Black Stains in Children: A New Classification and an Innovative Flowchart for Management and Recurrence Prevention

Exogenous black pigmentations, commonly referred to as black stains (BS), are an acquired oral pathology, prevalent among children. The condition is characterized by black punctiform spots that are distributed variably on the lingual and vestibular surfaces of both deciduous and permanent teeth. These spots are predominantly located on the cervical third of the crown but can also be found on the middle third, until the crown third, of the affected tooth's crown. These stains present a therapeutic challenge due to their high recurrence rate and the often-insufficient oral hygiene practices among children and their caregivers. Although general dentists may not be familiar with the classification of BS, the clinical diagnosis of this condition is typically straightforward. There is still no consensus among researchers regarding the prevalence of BS, and the etiopathogenesis of this condition remains not fully understood. Although BS are not a serious pathology, many children and their families experience significant embarrassment, anxiety, and negative psychological effects due to the condition. Recent literature on the treatment of BS indicates that a universally effective clinical protocol has not yet been established. This study introduces a new classification based on therapeutic approach and a flow chart designed to assist paediatric dentists in managing BS with a focus on preventing recurrence.