牙面黑色素沉着与铁、龋病关系的研究进展

doi:10.7518/gjkq.2025051

Abstract

Abstract:

Black tooth stain (BTS) is characterized by brownish-black bands along the gingival margin. It is typically confined to the cervical region of the teeth. The etiology of BTS is closely linked to the oral microbiota, particularly bacteria, such as Actinomyces and Porphyromonas. Additionally, the use of probiotics may represent a potential therapeutic approach for BTS. Epidemiological studies have demonstrated a significant correlation between BTS and iron supplement use, iron-rich diets, and iron-containing drinking water, with the excessive consumption of iron-rich foods increasing the risk of developing BTS. Moreover, an association exists between iron status and dental caries, with iron deficiency increasing susceptibility to caries. On the basis of the above findings, this review aims to provide dietary guidance for children with BTS; explore future research directions concerning the microbiota involved in BTS; and examine the interrelationship among BTS, dental caries, and iron. The goal of this review is to propose new strategies for the prevention and management of BTS and dental caries.

Key words: black tooth stain, iron, oral flora, iron-containing diet, caries, Actinomyces, Prevotella, Por-phyromonas

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Jianxin Wang,Shuting Wang,Lei Ma,Jin Yue,Chuanyue Qiao,Kaijie Lin,Rui Han. Advances in the research on the relationship among black tooth stain, iron, and caries[J].Int J Stomatol, 2025, 52(4): 456-465.

Figures/Tables 5

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References 69

[1]	宋思行, 赵蕾, 肖诗梦. 牙龈色素沉着诊疗研究进展[J]. 口腔疾病防治, 2022, 30(6): 438-442.
	Song SX, Zhao L, Xiao SM. Research progress on diagnosis and treatment of gingival pigmentation[J]. J Prev Treat Stomatol Dis, 2022, 30(6): 438-442.
[2]	Chen X, Zhan JY, Lu HX, et al. Factors associated with black tooth stain in Chinese preschool children[J]. Clin Oral Investig, 2014, 18(9): 2059-2066.
[3]	Mousa HRF, Radwan MZ, Wassif GOM, et al. The association between black stain and lower risk of dental caries in children: a systematic review and meta-analysis[J]. J Egypt Public Health Assoc, 2022, 97(1): 13.
[4]	Janjua U, Bahia G, Barry S. Black staining: an overview for the general dental practitioner[J]. Br Dent J, 2022, 232(12): 857-860.
[5]	Alammari ST, Al Rubaie FM, Shukr BS. Chromogenic black dental staining in children: a case report[J]. Cureus, 2024, 16(1): e51984.
[6]	Natoli V. Black stain in adult: a case report[J]. Saudi J Oral Dent Res, 2019, 4(8): 557-560.
[7]	丁慧, 周庆, 冯汝舟, 等. 清除儿童外源性牙面黑色素两种方法的疗效比较[J]. 昆明医科大学学报, 2023, 44(8): 133-138.
	Ding H, Zhou Q, Feng RZ, et al. Comparison of the therapeutic effects of two methods for removing black tooth stain in children[J]. J Kunming Med Univ, 2023, 44(8): 133-138.
[8]	Reid JS, Beeley JA, MacDonald DG. Investigations into black extrinsic tooth stain[J]. J Dent Res, 1977, 56(8): 895-899.
[9]	Fan L, Ou YJ, Zhu YX, et al. Lif deficiency leads to iron transportation dysfunction in ameloblasts[J]. J Dent Res, 2022, 101(1): 63-72.
[10]	高玮, 韩蕊, 马雷, 等. 2018年青岛市学龄前儿童龋齿状况及其相关因素分析[J]. 中华预防医学杂志, 2019, 53(6): 611-613.
	Gao W, Han R, Ma L, et al. Analysis of dental caries and related factors in preschool children in Qingdao in 2018[J]. Chin J Prev Med, 2019, 53(6): 611-613.
[11]	纪帅旗, 韩蕊, 林豪, 等. 2019年青岛市学龄前儿童乳牙龋病患病现况及影响因素分析[J]. 中华预防医学杂志, 2021, 55(9): 1129-1132.
	Ji SQ, Han R, Lin H, et al. Prevalence and influen-cing factors of deciduous dental caries among preschool children in Qingdao city in 2019[J]. Chin J Prev Med, 2021, 55(9): 1129-1132.
[12]	Qiao C, Han R, Yang J, et al. Black stain and dental caries in primary dentition of preschool children in Qingdao, China[J]. J Clin Pediatr Dent, 2024, 48(4): 200-205.
[13]	Ji SQ, Han R, Huang PP, et al. Iron deficiency and early childhood caries: a systematic review and meta-analysis[J]. Chin Med J (Engl), 2021, 134(23): 2832-2837.
[14]	Ji S, Guan X, Ma L, et al. Iron deficiency anemia associated factors and early childhood caries in Qing-dao[J]. BMC Oral Health, 2022, 22(1): 104.
[15]	Zhang F, Li Y, Xun Z, et al. A preliminary study on the relationship between iron and black extrinsic tooth stain in children[J]. Lett Appl Microbiol, 2017, 64(6): 424-429.
[16]	Garcia Martin JM, Gonzalez Garcia M, Seoane Les-ton J, et al. Prevalence of black stain and associa-ted risk factors in preschool Spanish children[J]. Pediatr Int, 2013, 55(3): 355-359.
[17]	吴海燕, 袁嘉璐, 葛文娟, 等. 学龄前儿童乳牙色素沉着与乳牙龋关系研究[J]. 实用口腔医学杂志, 2018, 34(2): 253-256.
	Wu HY, Yuan JL, Ge WJ, et al. The relationship between tooth discoloration and caries in primary teeth in preschool children[J]. J Pract Stomatol, 2018, 34(2): 253-256.
[18]	Elakiya S, Rajmohan M, Prabu D, et al. Assessing the effect of iron on oral health status among the general population residing in high and low levels of iron blocks in namakkal district, Tamil Nadu, India: a cross-sectional study[J]. J Pharm Bioallied Sci, 2023, 15(): S729-S733.
[19]	Han R, Yue J, Lin H, et al. Salivary microbiome variation in early childhood caries of children 3-6 years of age and its association with iron deficiency anemia and extrinsic black stain[J]. Front Cell Infect Microbiol, 2021, 11: 628327.
[20]	Elelmi Y, Mabrouk R, Masmoudi F, et al. Black stain and dental caries in primary teeth of Tunisian preschool children[J]. Eur Arch Paediatr Dent, 2021, 22(2): 235-240.
[21]	de Rezende VS, Fonseca-Silva T, Drumond CL, et al. Do patients with extrinsic black tooth stains have a lower dental caries experience? A systematic review and meta-analysis[J]. Caries Res, 2019, 53(6): 617-627.
[22]	Xu L, Wang J, Han R, et al. Iron level participates in the pathological damages of dental caries in infant rats by affecting enamel mineralization[J]. J Clin Pediatr Dent, 2023, 47(4): 86-94.
[23]	Atri Y, Garg N, Pathivada L, et al. Association between serum iron, serum ferritin levels, and severe early childhood caries: a case-control study[J]. Int J Clin Pediatr Dent, 2023, 16(): 288-292.
[24]	Hesse D, Bonifácio CC. Is there an association between early childhood caries and iron deficiency anaemia[J]. Evid Based Dent, 2022, 23: 146-147.
[25]	Wang R, Kaplan A, Guo L, et al. The influence of iron availability on human salivary microbial community composition[J]. Microb Ecol, 2012, 64(1): 152-161.
[26]	Zhou J, Jiang N, Wang Z, et al. Influences of pH and iron concentration on the salivary microbiome in individual humans with and without caries[J]. Appl Environ Microbiol, 2017, 83(4): e02412-e02416.
[27]	Sangermano R, Pernarella S, Straker M, et al. The treatment of black stain associated with of iron metabolism disorders with lactoferrin: a litterature sear-ch and two case studies[J]. Clin Ter, 2019, 170(5): e373-e381.
[28]	Miguel JC, Bowen WH, Pearson SK. Effects of iron salts in sucrose on dental caries and plaque in rats[J]. Arch Oral Biol, 1997, 42(5): 377-383.
[29]	Parnas L, Chevion M, Berenshtein E, et al. Are there metallic traces in black extrinsic dental stain[J]. Quintessence Int, 2013, 44(5): 427-432.
[30]	钟南萍, 李炯, 王妍, 等. 儿童乳牙外源性黑色素沉着的影响因素分析[J]. 名医, 2021(2): 100-103.
	Zhong NP, Li J, Wang Y, et al. Analysis of factors influencing black tooth stain in primary teeth in children[J]. Renowned Doc, 2021(2): 100-103.
[31]	Pani SC, Alenazi FM, Alotain AM, et al. Extrinsic tooth staining potential of high dose and sustained release iron syrups on primary teeth[J]. BMC Oral Health, 2015, 15: 90.
[32]	Talebi M, Parisay I, Mokhtari N. The parents’ knowledge and behavior towards the effects of u-sing iron supplements on tooth staining and dental caries in Mashhad, Iran[J]. Dent Res J, 2012, 9(6): 715-718.
[33]	Prskalo K, Klarić Sever E, Alerić I, et al. Risk factors associated with black tooth stain[J]. Acta Clin Croat, 2017, 56(1): 28-35.
[34]	Brzezińska-Rojek J, Rutkowska M, Brzezicha J, et al. Mineral composition of dietary supplements-analytical and chemometric approach[J]. Nutrients, 2021, 14(1): 106..
[35]	Chhikara N, Kushwaha K, Sharma P, et al. Bioactive compounds of beetroot and utilization in food processing industry: a critical review[J]. Food Chem, 2019, 272: 192-200.
[36]	Rebelo de Sousa K, Batista MJ, Rocha Gonçalves J, et al. Extrinsic tooth enamel color changes and their relationship with the quality of water consumed[J]. Int J Environ Res Public Health, 2012, 9(10): 3530-3539.
[37]	苗芬, 马浩然, 刘子晗. 乳牙列色素沉着相关因素及患龋情况探讨[J]. 上海口腔医学, 2022, 31(3): 282-285.
	Miao F, Ma HR, Liu ZH. Research on the pathogeny of black tooth stain and association between black tooth stain and primary dentition caries in children[J]. Shanghai J Stomatol, 2022, 31(3): 282-285.
[38]	Ortiz-López CS, Veses V, Garcia-Bautista JA, et al. Risk factors for the presence of dental black plaque[J]. Sci Rep, 2018, 8(1): 16752.
[39]	Pushpanjali K, Khanal SS, Niraula SR. The relationship of dental extrinsic stains with the concentration of trace elements in water sources in a district of Nepal[J]. Oral Health Prev Dent, 2004, 2(1): 33-37.
[40]	Tirth A, Srivastava BK, Nagarajappa R, et al. An investigation into black tooth stain among school children in chakkar ka milak of Moradabad city, India[J]. J Oral Health Community Dent, 2009, 3(2): 34-37.
[41]	França-Pinto CC, Cenci MS, Correa MB, et al. Association between black stains and dental caries in primary teeth: findings from a Brazilian population-based birth cohort[J]. Caries Res, 2012, 46(2): 170-176.
[42]	杨彬, 张皓, 张颖. 82例儿童牙色素沉着危险因素分析[J]. 上海口腔医学, 2022, 31(4): 410-413.
	Yang B, Zhang H, Zhang Y. Risk factors for the presence of dental black stain in 82 children[J]. Shanghai J Stomatol, 2022, 31(4): 410-413.
[43]	Surdacka A. Amount and pH of the saliva in children and adolescents with black tartar[J]. Czas Stomatol, 1989, 42(6): 381-386.
[44]	Garan A, Akyüz S, Oztürk LK, et al. Salivary parameters and caries indices in children with black tooth stains[J]. J Clin Pediatr Dent, 2012, 36(3): 285-288.
[45]	Nuraeni A, Budiardjo SB, Fauziah E. Ferum and magnesium levels in the plaque and saliva of children with dental black stain who consume UHT milk[J]. J Int Dent Med Res, 2018, 11(3): 994-996.
[46]	Mesonjesi I. Are extrinsic black stains of teeth iron-saturated bovine lactoferrin and a sign of iron deficient anemia or iron overload[J]. Med Hypotheses, 2012, 79(2): 219-221.
[47]	Zhang Y, Yu R, Zhan JY, et al. Epidemiological and microbiome characterization of black tooth stain in preschool children[J]. Front Pediatr, 2022, 10: 751361.
[48]	孙加义, 赵霞, 滕琦, 等. 学龄前儿童牙面色素沉着形成原因及与龋病关系的研究[J]. 中国实用口腔科杂志, 2013, 6(9): 538-541.
	Sun JY, Zhao X, Teng Q, et al. The research on the pathogeny of black tooth stain and the association between black tooth stain and primary dentition ca-ries in preschool children[J]. Chin J Pract Stomatol, 2013, 6(9): 538-541.
[49]	Bardellini E, Amadori F, Gobbi E, et al. Does Streptococcus salivarius strain M18 assumption make black stains disappear in children[J]. Oral Health Prev Dent, 2020, 18(2): 161-164.
[50]	Slots J. The microflora of black stain on human primary teeth[J]. Scand J Dent Res, 1974, 82(7): 484-490.
[51]	Saba C, Solidani M, Berlutti F, et al. Black stains in the mixed dentition: a PCR microbiological study of the etiopathogenic bacteria[J]. J Clin Pediatr Dent, 2006, 30(3): 219-224.
[52]	Heinrich-Weltzien R, Bartsch B, Eick S. Dental ca-ries and microbiota in children with black stain and non-discoloured dental plaque[J]. Caries Res, 2014, 48(2): 118-125.
[53]	Costa MT, Dorta ML, Ribeiro-Dias F, et al. Biofilms of black tooth stains: PCR analysis reveals presence of Streptococcus mutans [J]. Braz Dent J, 2012, 23(5): 555-558.
[54]	Li Y, Zhang Q, Zhang FF, et al. Analysis of the microbiota of black stain in the primary dentition[J]. PLoS One, 2015, 10(9): e0137030.
[55]	Chen L, Zhang Q, Wang Y, et al. Comparing dental plaque microbiome diversity of extrinsic black stain in the primary dentition using Illumina MiSeq sequencing technique[J]. BMC Oral Health, 2019, 19(1): 269.
[56]	Chen Y, Dou G, Wang D, et al. Comparative microbial profiles of caries and black extrinsic tooth stain in primary dentition[J]. Caries Res, 2021, 55(4): 310-321.
[57]	Veses V, González-Torres P, Carbonetto B, et al. Dental black plaque: metagenomic characterization and comparative analysis with white-plaque[J]. Sci Rep, 2020, 10(1): 15962.
[58]	张明珠, 税艳青, 吕罕鲜, 等. 成人牙面色素沉积与口腔产黑菌关系的研究[J]. 牙体牙髓牙周病学杂志, 2012, 22(11): 650-652.
	Zhang MZ, Shui YQ, Lü HX, et al. Correlation between black-pigmented bacteria and tooth pigmentation[J]. Chin J Conserv Dent, 2012, 22(11): 650-652.
[59]	Hirtz C, Mannaa AM, Moulis E, et al. Deciphering black extrinsic tooth stain composition in children using metaproteomics[J]. ACS Omega, 2022, 7(10): 8258-8267.
[60]	Çelik ZC, Çakiris A, Yanıkoğlu F, et al. Metageno-mic analysis of black-stained plaques in permanent dentition[J]. Arch Oral Biol, 2021, 128: 105171.
[61]	Gobbi E, de Francesco MA, Piccinelli G, et al. In vitro inhibitory effect of two commercial probiotics on chromogenic actinomycetes[J]. Eur Arch Paedia-tr Dent, 2020, 21(6): 673-677.
[62]	Salim HP, Mallikarjun SB, Raju S, et al. Randomi-zed clinical trial of oral probiotic Streptococcus salivarius M18 on salivary Streptococcus mutans in preprimary children[J]. Int J Clin Pediatr Dent, 2023, 16(2): 259-263.
[63]	Babina K, Salikhova D, Doroshina V, et al. Antigingivitis and antiplaque effects of oral probiotic containing the Streptococcus salivarius M18 strain: a randomized clinical trial[J]. Nutrients, 2023, 15(18): 3882.
[64]	Velliyagounder K, Chavan K, Markowitz K. Iron deficiency anemia and its impact on oral health-a lite-rature review[J]. Dent J (Basel), 2024, 12(6): 176.
[65]	Leon-Rodriguez JA, Espinoza-Salcedo M, Gutierrez-Polanco YM, et al. Iron deficiency anemia as a risk factor for pulp disease in children from the central Peruvian jungle: a case-control study[J]. J Appl Oral Sci, 2024, 32: e20240014.
[66]	Nadeeshani H, Kudagammana ST, Herath C, et al. Early childhood caries and nutritional status of children: a review[J]. Food Nutr Bull, 2023, 44(4): 249-264.
[67]	Sukseree S, Schwarze UY, Gruber R, et al. ATG7 is essential for secretion of iron from ameloblasts and normal growth of murine incisors during aging[J]. Autophagy, 2020, 16(10): 1851-1857.
[68]	Shah FA. High-resolution Raman spectroscopy reveals compositional differences between pigmented incisor enamel and unpigmented molar enamel in Rattus norvegicus[J]. Sci Rep, 2023, 13: 12301.
[69]	Li Y, Ping H, Xie Q, et al. Fluorapatite nanorod arrays with enamel-like bundle structure regulated by iron ions[J]. RSC Adv, 2023, 13(40): 28112-28119.

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研究	例数/例	年龄/岁	含铁饮食	相关性
吴海燕等^[17]	675	3~6	铁补充剂	相关
钟南萍等^[30]	597	3~6	铁补充剂	相关
Pushpanjali等^[39]	551	≥4	高铁饮水	相关
Elakiya等^[18]	600	5~74	高铁饮水	相关
Rebelo de Sousa等^[36]	346	1~87	巴西莓	相关
Nuraeni等^[45]	16	4~8	牛奶	相关
Garcia Martin等^[16]	3 273	6	乳制品含铁高的豆类和蛋铁补充剂	相关相关相关
Mesonjesi^[46]	94	7~53	奶酪	相关
Prskalo等^[33]	60	15~25	甜菜铁补充剂	相关不相关
苗芬等^[37]	382	3~5	铁补充剂	不相关
Ortiz-López等^[38]	94	39.8	铁补充剂	不相关

Advances in the research on the relationship among black tooth stain, iron, and caries

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