Updated 9/30/21

I was horrified one day to find black stains all over my then 2 yr old’s teeth which I couldn’t remove with a toothbrush. I thought they were cavities and brought him to the pediatric dentist right away. Surprisingly, the dentist didn’t know what caused the stains or what the black stains were even called. After ruling out foods, iron intake and poor brushing habits, he suspected something had changed the flora in my child’s mouth. Perhaps the Xoponex (an asthma medication) that he had taken for a cold a few months earlier. A few other pediatric patients also had similar black stains and those stains were not cavities and on the contrary, often associated with a low incidence of cavities.

A Comprehensive Overview of Black Stains on Children’s Teeth

While there can be many more reasons for black stains on teeth in the adult population, the culprits are more limited for children. Below is a description of my finding and experience on the stains for children, though they may apply for adults as well.

What are the black stains on teeth?

I discovered that the black stains are caused by chromogenic bacteria and they feed off of the plaque on the teeth. The fact that our kids were not consumers of tea, coffee, iron supplements, dried fruit and other stain-creating foods leads us to believe that their stains were not caused by these culprits as commonly suggested by dentists. Our pediatric dentist said anecdotally that the black stains seem to occur more frequently with the Asian and Hispanic population. It varies in degree of severity. I see many posts where adults complain of having these stains, and not being able to keep the stains at bay (frequent dental visits not enough, regular brushing, etc). I also read about one frustrated woman whose children had lots of stains recurring as quickly as the day after their dental visit. Because it’s bacteria, it needs plaque to grow so it tends to appear along the gumline and in grooves and spots where it is difficult to brush well or where food sugars tend to linger between brushing sessions.

Our dentist also suggested that the black stains decrease and may even disappear with age. However, it was unclear to him if this was from better brushing habits or something in the child’s mouth flora that changes. Unfortunately, bacteria can be transmitted from one child to another and even to an adult! My oldest had the staining first, followed by his brother and eventually their dad got it, too. Fortunately (knock on wood), my teeth don’t show signs of the chromogenic bacteria yet (4 years of exposure and counting) which suggests that there can be something in your mouth flora that also prevents its growth. After all, I kiss my kids and share drinks and food with my kids all the time.

How to remove black stains on teeth

There doesn’t seem to be any definitive treatment or solution for keeping these black stains at bay. However, from first hand experience and tips from a couple of different dentists and readers, I’ve compiled this growing list (more than 6 things to try now!), starting with what has worked best for us:

1. Sonicare toothbrush (most effective with my kids, recommended by the pediatric dentist, something about the vibration of the toothbrush). In 2021, I’ve also started alternating with the Oral-B rotating toothbrush. My theory is that the different brushes are better at different parts of the teeth, so alternating them helps me brush the teeth more thoroughly.
2. Swimming in chlorine pools frequently We saw a noticeable reduction in visible black stains over one spring break week spent daily in the pool. We saw even more reduction over a summer when swimming occurred 4 days/week. Remember, this is a 2-child data set. However, I suspect the chlorine kills the bacteria or changes the mouth flora. Update as of 1/23/20: despite not swimming in chlorinated pools for the last 3 months, the reduction of black stains on our kids’ teeth seems to be holding steady.
3. Listerine mouthwash (helpful for my husband)
4. Periodic hydrogen peroxide mouth rinse (didn’t dare try it with my kids and this would be too abrasive to do on a long-term basis)
5. Pumice powder, before you buy it, ask your dentist for a sample to see if it works for you (didn’t really work for us). Also, overuse of pumice and abrasive agents will erode your tooth enamel long-term. Update as of 3/15/21: We tried pumice powder again and it actually helped. Previously, we had added it to the toothpaste first, and that was ineffective. This time, we smeared it onto the areas with stains first and then brushed those teeth directly with an electric toothbrush.
6. Regular visits to the dentist – The dentist uses a polisher (technically called a prophy angle) with some pumice powder and a scaler to scrape off the parts that remain after polishing. Even our dentist can’t remove all the stains, as some of the stains along the gumline and in the grooves are particularly stubborn. I’ve considered getting one of the polishers from Amazon, but most have pretty bad reviews. Recently, I saw this Bilistic Pro Series and it looks more promising, but I haven’t tried it. Let me know if you have!
7. A dental scraper (added as of 5/21/20) – During this pandemic, we’re not making it to the dentist routinely, and I notice that the black stains seem to be gaining ground (particularly with my 9 yr old with braces!), so I started using a dental scraper tool like this one. The results aren’t perfect, but I’m able to easily scrape off the black stains on the flatter parts of the teeth and loosen some of the stubborn black stains that build up along the gumline. I noted that when I scraped the stains along the gumline, it would often seem like I hadn’t removed anything. However, when we brushed afterwards and over the course of the following few days, some of the stains could be brushed away, so I think the scraper can agitate or loosen the stains a bit.
8. Probiotics (added as of 9/1/20) – we haven’t tried probiotics yet, but a reader sent me a tip that eating Greek yogurt regularly (which has cultures containing: L. Bulgaricus, S. Thermophilus, L. Acidophilus, Bifidus, L. Casei) seemed to have reduced some of the black staining in their family. Whether it’s yogurt or probiotic capsules, some form of probiotics may be another thing to try. It seems to make sense given the bacterial nature of the staining and the beneficial bacterias found in probiotics and yogurt, etc.
9. Brushing teeth before breakfast (added as of 9/30/21) – I’m suspecting this is making a remarkable difference, but only time will tell. I suddenly noticed this week that one child amazingly doesn’t have ANY black staining and my other child seems to have a lot less than usual. The only change I could think of is that they both started brushing their teeth before breakfast instead of after breakfast. It’s only been a month so far, so I’ll have to see if the stains continue to stay away this time. As for the theory why this might help? I actually covered this in a previous post about teeth brushing, but I didn’t have my kids brush before breakfast until school started again this year. This other post gets in-depth on the benefits of getting rid of overnight plaque and my theory is that this is slowing down the black-staining chromogenic bacteria.

Resources

• Provides some medical explanation of the black stains on teeth:
  • https://www.omicsonline.org/open-access/black-stains-in-primary-teeth-overview-.php?aid=81971
  • https://www.amhsr.org/articles/occurrence-of-black-chromogenic-stains-and-its-association-with-oral-hygiene-of-patients-4355.html
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560370/
• A hygienist explains black stains on teeth in layman terms: https://dentistrydonedifferently.com/2015/06/15/black-line-stain
• Read the posts in response to this topic and realize that you are not alone: http://www.steadyhealth.com/topics/chromogenic-bacteria-stain-on-teeth
• Summary of products that might help remove black stains on teeth:
  • Sonicare toothbrush
  • Oral-B rotating toothbrush
  • prophy angle
  • Listerine mouthwash
  • pumice powder
  • dental scraper

This page will definitely be updated if I find out a way to remove or prevent these stains permanently!