Scanning electron microscopy of black stain on human permanent teeth

Black stain may develop on the coronal surfaces of human teeth, and this type of stain is common in the Hong Kong Chinese population. The present study was undertaken to ascertain if the deposit conforms in composition to the black stain found elsewhere, and to describe its ultrastructure using the scanning electron microscope. Gram-stained smears were made from black stain on the teeth of 11 adult Hong Kong Chinese and studied microscopically. From another 15 persons extracted teeth exhibiting black stain were obtained and fixed. Two ground sections were made from each tooth, one was stained with toluidine blue, the other was dried and prepared for scanning electron microscopy. The gram-stained smears demonstrated predominantly gram-positive filamentous microorganisms with an admixture of gram-positive cocci and rods. The ground sections revealed a deposit on the outer surface of the enamel, which was clearly divided into two distinctly different layers: an inner yellow opaque layer, and an outer layer of microorganisms. Scanning electron microscopy demonstrated that the deposit consisted entirely of microorganisms, and that in portions close to the enamel they were often obscured by a substance indicative of calcification. Thus the black stain found on the teeth of Hong Kong Chinese is similar in composition and structure to that reported to occur in other populations. The black stain is a special type of dental plaque characterized by its simple flora and its tendency to calcify.