O. Ibiyemi and J.O. Taiwo

Department of Periodontology and Community Dentistry, University of Ibadan.


Background: Aesthetic problems in adolescence can have a significant effect on their psychosocial development. Abnormalities in tooth color can lead to such problem especially if it affects anterior teeth.

Objective: This study therefore assessed the effects of anterior tooth discoloration on the psychosocial well-being of adolescents with a view to providing information that will aid the prevention and treatment of this dental problem.

Materials and methods: This study was a cross-sectional study involving 384 adolescents aged between 10 and 20years in Igboora southwestern Nigeria. Twenty-six item semi-structured questionnaire comprising variables on demographics and psychosocial effects were researcher-administered. Oral examination of the labial surfaces of the anterior permanent teeth was carried by two examiners. Frequencies and mean were generated. Chi-square and Fischer’s exact tests were used to test associations between categorical variables at (P<0.05).

Results: The mean age of participants was 14.7±2.3 years. Ninety four (24.5%) participants perceived that their anterior teeth were discolored, 65 (69.1%) of these did not like the discoloration. Sixty two (65.9%), 47 (50.0%) and 38 (40.4%) respectively reported that it prevented them from freely answering questions, smiling and interacting. After oral examination, 120 (31.2%) subjects had one form of anterior tooth discoloration. The cause of tooth discoloration in the majority 64 (16.7%) of the participants was due to extrinsic stains from compounds incorporated into plaque and calculus. Age group, sex, class of participants and presence of tetracycline stained teeth were significantly related with reported psychosocial problems (p<0.05).

Conclusion: About one third of adolescents had anterior tooth discoloration and the majority reported one form of psychosocial problem.

Keywords: Psychosocial, Anterior tooth discolouration, Adolescents


Dr. Olushola Ibiyemi
Dept. of Perio. & Comm. Dentistry
University of Ibadan,
PMB 5017, GPO Dugbe,
Ibadan, Nigeria.
Tel: 2348037201253


Teeth form an important part of the body that aids chewing, speech as well as contributing to appearance. Robinson1 mentioned that the colour of the teeth is an important feature in determining the attractiveness of the face. The colour of teeth varies from white to creamish yellow. It is lighter in children and becomes darker as age increases. The tooth can be discoloured by deposition of pigments in its internal structure and on its surface. Tooth discoloration varies in etiology, presentation and severity. It could be intrinsic, extrinsic and a combination of both2. Intrinsic or endogenous discoloration is caused by incorporation of chromatogenic material into dentine and enamel during odontogenesis or after eruption either locally or systemically. Exposure to high levels of fluoride, tetracycline or some other drugs, inherited developmental disorders and trauma to developing tooth may result in pre-eruptive discoloration3. After eruption of the tooth, aging, pulp necrosis and iatrogenic causes account for most intrinsic discoloration. Tooth discoloration is said to be extrinsic or exogenous when compounds from substances such as tobacco, coffee, tea, herbs, red wine, carrots, oranges are incorporated into the acquired pellicle on the surface of the tooth.2,4

Tooth discoloration can cause significant cosmetic problem especially when it affects the anterior teeth, which is usually exposed when a patient smiles. Anterior tooth discoloration is one of the most frequent reasons for seeking dental treatment.5 In most societies the concern about appearance is increasing. The appearance of the dentition is of concern to a large number of people seeking dental treatment and the colour of the teeth is of particular cosmetic importance.4 Patients now demand not only a healthy mouth but also a perfect smile6. It has been reported that 34% of an adult population in the USA were dissatisfied with their tooth colour7 and 28% of adults in the UK were dissatisfied with the appearance of their teeth8. There has been a recent increase in interest in the treatment of tooth staining and discolouration as shown by the large number of tooth whitening agents appearing on the market.

A smile has a great impact in our beauty-conscious society and when it is diminished by dental disease, it often results in loss of self-esteem and damage to physical and mental health.9,10 Tooth discolouration produces profound embarrassment and more psychological distress than can only be imagined11. Negative emotions such as fear, anxiety, depression and timidity are sometimes exhibited in cases of anterior tooth discolouration. This can affect the general health and ability of an individual to participate fully in society, fulfilling roles as family members, friends, co-workers and other roles requiring interaction with others. The psychosocial consequences of tooth discolouration could be considerable.12,13 Bryan and Welbury14 reported that aesthetic problems in childhood and adolescence can have a significant effect on psychosocial development and interaction with peers. They further mentioned that abnormalities of shape, size, colour and structure of the whole or part of the anterior dentition of children can lead to such problems. During this developmental stage, emphasis is placed on aesthetics and attractiveness and this can have great psychosocial effect on their general wellbeing. There is dearth of literature on the psychosocial effects of anterior tooth discolouration among adolescents in Nigeria. Therefore, this study assessed the effects of anterior tooth discolouration on the psychological and social aspects of the general wellbeing of adolescents in Igbo-ora, a rural community southwestern Nigeria with a view to providing evidence to strengthen the case to provide standard facilities for the prevention and treatment for dental cases even in rural settings.

This study was a cross-sectional study carried out among adolescents aged 10 to 20 years who have been living in Igbo-ora community for 5 consecutive years preceding the time of study. Igbo-ora, a rural community and the headquarters of Ibarapa Central Local Government Area of Oyo State is inhabited by about 60,000 people whose main occupations are farming and trading15. It is situated about 80 km south of Ibadan, the capital city of Oyo State, Southwestern Nigeria and the largest city in West Africa.15

A sample size of 384 study participants who had only permanent teeth was determined using the Kish and Leslie formula for cross-sectional studies at a prevalence of 50.0%. Four public and four private secondary schools were randomly selected from a list of government approved public and private secondary schools obtained from the Local Education Authority. A list of all junior and senior secondary school classes were obtained from the principals of the selected schools. Permission to conduct the study was obtained from the Local Government Education Authority and the school authorities. Written informed consent was obtained from the study subjects and their parents/ guardians before the commencement of the study. The study was carried out in strict compliance with Helsinki Declaration on studies involving human subjects in which all participants were treated equally and no harm was inflicted.

The 384 participants were chosen by simple random sampling using ballot papers. The junior secondary school classes were twice the number of senior secondary school classes. A 26-item semi-structured questionnaire comprising two sections was administered. Section A covered socio-demographic data and section B sought participant’s perception on the appearance of anterior teeth and the attendant psychosocial problems in cases of discoloration. The study attempted to determine presence of psychosocial effect through probing questions on negative emotions, on inhibitions and restricted participation in normal social activities. The content validity of the instrument was established before using it in this study.

All examinations were conducted outdoors in a welllit space. Oral examination of the labial surface of the anterior permanent teeth was carried out with gloved hands and wooden spatulas to establish presence of tooth discolouration and their types under natural light by two examiners between 9 am and 11am. This was done by comparing the colour of the tooth with Vita Shade Guide (C-101), a tooth shade guide. Prior to the oral examination, a one day training on the diagnostic criteria for the types of tooth discolouration was carried out among the examiners. The Dean Index criteria for fluorosis and the World Health Organization criteria for recording enamel disorders as outlined in its basic methods for oral health surveys16 were used for this study. Other enamel disorders, such as tetracycline stain, opacities and hypoplasia were recorded if present. Extrinsic stains due to incorporation of metallic and non-metallic compounds into plaque and calculus were also recorded.