Child Tooth Discoloration: Causes by Color

What causes tooth discoloration in children?

Tooth discoloration in children has two kinds of cause: stains that sit on the outer surface of the tooth, and changes inside the tooth itself. Dentists call them extrinsic and intrinsic, and a child can have both at once.⁠¹

MedlinePlus, the National Library of Medicine’s health service, defines abnormal tooth color as any color other than white to yellowish-white, and its list of causes runs from tea and iron-containing liquids to high fever while teeth are forming, tooth nerve damage and severe jaundice in a newborn.⁠²

• Surface stains (extrinsic)

  Iron and other metal salts, dark fruits and dark drinks, and plaque bacteria leave color on the enamel; brushing or a professional cleaning can usually reduce it.⁠¹

• How the enamel formed (intrinsic)

  Fluorosis, molar-incisor hypomineralization, enamel hypoplasia and inherited enamel or dentin conditions are built into the tooth before it comes in.⁠^1,11

• What happened to the tooth since (intrinsic)

  Decay, bleeding or nerve damage inside the tooth after an injury, and some medicines change color from within.⁠¹

Timing explains a lot. Babies are born with all 20 baby teeth already in the jaw, and most permanent teeth form during the first eight years of life, so a mark that is already there when a tooth comes through began while it was forming.⁠^16,17

Fluorosis shows the rule clearly: it can only form while a tooth is developing, and the American Dental Association (ADA) states that once teeth erupt they cannot develop it.⁠¹⁴

What is the difference between extrinsic and intrinsic tooth stains?

Extrinsic stains are colored deposits on the enamel surface; intrinsic discoloration sits inside the tooth, in the enamel or the dentin beneath it. The difference decides what can remove it.⁠¹

Juice is a good example of an extrinsic stain. In a 2026 laboratory study of 80 extracted baby teeth, black mulberry and pomegranate juice stained the most, orange juice much less, and brushing reduced the staining whether or not the toothpaste contained fluoride.⁠¹⁸

What does each tooth color mean in a child?

Each color points to a short list of likely causes, though color alone cannot make a diagnosis: the same shade can come from a stain, a defect or decay, and a dentist tells them apart.⁠^1,2

Pattern matters as much as color. The AAPD describes MIH patches as asymmetrical with sharp borders, unlike the diffuse, symmetrical opacities of fluorosis.⁠¹¹

What do white spots on a child’s teeth mean?

White spots on a child’s teeth are usually one of four things: early decay, molar-incisor hypomineralization, fluorosis or enamel hypoplasia. Only the first is an active process, and it is the one worth catching early.⁠^5,11,17

A dull, chalky white spot can be the first sign of decay, where acid has drawn minerals out of the enamel. The National Institute of Dental and Craniofacial Research (NIDCR) says decay can be stopped or reversed at this point, while a cavity is permanent damage that needs a filling.⁠⁵

The others are permanent records of how the enamel formed. Fluorosis ranges from barely visible lacy white markings to opaque areas, while MIH patches are sharply bordered and uneven from side to side.⁠^11,17

White spots in depthWhite spots on kids’ teethEnamel hypoplasia

Why are my child’s teeth yellow?

Yellow teeth in a child can come from plaque and surface stain, or simply from new permanent teeth that look different from the remaining baby teeth. The AAPD notes that because enamel thickness differs between baby and permanent teeth, tooth color in the same mouth may vary significantly while both are present.⁠^2,4

Dentin, the layer under the enamel, is yellower than enamel. The ADA explains that thinner, more translucent enamel lets that yellower dentin show through.⁠¹

• Plaque and poor brushing. MedlinePlus lists poor oral care among the causes, and good oral hygiene helps when teeth are stained by food or fluid or poorly cleaned.⁠²
• MIH. Patches range from white to yellow to brown, and the yellow-brown ones run through the full thickness of the enamel and break down more easily.⁠¹¹
• Thin enamel. In the hypoplastic form of amelogenesis imperfecta, the inherited enamel condition, the enamel is thin.⁠²⁷
• One baby tooth turning yellow after a knock. In a study of dark baby incisors after injury, 52% faded or turned yellowish, and pulp canal obliteration, the pulp space filling with hard tissue, was seen in 78% of the teeth that turned yellow against 6% of those that stayed dark.⁠⁹

A yellow tooth after an injury is generally the better sign: in the same study, signs of infection were associated far more with dark hues than with yellowish ones (83% against 17%).⁠⁹

What causes brown spots or brown teeth in toddlers and children?

Brown spots on a toddler’s or child’s teeth can be decay, a surface stain, or an enamel defect such as MIH. The NIDCR lists white, brown or black staining among the signs of tooth decay.⁠^11,19

Decay in young children is common. The AAPD defines early childhood caries as any decayed, missing (from decay) or filled surface of a baby tooth in a child under 6, and the CDC reports that more than half of children aged 6 to 8 have had a cavity in a baby tooth.⁠^28,29

In a toddler, any brown or chalky area on a tooth deserves a prompt look: the AAPD counts any sign of smooth-surface decay before age 3 as severe early childhood caries.⁠²⁸

Why is a baby tooth coming in brown?

A baby molar that erupts with cream or brown patches may have hypomineralized second primary molars (HSPM), the baby-tooth version of MIH; children with HSPM are 10 times more likely to have MIH in their permanent molars.⁠¹¹

Enamel defects in baby teeth are also linked to low birth weight: a 2025 meta-analysis of 60 articles found evidence of a causal link for baby teeth, though not for permanent teeth.⁠³⁰

• Surface stains: tea, soft drinks and certain foods, and metals such as iron supplements.⁠⁴
• Fluorosis: in its pitted, more severe forms the pits can stain yellow to dark brown.⁠¹⁷
• Inherited conditions: dentinogenesis imperfecta makes teeth blue-gray or yellow-brown and translucent.⁠²⁰

Why does my child have black spots or a black line near the gums?

A thin black line or a row of tiny black dots along the gum edge of otherwise healthy teeth is typical of black stain, a surface stain linked to mouth bacteria. A 2025 review describes it as a dark line or an incomplete chain of dark spots on the third of the tooth nearest the gum.⁠⁷

It is fairly common and is not decay. A 2025 systematic review included 14 studies; pooling the five with usable data on each question, it put black stain’s prevalence in children at 9.4% and found lower odds of cavities in children who had it (odds ratio 0.53), and its authors urge caution because so few studies could be pooled and they differed.⁠⁶

Whether it protects is unclear: an earlier meta-analysis asked whether black stain prevents decay or simply forms more easily in children whose mouths are already low-risk. Removing it takes a professional cleaning, and the standard treatment is repeated cleaning.⁠^7,31

Silver diammine fluoride is a liquid dentists paint on cavities to stop them; the AAPD notes decay affects more than 1 in 5 US children aged 2 to 5, and the black color is the trade-off for arresting it without drilling.⁠²¹

Why has my child’s tooth turned gray or dark after a fall?

A single baby tooth that turns gray, dark or blue-gray often follows an injury, sometimes a knock nobody noticed. International guidelines endorsed by the AAPD call discoloration a common complication after a tooth is loosened or pushed out of place.⁠³

It is common. In a Brazilian trauma clinic’s records of 355 children with 628 injured baby teeth, 27.9% of the children developed crown discoloration, most often those injured at age 2 to 4, and discolored teeth had twice the risk of the nerve dying and the root canal becoming infected.⁠⁸

The color can fade. The guidelines say the tooth may regain its original shade over weeks or months, and in a prospective study of 97 dark baby incisors, 52% faded or turned yellowish while 48% stayed dark.⁠^3,9

Can a black or gray baby tooth be saved?

Often, yes. In that study, more than half of the baby incisors that stayed dark remained free of symptoms until the adult tooth came in, and the guidelines advise against root canal treatment for a discolored tooth unless there are signs of infection.⁠^3,9

What it needs is follow-up. Infection was associated far more with dark teeth than yellow ones and can appear years after the injury, so the dentist records the color at each visit and parents watch for swelling of the gum, a pimple on the gum (a sinus tract) or increasing looseness.⁠^3,9

In a permanent tooth, darkening after an injury can mean the nerve has died; the ADA lists bleeding, breakdown or death of the pulp among the causes of intrinsic discoloration, and the AAPD notes that a dental assessment can find pulp problems behind a single discolored tooth.⁠^1,4

What does a pink tooth in a child mean?

A pink tooth in a child usually means something is happening inside the tooth, often after an injury, and it should be seen by a dentist promptly. Bleeding in the pulp is one of the causes of intrinsic discoloration the ADA lists.⁠¹

Soon after a knock, bleeding inside the pulp can tint a tooth pink or red. One case report followed two injured baby incisors: on one the red color disappeared, on the other it faded but stayed until the tooth fell out.⁠²²

A pink patch that appears later can mean internal resorption, where tissue inside the tooth dissolves dentin from within; advanced cases can show pink through the crown, called the pink tooth of Mummery. A 2026 review of 62 articles found trauma the most often reported cause and said early diagnosis is essential.⁠²³

Very rarely, reddish-brown teeth (erythrodontia) are a sign of congenital erythropoietic porphyria, an inherited condition marked by severe sensitivity of the skin to light, usually from birth or early infancy.⁠²⁴

What causes green teeth in babies and children?

Baby teeth that come in green are rare and are most often linked to bilirubin, the pigment behind jaundice, laid down in the teeth while they formed during severe or prolonged newborn jaundice. The condition is called chlorodontia.⁠²⁵

The jaundice behind it is severe or prolonged. One case report lists neonatal cholestasis such as biliary atresia, sepsis, other pathological jaundice, metabolic diseases, hemolytic anemia, congenital hypothyroidism and drugs. In a newborn, hemolytic anemia includes hemolytic disease of the newborn, also called erythroblastosis fetalis.⁠^26,32

The color ranges from yellow to deep green, and because it forms with the tooth, it stays. Teeth that form later can be less affected: in a 2026 case of an extremely preterm baby, later-erupting teeth showed less green, though they still had enamel defects.⁠^25,26

Green can also be a surface stain; the same report lists poor oral hygiene, chromogenic (pigment-making) bacteria, colored foods and drinks, metals and topical medicines. Options for intrinsic green include tooth-colored resin restorations and bleaching, in a dentist’s hands.⁠²⁶

Newborn healthYour baby’s first year

Can iron supplements stain a child’s teeth?

Yes. Liquid iron can stain the surface of a child’s teeth, and MedlinePlus lists teeth staining among the side effects of iron. The AAPD classes iron staining as extrinsic and easier to treat than intrinsic color.⁠^4,33

In a laboratory study, all five iron drops tested were acidic and visibly discolored extracted baby teeth, and the authors called for staining warnings on medicine labels.⁠³⁴

MedlinePlus advises mixing the liquid (elixir) form with water or fruit juice to avoid staining, says drops may be given directly or mixed with water, breast milk, cereal, formula or fruit juice, and warns never to give children iron products made for adults.⁠³³

Products differ. In a 2025 laboratory study of 65 baby teeth, ferrous sulfate and a sucrosomial iron discolored the teeth more than polysaccharide or liposomal iron, and the authors note that staining may discourage parents from continuing treatment; a 2026 review counts the absence of staining among the practical points in choosing a product.⁠^35,36

Do not stop iron your child’s doctor prescribed because of a stain; ask the doctor whether another product would suit, and the dentist about cleaning.

Which medicines can discolor a child’s teeth?

Several medicines can change tooth color. The one with a standing warning is tetracycline: MedlinePlus says that used during pregnancy or in children under 8, it can permanently stain teeth.⁠¹²

Medicines a mother takes during pregnancy, or a child takes while teeth are forming, can change the color and hardness of the enamel, MedlinePlus explains. If a medicine worries you, ask the prescriber before stopping it.⁠²

What is dental fluorosis, and what does it look like?

Dental fluorosis is a change in the enamel caused by swallowing more fluoride than needed over a long period while teeth are forming. Mild forms are faint white lines or flecks; severe forms are opaque and pitted, and the pits can stain yellow to dark brown.⁠^14,17

It is common in the US and usually very mild. In national survey data from 1999 to 2004, about 23% of people aged 6 to 49 had some fluorosis: 16.0% very mild, 4.8% mild, 2.0% moderate and less than 1% severe. Adolescents aged 12 to 15 had the highest rate, 40.6%.⁠¹⁷

The window is early childhood. The AAPD says children aged 15 to 30 months are the most susceptible to fluorosis of the permanent front teeth, and the ADA says fluorosis cannot form once teeth have erupted.⁠^14,40

Prevention is about the amount, not avoiding fluoride. The AAPD says a smear the size of a grain of rice for children under 3 may decrease the risk, and the ADA advises storing toothpaste where young children cannot reach it without help.⁠^14,40

Fluorosis usually sits in a symmetrical pattern across matching teeth, which helps a dentist tell it from MIH. For permanent teeth where appearance matters, the AAPD describes microabrasion and resin infiltration.⁠^4,11

Why are my child’s new permanent teeth coming in discolored?

New permanent teeth that come in with white, cream, yellow or brown patches can have molar-incisor hypomineralization (MIH), enamel hypoplasia, fluorosis, or damage from an injury or infection of the baby tooth before them.⁠^11,17,41

What is molar-incisor hypomineralization (MIH)?

MIH is soft, poorly mineralized enamel on one to four of the first permanent molars, often with the front teeth affected too. A 2021 meta-analysis of 116 studies put its worldwide prevalence at 13.5%, with the front teeth involved in 36.6% of cases.⁠^10,11

It matters because the enamel can break down after the tooth comes in, the teeth can be sensitive, and decay risk is up to 4.6 times higher. The exact cause is unknown; the AAPD lists suspected factors around pregnancy and early childhood such as premature birth, low birth weight, infant illness, high fever and antibiotic use.⁠¹¹

Sensitive teethTooth sensitivity in children

What is enamel hypoplasia?

Enamel hypoplasia means less enamel rather than softer enamel: the AAPD describes thin, pitted, deficient enamel with smooth borders. Enamel that breaks down after eruption in MIH can be mistaken for it, which is one reason a dentist examines the tooth rather than a photo.⁠¹¹

Enamel defectsEnamel hypoplasia in children

What is a Turner tooth?

A Turner tooth is a permanent tooth with a developmental defect left by an infection or injury of the baby tooth it replaces. The AAPD lists uneven enamel color on a permanent tooth after trauma or infection of the baby tooth among the discolorations dentists treat.⁠^4,41

Injuries to baby teeth can cause malformed, impacted or late-erupting permanent teeth, which is one reason any knock to a baby tooth deserves a dental visit.⁠³

Which genetic and medical conditions change tooth color?

Several inherited and medical conditions change tooth color, most of them rare. The inherited enamel and dentin conditions can affect both baby and permanent teeth.⁠^20,27

If enamel problems show up across several teeth without an obvious cause, MedlinePlus advises talking to your child’s doctor as well as the dentist, since the color can be related to a medical condition.⁠²

Why are my child’s gums dark or brown?

Dark or brown gums in a toddler or child are usually normal pigment. A 2026 consensus report of the European periodontal and pediatric dental societies says gum pigmentation is typically physiological, from melanin, and common in children with darker skin tones.⁠⁴⁵

A study of 310 preschoolers in India found gum pigmentation increased with age and was darker in children with darker skin. A smaller study of 140 children aged 8 to 14, also in India, linked parental smoking with gum pigmentation.⁠^46,47

Rarer causes include some medicines, heavy metals such as lead, a pigmented spot (nevus), melanoma and a few syndromes. The consensus report advises a closer look, occasionally with a biopsy, for patches that are irregular, changing quickly or otherwise suspicious.⁠⁴⁵

When should a child with discolored teeth see a dentist?

See a dentist for any discoloration that stays after good brushing, and promptly for any tooth that changes color after an injury. MedlinePlus advises contacting a provider when abnormal color lasts after cleaning.⁠^2,3

• Swelling, fever or pain

  Facial swelling, infection and pain are dental emergencies, the AAPD says; contact the dentist right away.⁠⁴⁸

• A pimple or swelling on the gum

  After an injury, swelling of the gums or a sinus tract can mean infection, even without pain.⁠³

• Any knock to a tooth

  Orofacial trauma is a dental emergency, and injured baby teeth can affect the adult teeth beneath them.⁠^3,48

• One tooth turning gray, dark or pink

  A single discolored tooth can mean pulp problems that a dental assessment can find.⁠^4,23

• Chalky white bands near the gums

  A sign of early decay, still reversible at this stage.⁠⁵

• Brown or black spots or holes

  Possible decay, which has no symptoms early.⁠¹⁹

• Cream or brown patches on new molars

  Often MIH, which needs early protection.⁠¹¹

• Color that stays after cleaning

  A reason to contact the dentist, MedlinePlus advises.⁠²

Even without a problem, the AAPD recommends a dental home, with an exam and advice, by 12 months of age.⁠¹⁵

Getting readyPreparing for the first dental visitSensory-friendly dentistry

How do dentists find the cause of a child’s tooth discoloration?

Dentists find the cause mainly by looking and asking: which teeth, what pattern, how the surface feels, and when it started. MedlinePlus says testing may not be necessary in many cases.⁠^2,11

1. The history. When the color appeared, foods, medicines, health history, fluoride exposure and brushing habits.⁠²
2. The pattern. One tooth or many, symmetrical or not, sharp borders or diffuse.⁠¹¹
3. The surface. Whether it polishes off in a cleaning, which separates stain from defect.⁠^1,49
4. Injured teeth. Photos and the color recorded at every visit, with x-rays only where they change the plan.⁠³
5. Medical clues. Testing where a medical condition is suspected.⁠²

X-raysYour child’s dental x-ray

How are discolored teeth treated in children?

Treatment depends on the cause: surface stains are cleaned off, early decay is remineralized, enamel defects are protected or repaired, and an injured tooth is usually watched. Cosmetic work generally waits.⁠^3,5,11,49

Sealants are a thin coating on the chewing surfaces of back teeth. The AAPD and ADA guideline strongly recommends them for children’s molars, and the CDC says sealants on back teeth prevent 80% of cavities.⁠^29,51

Is teeth whitening safe for children?

Not while a child still has baby teeth. The AAPD discourages full-arch cosmetic bleaching in the primary and mixed dentitions, the years when a child has only baby teeth or a mix of baby and permanent teeth.⁠⁴

Its reasons are practical: research on bleaching baby teeth is lacking, and whitening a mixed set would leave the teeth mismatched once the permanent teeth are all in.⁠⁴

For teenagers the AAPD is more open: it recognizes that discoloration can affect an adolescent’s self-image, and it asks that over-the-counter or dentist-dispensed home products used by young people be supervised by an adult, as part of a dentist’s plan.⁠⁴

Side effects are mostly temporary: sensitivity is reported in 8% to 66% of patients, along with gum irritation, and overuse can harm tooth structure. A dental exam first can also find a dying nerve behind a single dark tooth.⁠⁴

Whitening toothpastes mainly polish away surface stains; the ADA says over-the-counter products of this kind have no significant effect on intrinsic stains.⁠¹

How can you prevent tooth discoloration in children?

Most preventable discoloration comes from decay and surface stain, so prevention is good daily brushing with the right amount of fluoride toothpaste, fewer sugary drinks, and early dental care.⁠^5,40

• Water between meals. The AAPD calls fluoridated water the preferred drink outside meals and snacks.⁠⁵²
• No bottle to fall asleep with. Bottle feeding to sleep at 24 months is linked to more early childhood decay.⁠⁵²
• No juice before 12 months. And fewer acidic drinks later, which can erode enamel.⁠^15,52
• Fluoride varnish. Recommended from the first tooth, and a pediatrician can apply it; the CDC says it prevents a third of cavities in baby teeth.⁠^29,50
• A first dental visit by 12 months.⁠¹⁵
• Sealants on molars as they come in.⁠⁵¹
• Mouthguards for sports, since injuries can darken teeth; helmets, face masks and mouthguards reduce dental injuries.⁠^3,53
• Liquid iron given as directed, mixed as the label says, and stored out of reach.⁠^33,37

Daily careBrushing from the first toothBottles and teethWhen brushing is a battle

What should you ask your child’s dentist about discolored teeth?

Bring a dated photo if the color has changed, and a list of medicines and supplements, including iron. A photo taken in good light helps the dentist judge whether a mark is growing.

Related guides on DrSensory

• White spots on kids’ teeth

  Early decay, MIH, fluorosis and hypoplasia, and how to tell them apart.

• Enamel hypoplasia

  Thin or pitted enamel, why it happens and how to protect it.

• Tooth sensitivity

  Why some children’s teeth hurt with cold or brushing.

• The first dental visit

  When to go and what happens.

• Brushing from the first tooth

  Toothpaste amounts and routines by age.

• Dental and oral development

  Every DrSensory guide to children’s teeth and mouths.

Sources

1. American Dental Association. Whitening (Oral Health Topics). Last updated August 16, 2022. Checked October 22, 2026.
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   “Tooth discolorations are typically classified as extrinsic, intrinsic, or a combination of both types.” “Extrinsic discoloration is primarily associated with environmental factors or individual behaviors, such as tobacco use, exposure to metal salts (e.g., iron or copper), or the consumption of highly pigmented foods (e.g., dark fruits) or beverages (e.g., red wine, coffee, tea, or cola drinks).” “Extrinsic tooth stains vary widely in color and severity”; “A wide range of extrinsic stains can be effectively reduced with mechanical interventions such as brushing with a whitening toothpaste or professional prophylaxis.” “Intrinsic stains occur inside the tooth (within the enamel or the underlying dentin)”; “Other causes of intrinsic discoloration include certain antibiotic use in childhood (e.g., tetracycline)”, “caries, amalgam restorations, and pulpal hemorrhage, decomposition or necrosis” “Intrinsic discoloration can also occur with prolonged use of antiseptic mouthrinse (e.g., chlorhexidine rinse).” On aging, “enamel becomes more translucent and thinner, which allows the yellower dentin to show through”.
2. MedlinePlus (US National Library of Medicine). Tooth: abnormal colors. Review date February 5, 2026. Checked October 22, 2026.
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   “Abnormal tooth color is any color other than white to yellowish-white.” Causes listed include “Antibiotic tetracycline use before age 8”, “Eating or drinking items that temporarily stain the teeth, such as tea, coffee, red wine, or iron-containing liquids”, “High fever at an age when teeth are forming”, “Poor oral care”, “Tooth nerve damage”, “Severe neonatal jaundice” and porphyria. “Illicit drugs and medicines taken by a mother during pregnancy or by a child during the time of tooth development can cause changes in the color and hardness of the enamel.” “if the color seems to be related to a medical condition, you should talk to your regular health care provider as well”. Contact a provider if “Abnormal tooth color lasts, even after cleaning your teeth well”; “Testing may not be necessary in many cases.” “More severe discoloration may need to be masked using fillings, veneers, or crowns.”
3. Day PF, Flores MT, O’Connell AC, et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Dental Traumatology. 2020;36(4):343–359. doi:10.1111/edt.12576; endorsed by the AAPD and reprinted in its Reference Manual. Checked October 22, 2026.
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   “Discoloration is a common complication following luxation injuries.” “This discoloration may fade, and the tooth may regain its original shade over a period of weeks or months.” “Root canal treatment is not indicated for discolored teeth unless there are clinical or radiographic signs of infection of the root canal system.” “The color of injured and uninjured teeth should be recorded at each clinic visit.” Parents “should watch for signs of infection such as swelling of the gums”; injuries to baby teeth can lead to tooth malformation, impacted teeth and eruption disturbances in the permanent teeth.
4. American Academy of Pediatric Dentistry. Policy on the use of dental bleaching for child and adolescent patients. The Reference Manual of Pediatric Dentistry. 2025:136–40 (latest revision 2023). Checked October 22, 2026.
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   Stains from “metals (eg, iron supplements) or consumption of tea, coffee, soft drinks, alcohol, and certain foods” are extrinsic and “easier to treat compared to intrinsic factors whether congenital or acquired”. “tooth coloration within a dental arch may vary significantly during the mixed dentition”; “research is lacking on the effects of bleaching on the primary dentition”; “A pretreatment dental assessment helps identify pulpal pathology that may be associated with a single discolored tooth.” The AAPD discourages “full-arch cosmetic bleaching for patients in the mixed dentition and primary dentitions” and encourages “over-the-counter or dentist-dispensed at-home bleaching products used by young patients to be supervised by an adult”. Post-bleaching sensitivity is reported in 8% to 66% of patients; microabrasion and resin infiltration are described for fluorosis and hypomineralization.
5. National Institute of Dental and Craniofacial Research. The tooth decay process: how to reverse it and avoid a cavity. Checked October 22, 2026.
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   “A white spot may appear where minerals have been lost. This is a sign of early decay.” “Tooth decay can be stopped or reversed at this point.” “A cavity is permanent damage that a dentist has to repair with a filling.”
6. Borrell-Garcia C, Boo-Gordillo P, Guinot-Barona C, Marqués-Martínez L, Garcia-Miralles E, Aura-Tormos JI. Association between chromogenic black stain and dental caries in children: a systematic review and meta-analysis. Children. 2025;12(12):1624. doi:10.3390/children12121624 (PMID 41462765). Checked October 22, 2026.
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   “Fourteen studies met inclusion criteria.” “Five studies were included in the meta-analysis, which indicated that children with BS had significantly lower odds of caries (pooled OR = 0.53; 95% CI: 0.36-0.78).” “this estimate is based on only five studies and should be interpreted cautiously”; a different set of five studies “reported data suitable for pooling prevalence estimates”: “The pooled prevalence of BS was 9.4% (95% CI: 6.6-12.2%)”; the finding “should be interpreted with caution given the limited number of studies and substantial heterogeneity”.
7. Al-Shareef A, González-Martínez R, Cortell-Ballester I, Jovani-Sancho M, Sheth CC, Veses V. Current perspective on dental black stain of bacterial origin: a narrative review. European Journal of Oral Sciences. 2025;133(3):e70007. doi:10.1111/eos.70007 (PMID 39994703). Checked October 22, 2026.
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   Black stain appears “as a dark line or an incomplete coalescence of dark spots in the cervical third of the tooth”; “Dental black plaque has a prevalence rate of 2.4%-20%”; “Standard treatment involves repeated professional ultrasonic cleaning.”
8. Goettems ML, Thurow LB, Noronha TG, da Silva Júnior IF, Kramer PF, Feldens CA, da Costa VPP. Incidence and prognosis of crown discoloration in traumatized primary teeth: a retrospective cohort study. Dental Traumatology. 2020;36(4):393–399. doi:10.1111/edt.12552 (PMID 32064750). Checked October 22, 2026.
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   355 children, 628 injured teeth: “The incidence of crown discoloration was 27.9%, and 20.5% of the teeth were affected.” “Discolored teeth had a twofold risk of pulp necrosis and subsequent infection of the root canal system”.
9. Holan G. Development of clinical and radiographic signs associated with dark discolored primary incisors following traumatic injuries: a prospective controlled study. Dental Traumatology. 2004;20(5):276–287. doi:10.1111/j.1600-9657.2004.00285.x (PMID 15355387). Checked October 22, 2026.
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   97 dark-discolored baby incisors followed 12 to 75 months: “In 50 teeth (52%) the color faded or became yellowish and in 47 (48%) it remained dark.” Signs of infection “were associated significantly more with dark than yellowish hues (83 and 17%, respectively)”; “Teeth that had changed their color to become yellow presented more PCO than teeth with black/gray/brown coronal discoloration (78 and 6%, respectively).” “more than 50% of the primary incisors that retain their dark coronal discoloration acquired after dental injuries remain clinically asymptomatic till the eruption of the permanent successor”.
10. Lopes LB, Machado V, Mascarenhas P, Mendes JJ, Botelho J. The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis. Scientific Reports. 2021;11:22405. doi:10.1038/s41598-021-01541-7 (PMID 34789780). 116 observational studies: “The pooled prevalence of MIH was 13.5% (95% CI 12.0-15.1”; “Affected incisors were seen in 36.6%” of cases. Checked October 22, 2026.
11. American Academy of Pediatric Dentistry. Molar-incisor hypomineralization. The Reference Manual of Pediatric Dentistry. 2025:465–72 (adopted 2024). Checked October 22, 2026.
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    “Severity ranges widely from distinct isolated white, yellow, or brown opacities to severe posteruptive breakdown”; “They are distributed in an asymmetrical fashion and have well-defined and discrete borders that distinguish them from the diffuse symmetrical opacities of enamel fluorosis.” “The yellow-brown defects typically extend through the entire enamel thickness”; caries risk is “up to 4.6 times higher than in teeth without MIH”; “Children with HSPM have 10 times greater probability of having MIH than children without HSPM.” “While the exact etiology of MIH is unknown”, suggested factors include premature birth, low birth weight, infant illness, high fever and antibiotic use. Hypoplastic enamel “is differentiated from PEB by having smooth enamel borders with thin, pitted, and deficient enamel across the tooth surface”. Mild cases are managed with remineralizing agents, silver diammine fluoride and sealants; moderate and severe cases may need restorations or extraction.
12. MedlinePlus (US National Library of Medicine). Tetracycline. Last revised June 15, 2026. “when tetracycline is used during pregnancy or in babies and children under 8 years old, it can permanently stain teeth”. Checked October 22, 2026.
13. Machuca-Portillo C, Suárez-Marchena C, Chandler-Gutiérrez L, Barra-Soto MJ, Caleza-Jiménez C, Valle LL, Segura-Egea JJ. Risk of permanent dental staining following exposure to newer-generation tetracycline derivatives in children: a systematic review and meta-analysis. Children. 2026;13(8):1029. doi:10.3390/children13081029 (PMID 42650369). Checked October 22, 2026.
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    Six observational studies: “short-course doxycycline is associated with little or no clinically relevant risk of permanent dental staining in children younger than 8 years”; “the certainty of evidence was low for doxycycline/minocycline”.
14. American Dental Association. Fluoride: topical and systemic supplements (Oral Health Topics). Last updated June 14, 2023. Checked October 22, 2026.
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    Under 3, “no more than a smear or alternatively as the size of a grain of rice”; “For children 3 to 6 years of age, parents and caregivers should dispense no more than a pea-sized amount of fluoride toothpaste.” “Fluorosis varies in appearance from white striations to stained pitting of enamel”; “Enamel fluorosis occurs only when primary and permanent teeth are developing. Once teeth erupt, they cannot develop enamel fluorosis.” Excess exposure is minimized “by storing toothpaste where young children cannot access it without parental assistance”.
15. American Academy of Pediatric Dentistry. Perinatal and infant oral health care. The Reference Manual of Pediatric Dentistry. 2025:337–41 (latest revision 2025). Recommends a dental home with “anticipatory guidance for infants by 12 months of age”; “no juice should be introduced before 12 months of age”. Checked October 22, 2026.
16. American Dental Association (MouthHealthy). Baby teeth. “Babies are born with all 20 primary teeth already in their jaws.” “Sometime around 6 months of age, the first teeth break through the gums” Checked October 22, 2026.
17. Beltrán-Aguilar ED, Barker L, Dye BA; National Center for Health Statistics. Prevalence and severity of dental fluorosis in the United States, 1999–2004 (NCHS Data Brief No. 53, 2010). Read from the Internet Archive copy of July 25, 2026. Checked October 22, 2026.
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    Fluorosis forms during “first 8 years of life for most permanent teeth excluding third molars”; “Changes range from barely visible lacy white markings in milder cases to converged opaque areas and pitting of the teeth in severe forms. After eruption the pitted areas can become stained yellow to dark brown.” “Among persons aged 6-49, 16.0% had very mild fluorosis, 4.8% had mild fluorosis, 2.0% had moderate fluorosis, and less than 1% had severe fluorosis”; “Adolescents aged 12-15 had the highest prevalence of dental fluorosis (40.6%)”.
18. Kaya E, Eren MG, Özçiftçi HE, Akyildiz G, Oksuz NC. Impact of common fruit juices and toothbrushing on the discoloration of primary teeth. Journal of Visualized Experiments. 2026;(229). doi:10.3791/70572 (PMID 41973629). Checked October 22, 2026.
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    Eighty extracted baby teeth: “Black mulberry and pomegranate produced the greatest total discoloration, while orange juice resulted in markedly lower ΔE values.” “Brushing consistently reduced discoloration across all groups”.
19. National Institute of Dental and Craniofacial Research. Tooth decay. “In early tooth decay, there are not usually any symptoms.” “Tooth decay signs include white, brown, or black staining on the tooth.” Checked October 22, 2026.
20. MedlinePlus Genetics (US National Library of Medicine). Dentinogenesis imperfecta. “This condition causes the teeth to be discolored (most often a blue-gray or yellow-brown color) and translucent.” “Type I occurs in people who have osteogenesis imperfecta”; “Dentinogenesis imperfecta affects an estimated 1 in 6,000 to 8,000 people.” Checked October 22, 2026.
21. American Academy of Pediatric Dentistry. Chairside guide: silver diammine fluoride in the management of dental caries lesions. The Reference Manual of Pediatric Dentistry. 2025. Checked October 22, 2026.
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    “Dental caries affects more than 1 of every 5 children ages 2 through 5 years in the US.” “Caries lesions treated by SDF usually turn black and hard.” Consent should cover “permanent staining of treated lesions”.
22. Aguiló L, Gandía JL. Transient red discoloration: report of case. ASDC Journal of Dentistry for Children. 1998;65(5):346–348, 356. PMID 9795741. Checked October 22, 2026.
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    Red discoloration of two injured baby incisors: “In the right central incisor the red discoloration disappeared; in the left it faded but was sustained until exfoliation.” “The resorption of posttraumatic intrapulpal bleeding in a primary tooth is discussed as a possible pathogenesis.”
23. Mercante HS, Nunes GP, Alves de Toledo PT, et al. Internal root resorption: understanding the pink tooth of Mummery and its clinical implications. Journal of Clinical and Experimental Dentistry. 2026;18(5):e616–e627. doi:10.4317/jced.63932 (PMID 42434214). Checked October 22, 2026.
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    Review of 62 articles: “advanced cases may present as a pink discoloration of the crown, known as Pink Tooth of Mummery (PTM)”; “Trauma was the most frequently reported etiological factor”; “Early diagnosis is essential for the appropriate management of IRR.”
24. Erwin A, Balwani M, Desnick RJ; Porphyrias Consortium of the NIH-Sponsored Rare Diseases Clinical Research Network. Congenital erythropoietic porphyria. In: Adam MP, Bick S, Mirzaa GM, et al., editors. GeneReviews. Seattle (WA): University of Washington, Seattle; 1993–. Initial posting September 12, 2013; revised April 15, 2021. PMID 24027798. Checked October 22, 2026.
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    “Porphyrin deposition may lead to corneal ulcers and scarring, reddish-brown discoloration of the teeth (erythrodontia), and bone loss”.
25. Szymczak-Paluch M, Bruzda-Zwiech A, Kłosek S. Presumptive bilirubin-related chlorodontia and developmental enamel defects of the primary dentition in an extremely preterm infant: a case report. Journal of Clinical Medicine. 2026;15(14):5423. doi:10.3390/jcm15145423 (PMID 42513336). Checked October 22, 2026.
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    “Chlorodontia is a rare condition characterized by intrinsic green discoloration of teeth. It is most often reported in association with bilirubin pigment deposition during teeth development, in cases of severe and/or prolonged neonatal hyperbilirubinemia.”
26. Dhar S, Gupta D, Ghosh A. An unusual case of green teeth secondary to neonatal hyperbilirubinemia. Indian Journal of Dermatology. 2022;67(1):74–75. doi:10.4103/ijd.ijd_216_21 (PMID 35656245). Checked October 22, 2026.
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    “Green teeth are a rare finding in children with neonatal hyperbilirubinaemia, which may be secondary to neonatal cholestasis (e.g., biliary atresia, sepsis, pathological hyperbilirubinemias, and metabolic diseases), hemolytic anemia, congenital hypothyroidism, and drugs.” “The pigmentation may vary from yellow to deep shades of green.” “Other causes can be poor oral hygiene, chromogenic bacteria, colored foods and beverages, metallic compounds, and topical medication.” Treatment options listed include “composite resin restorations, bleaching techniques”.
27. MedlinePlus Genetics (US National Library of Medicine). Amelogenesis imperfecta. “tooth enamel does not form properly”; teeth “may be unusually small, discolored, pitted, or grooved”; incidence “from 1 in 700 people in northern Sweden to 1 in 14,000 people in the United States”. Checked October 22, 2026.
28. American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): consequences and preventive strategies. The Reference Manual of Pediatric Dentistry. 2025:96–100 (latest revision 2025). Checked October 22, 2026.
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    ECC is “the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth” in a child under 72 months; severe ECC includes “any sign of smooth-surface caries in a child younger than 3 years of age”.
29. Centers for Disease Control and Prevention. Oral health tips for children. Read from the Internet Archive copy of October 17, 2026. Checked October 22, 2026.
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    “More than half of children aged 6 to 8 years have had a cavity in at least one of their baby (primary) teeth.” “Fluoride varnish can prevent one-third (33%) of cavities in the primary (baby) teeth.” “Applying dental sealants to the back teeth prevents 80% of cavities.”
30. Dantas ELA, Vieira BR, Santiago BM, Cavalcanti YW, de Sousa FB. Association of low birth weight with development defects of enamel: systematic review with meta-analysis. Archives of Oral Biology. 2025;177:106313. doi:10.1016/j.archoralbio.2025.106313 (PMID 40472787). 60 articles: “the evidence suggests a causal association between LBW and DDE in the deciduous, but not in the permanent dentition”. Checked October 22, 2026.
31. Mousa HRF, Radwan MZ, Wassif GOM, Wassel MO. The association between black stain and lower risk of dental caries in children: a systematic review and meta-analysis. Journal of the Egyptian Public Health Association. 2022;97(1):13. doi:10.1186/s42506-022-00107-3 (PMID 35906494). Checked October 22, 2026.
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    “it is questionable whether black stain has a protective effect against dental caries, or whether children at low risk of dental caries are more likely to develop BS because their oral microbiome favors BS-forming organisms”.
32. MedlinePlus (US National Library of Medicine). Hemolytic disease of the newborn. Other names listed include “Erythroblastosis fetalis”. In HDN, the mother’s antibodies “attack the RBCs in the baby’s blood and cause them to break down too early”. Checked October 22, 2026.
33. MedlinePlus (US National Library of Medicine). Ferrous sulfate (iron). Last revised April 15, 2025. Checked October 22, 2026.
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    “Mix the elixir with water or fruit juice to avoid possible teeth staining”; iron drops “may be placed directly in the mouth or mixed with water, breastmilk, cereal, formula, or fruit juice”; “Do not give iron products that are made for adults to children.” Side effects listed include “teeth staining”. “In case of overdose, call the poison control helpline at 1-800-222-1222”; “If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.”
34. Babaei N, Molaei T, Belyad S, Hekmatfar S. Relationship of pH and the viscosity of five different iron supplements with the absorption of iron ions and enamel discoloration in the anterior primary teeth (an in vitro study). Dental Research Journal. 2021;18:7. doi:10.4103/1735-3327.310036 (PMID 34084294). Checked October 22, 2026.
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    Sixty extracted baby teeth: “all medications demonstrated acidic pH and discoloration”; “Medicine labels should include warning statements on the feasibility of dental discoloration and erosion.”
35. Vahedi P, Bagheri N, Khoramian Tusi S, Mohammadian M. Comparative evaluation of the effects of four types of iron supplements on primary teeth discoloration: an in vitro study. BMC Oral Health. 2025;25(1):1428. doi:10.1186/s12903-025-06846-x (PMID 40993654). Checked October 22, 2026.
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    65 extracted baby front teeth: “This staining may discourage parents from continuing treatment.” Color change was “significantly higher in the groups treated with Amivital Ferrous Sulphate and SiderAl iron supplements compared to the other groups”; “polysaccharide and liposomal iron supplements may cause less discoloration in vitro, though further clinical research is needed”.
36. Alexiadou S, Tsouvala E, Mantadakis E. Pediatric oral iron therapy: choosing the right product for your patient. Hematology Reports. 2026;18(2):20. doi:10.3390/hematolrep18020020 (PMID 41874103). Side effects of iron salts include “teeth staining”; “Easy swallowing, an acceptable taste without a metallic aftertaste, and the absence of dental staining are important additional practical considerations.” Checked October 22, 2026.
37. US Code of Federal Regulations. 21 CFR 101.17(e): dietary supplements containing iron or iron salts. Checked October 22, 2026.
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    The required label warning: “Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep this product out of reach of children. In case of accidental overdose, call a doctor or poison control center immediately.”
38. MedlinePlus (US National Library of Medicine). Doxycycline. Last revised May 15, 2026. “Doxycycline should not be used in children under 8 years of age except for inhalational anthrax, Rocky Mountain spotted fever, or if your doctor decides it is needed.” Checked October 22, 2026.
39. MedlinePlus (US National Library of Medicine). Minocycline. Last revised May 15, 2026. “It is also used to treat acne and rosacea”; side effects include “changes in color of skin, scars, nails, teeth or gums”. Checked October 22, 2026.
40. American Academy of Pediatric Dentistry. Fluoride therapy. The Reference Manual of Pediatric Dentistry. 2025:372–8 (latest revision 2023). Checked October 22, 2026.
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    “Using no more than a pea-sized amount of fluoridated toothpaste (0.25 mg F) is appropriate for children 3 to 6 years of age”; a smear or rice-sized amount for children under 3 “may decrease risk of fluorosis”; “supervised toothbrushing should be done twice a day, and rinsing after brushing should be kept to a minimum”; fluorosis risk is highest with “children 15-30 months of age being most susceptible for fluorosis of the permanent incisors”; “Over-ingestion of fluoridated toothpaste combined with other dietary fluoride sources may lead to daily intake greater than the recommended amount and could lead to development of dental fluorosis.”
41. Di T, Liu Y, Xu J, Zhang X, Li J, Wang L, Chen Y. A histopathological case-control study of severe Turner teeth and normal teeth: structural and compositional alterations in pulp and periodontal tissues. BMC Oral Health. 2026;26(1):1918. doi:10.1186/s12903-026-09187-5 (PMID 42426693). Checked October 22, 2026.
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    “Turner teeth are developmental defects of permanent teeth commonly associated with disturbances affecting the corresponding primary predecessors, particularly infection or trauma.”
42. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of celiac disease. In children, poor absorption of nutrients can lead to “damage to the permanent teeth’s enamel”. Checked October 22, 2026.
43. Zhao Y, Feng W. Relative risk of oral manifestations with celiac disease: a systematic review and meta-analysis. BMC Gastroenterology. 2026;26(1):343. doi:10.1186/s12876-026-04860-z (PMID 42021157). 22 observational studies; the pooled relative risk “for dental enamel defects (DED), it was 2.49 (95% CI, 2.12–2.93)”. Checked October 22, 2026.
44. MedlinePlus (US National Library of Medicine). Congenital syphilis. Signs in older infants and children include “Abnormal notched and peg-shaped teeth, called Hutchinson teeth”. Checked October 22, 2026.
45. Chapple I, Gizani S, Sanz M, et al. Gingival and periodontal diseases and conditions in children and adolescents: consensus report. Journal of Clinical Periodontology. 2026;53(7):1068–1099. doi:10.1111/jcpe.70033 (PMID 41983269). Checked October 22, 2026.
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    A focused workshop of the European Federation of Periodontology and the European Academy of Paediatric Dentistry. Gingival pigmentation is “typically physiological, resulting from melanin deposition by melanocytes in the basal layer of the epithelium”; “This is common in children and adolescents with darker skin tones”; rarer causes include medications, “heavy metals such as lead or arsenic”, a nevus or melanoma, and some syndromes; a biopsy is occasionally needed, “particularly for lesions that are irregular, rapidly changing or suspicious”.
46. Verma J, Ahuja A, Ahuja V, Thosar NR. Reconnoitering the association of gingival melanin pigmentation with skin color, age, and sex in pre-school children of Hazaribag: a cross-sectional study. Cureus. 2022;14(10):e30699. doi:10.7759/cureus.30699 (PMID 36439562). Checked October 22, 2026.
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    310 children aged 3 to 6 in India: “Gingival pigmentation was found to increase with increasing age”; “the darker the skin tone, the darker was the gingival pigmentation”.
47. Anand A, Raja T, Thakur V, Agarwal N. Evaluation of the effect of parental smoking on gingival melanin pigmentation in children. International Journal of Clinical Pediatric Dentistry. 2024;17(2):173–175. doi:10.5005/jp-journals-10005-2773 (PMID 39184897). 140 children aged 8 to 14 in India: “There is a correlation between parental smoking and melanin pigmentation in the gingiva of children”. Checked October 22, 2026.
48. American Academy of Pediatric Dentistry. Policy on emergency oral care. The Reference Manual of Pediatric Dentistry. Latest revision 2026. “Dental emergencies include, but are not limited to, facial swelling, infections, uncontrolled bleeding, pain, and orofacial trauma.” Checked October 22, 2026.
49. American Academy of Pediatric Dentistry. Policy on the role of dental prophylaxis in pediatric dentistry. The Reference Manual of Pediatric Dentistry. 2025:104–6 (latest revision 2024). “The aim of oral prophylaxis is to remove supragingival plaque, extrinsic stain, and calculus” from the teeth. Checked October 22, 2026.
50. US Preventive Services Task Force. Prevention of dental caries in children younger than 5 years: screening and interventions (2021). “The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.” Grade B. Checked October 22, 2026.
51. Wright JT, Crall JJ, Fontana M, et al. Evidence-based clinical practice guideline for the use of pit-and-fissure sealants. American Academy of Pediatric Dentistry and American Dental Association. Pediatric Dentistry. 2016;38(5):E120–E136. AAPD reprint. Checked October 22, 2026.
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    The panel recommends sealants over nonuse on molars “with both sound occlusal surfaces and noncavitated occlusal carious lesions in children and adolescents” (strong recommendation, moderate-quality evidence).
52. American Academy of Pediatric Dentistry. Policy on nutrition and dietary counseling in the pediatric dental setting. The Reference Manual of Pediatric Dentistry. Latest revision 2026. Checked October 22, 2026.
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    “Fluoridated water is the preferred beverage for children and adolescents when consumed outside of meals or snacks.” “Bottle feeding to sleep at 24 months of age, beyond the recommended age of bottle cessation, is associated with greater early childhood caries (ECC) prevalence”; frequent acidic drinks “can lead to enamel erosion and dental sensitivity”.
53. American Academy of Pediatric Dentistry. Policy on prevention of sports-related orofacial injuries. The Reference Manual of Pediatric Dentistry. 2025:130–5 (latest revision 2023). “Helmets, facemasks, and mouthguards have been shown to reduce both the frequency and severity of dental and orofacial trauma.” Checked October 22, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical or dental advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. Never start, stop, or change a dose without medical guidance. Poison Control: 1-800-222-1222.