correct low serum beta carotene levels
  9. Vitamin A deficiency in the pregnant and lactating women leads to xerophthalmia and other effects are increased maternal and infant morbidity and mortality, increased anemia risk and slower infant growth and development.
  10. Vitamin A deficiencies tend to have low iron status, which can lead to anemia. It increases the severity and mortality risk of infections even before the onset of xerophthalmia

Treatment and prevention;

Taking vitamin A by mouth is effective for preventing and treating symptoms of vitamin A deficiency. Vitamin A deficiency can occur in people with protein deficiency, Diabetes, over active thyroid, liver disease, cystic fibrosis.

Vitamin A supplements may interact with some birth control pills, blood thinners, acne medicines, cancer treatment and many other drugs.

Vitamin A over dose:

Over dose of vitamin A is called as hypervitaminosis A. it refers to any number of a large amount of toxic effects from ingesting too much preformed vitamin A.This condition may be acute or chronic. Acute toxicity occurs after consumi9ng large amounts of vitamin A over a short period of time, typically within a few hours or days. Chronic toxicity occurs when large amounts of vitamin A build up in the body over a long period of time.

High intake of provitamin carotenoids such as beta-carotene, do not cause hypervitaminosis A as conversion to the active form of vitamin A is highly regulated.


  • Most people develop vitamin A toxicity by taking high dose dietary supplements or by taking more than the recommended amount over a long period of time
  • It may also be caused by long term use of certain acne treatments that contain high doses of vitamin A.


Long term use of large amounts of vitamin A might cause serious side effects including fatigue, irritability, mental changes, anorexia, stomach discomfort, nausea, vomiting, mild fever, excessive sweating, skin and hair changes, head ache.

In women who have passed menopause, taking too much vitamin A can increased risk of osteoporosis and hip fracture.

Over consumption of beta-carotene can cause carotenosis, in which the skin turns orange is a reversible condition. The skin turns into normal color after you stop taking excessive consumption of beta carotene.

Other symptoms are abnormal softening of skull bone, blurred vision, bone pain and swelling, heart valve calcification, liver damage, poor weight gain in infants and children, higher sensitivity to sun light


  • Don’t take more than recommended amount
  • Carotene forms from dietary sources are not toxic.
  • Pregnancy, liver disease, high alcohol consumption and smoking are indications for close monitoring and limitation of vitamin A administration.


  • Stop taking high consumption of vitamin A
  • Vitamin E may alleviate hypervitaminosis A

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