Black Chromogenic Stains- Why, How and What now?

Abstract

The prevalence of black chromogenic stains has become a common finding in the recent days, unsure if it has been present all these years and the diagnosis was missed due to its similarity with other extrinsic stains. The main concern has been the unesthetic appearance and the obstinate recurrence of the black stain. Often found on the cervical third of the tooth along the gingival margin in both paediatric and adult patients. The etiology of the black stains has been poorly understood and this knowledge is important for clinicians to be able to diagnose so as to give the appropriate treatment plan. The nature of the black pigmentation is dominated by chromogenic bacteria such as the Actinomyces species and is a unique type of plaque with tendency to calcify making its removal tedious. The main constituent of the black stain is ferric sulphide which is a product of the reaction between the ferric ions in the saliva and the hydrogen sulphide released from the chromogenic bacteria. Factors influencing the formation of the black stains are iron supplementation, pH of the saliva, dietary factors, microbial interaction, et cetera. The association between the black stains with dental caries and periodontal disease is a significant factor as it can determine the susceptibility of the individual. Professional hygiene procedures included ultrasonic scaling and polishing using either prophylactic paste or air/water-jet polishing. But professional cleaning was comparatively invasive if performed frequently and was not sufficient to eliminate these stains. Hence, the article was aimed to understand the various causative factors to provide a less invasive treatment..