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Thread: Chlorine and Tooth Discoloration

  1. #1
    Very Active Member ensignada's Avatar
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    Chlorine and Tooth Discoloration

    I took my 8 year old to the dentist today for a check-up. One of our concerns was the brown discoloration on her two front teeth. The first question the dentist asked was "Is she a tea drinker?" (No). The second question stunned me, "Is she a swimmer?"

    Apparently a few of his swim team patients over the years have experienced discoloration. It's not permanent (he was able to scrap her's off). He didn't explain the chemical reaction taking place.

    I have never heard of this before, so I thought I'd put it up here. Have any of you had this experience either with yourselves or your kids? And can anyone explain what the chlorine/dental connection is or could be?

    "...it is but well to be on friendly terms with all the inmates of the place one lodges in."
    Melville, Moby Dick

  2. #2
    Very Active Member aquageek's Avatar
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    Re: Chlorine and Tooth Discoloration

    I've never experienced this, nor has my wife nor kids. Sounds fishy to me. I'm going to a big kids' meet this weekend. I'll try to remember to check out some kid choppers. Two of my best friends are dentists. I'll also ask them. Stay tuned.

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    Very Active Member ALM's Avatar
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    Re: Chlorine and Tooth Discoloration

    I read something years ago about tooth enamel damage from chlorine. At the time I asked my dentist about it but he had never heard of such a thing.

    Swimming pool water is supposed to have a concentration of somewhere around 3 ppm of chlorine in the water.

    The below excerpt is from the OSHA web site, and discusses chlorine GAS and its effects. When they discuss ppm, they're discussing concentrations in air. I don't know that this would translate to water concentrations.

    http://www.osha.gov/SLTC/healthguide...cognition.html

    2. Effects on Humans: ....Earlier literature reported that exposure to a concentration of about 5 ppm caused respiratory complaints, corrosion of the teeth, inflammation of the mucous membranes of the nose and susceptibility to tuberculosis among chronically-exposed workers. However, many of these effects are not confirmed in recent studies and are of very dubious significance [ACGIH 1991].....

    ....Acne (chloracne) is not unusual among persons exposed to low concentrations of chlorine for long periods of time. Tooth enamel damage may also occur [Parmeggiani 1983]......

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    Very Active Member ALM's Avatar
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    Re: Chlorine and Tooth Discoloration

    Another article, this time from the CDC:

    http://www.cdc.gov/mmwr/preview/mmwrhtml/00000109.htm

    Erosion of Dental Enamel among Competitive Swimmers -- Virginia

    In September 1982, a Charlottesville, Virginia, dentist reported treating two women, one 17 and one 28 years old, for dental enamel erosion. Both exhibited general erosion of enamel from the anterior surfaces of the incisors and premolars, clinically consistent with exposure to acid (1,2). Neither had any history of unusual occupational, dietary, or medical exposures to acid. However, both were competitive swimmers who trained regularly at the same private club pool.

    To identify any additional cases, a questionnaire was mailed to all club-member households. A total of 747 members responded to the survey. Club members were considered to have symptoms compatible with enamel erosion if, during the summer of 1982, they reported having one or more of the following symptoms "a lot" or two or more of these symptoms "sometimes": 1) gritty or rough teeth; 2) transparent or yellow teeth; 3) "chalky" white teeth; 4) painful teeth when chewing. Members were also considered cases if their dentists had clinically diagnosed enamel erosion during or after the summer of 1982.

    Of the 452 frequent swimmers,* 69 (15%) reported symptoms compatible with enamel erosion, compared to nine (3%) of 295 infrequent or nonswimmers (p 0.001). In addition, of 59 members of a swim team, 23 (39%) met the case definition, compared to 12% (46/393) of all other frequent swimmers (p 0.001). A second questionnaire was sent to all 452 frequent swimmers and was returned by 294 (65%). Of the 132 persons who swam 5 or more days per week, 35 (27%) were cases, compared to 14 (9%) of 162 persons who swam less than 5 days per week (p 0.001).

    An oral pathologist examined 30 individuals who met the case definition and 60 control swimmers matched for age, race, and sex. Four (13%) of 30 cases had clinically evident general enamel erosion, compared to none of 60 controls (p = 0.005). Each of these four trained regularly in the pool for competitive swimming meets, compared to one of eight matched controls (p = 0.01). The four patients with clinically evident erosion did not differ significantly from controls with respect to history of occupational, dietary, and medical exposures to acid.

    A water sample, obtained from the pool in September by one of the swimmers and tested by Virginia's Consolidated State Laboratories, exhibited no buffering capacity and a pH of 2.7, i.e., an acid concentration approximately 100,000 times that recommended for swimming pools (3). State health department epidemiologists were unable to obtain additional samples directly from the pool because it had been drained at the conclusion of the swimming season.

    Site inspection in November by the Virginia State Department of Health revealed a gas-chlorinated pool with corrosion of metal fixtures and marked etching of unpainted cement exposed to the pool water. A review of pool management practices revealed the water was usually tested each morning for pH and the level of free chlorine. Soda ash (Na((2))CO((3))) was added to neutralize the acid when a standard colorimetric phenol red pH indicator (pH range 6.8-8.2) indicated the water was acidic. The manager did not report that the pool water was rechecked to verify that the pH had been brought up into the accepted range for swimming pools (pH 7.2-7.8) (4). No records were kept either of the daily readings of free chlorine levels and pH or of the daily use of chlorine gas and soda ash. According to the pool manager, the pH indicator kit commonly registered a pH of 6.8 during the 1982 season. Reported by RA Prindle, MD, Charlottesville Health Dept; RP Elzay, DDS, Medical College of Virginia; CW Armstrong, MD, LS Funkhouser, MD, GB Miller, Jr, MD, State Epidemiologist, Virginia State Dept of Health; Field Svcs Div, Epidemiology Program Office, CDC.
    Editorial Note

    Editorial Note: Large pools are sometimes chlorinated with chlorine gas (Cl((2))), instead of hypochlorite, because of the economic advantages (5). Unlike hypochlorite, gas chlorination causes pool water to become acidic because chlorine gas reacts with water to form hydrochloric acid (HCl): Cl((2)) + H((2))O --- HOCl + HCl. Hypochlorous acid (HOCl) is the germicidal agent in chlorination; HCl is an unwanted byproduct. Excess acidity is commonly neutralized and gas (Cl((2))), instead of hypochlorite, because of the economic advantages (5). Unlike hypochlorite, gas chlorination causes pool water to become acidic because chlorine gas reacts with water to form hydrochloric acid (HCl): Cl((2)) + H((2))O --- HOCl + HCl. Hypochlorous acid (HOCl) is the germicidal agent in chlorination; HCl is an unwanted byproduct. Excess acidity is commonly neutralized and buffered by the addition of soda ash.

    Tooth enamel does not decalcify in acidic solutions unless the pH is below 6.0 (6). Even at a pH between 5 and 6, hours of cumulative exposure are required for clinically evident decalcification to occur (6). With proper buffering to maintain a recommended pool pH (pH 7.2-7.8) (4), gas-chlorinated pools operate with a substantial margin of safety as regards enamel erosion. However, if a gas-chlorinated pool becomes inadequately buffered through the addition of inadequate quantities of soda ash, the pH may decrease rapidly--in one observed instance, from a pH of 7.4 to approximately 4.0 overnight (5).

    General enamel erosion has been observed among industrial workers exposed to acid fumes (1) and among people consuming excessive quantities of acidic fruit, beverages, and medication (2). In 1980, an outbreak of enamel erosion similar to the present one was investigated at a gas-chlorinated public pool in New Jersey. The swimming pool water was epidemiologically implicated as the cause, but the mechanism could not be determined (7). In the present outbreak, the epidemiologic evidence showed that prolonged exposure to the pool water was associated with enamel erosion and that, on at least one occasion, the water was far below the recommended pH. These findings, plus the apparently inadequate maintenance practices, implicated the pool water as the cause of the enamel erosion.

    The American Public Health Association recommends that proper pool maintenance records be kept, including thrice-daily chlorine levels and pH readings, as well as the daily use of chlorine gas and soda ash (3). Since, with a standard phenol red indicator system (pH range 6.8-8.2), any pool water sample with a pH below 6.8 will read as pH 6.8, the person testing the water should take into account the accuracy of the colorimetric pH indicator. If the phenol red indicator shows pH 6.8, the pool should be promptly corrected to pH 7.2 or above and so verified.

    References

    1. Bruggen Cate HF. Dental erosion in industry. Br J Ind Med 1968;25:249-66.
    2. Stafne EL, Loestadt SA. Dissolution of tooth substances by lemon juice, acid beverages, and acids from other sources. J Am Dent Assoc 1947;34:586-92.
    3. American Public Health Association. Public swimming pools: recommended regulations for design and construction, operation and maintenance. Washington, D.C.: American Public Health Association, 1981.
    4. Center for Environmental Health. Swimming pools--safety and disease control through proper design and operation. Atlanta, Georgia: Centers for Disease Control, Department of Health and Human Services, March 1983.
    5. White GC. Handbook of chlorination. New York: Van Nostrand Reinhold Company 1972:466-526.
    6. McClelland JR. The decalcification of human tooth enamel. Dental Cosmos 1926;68:127-32.
    7. Savad EN. Enamel erosion ... multiple cases with a common cause (?). J New Jersey Dent Assoc 1982;53:32-7, 60.

    Disclaimer: All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

  5. #5
    Very Active Member ourswimmer's Avatar
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    Re: Chlorine and Tooth Discoloration

    Yes, I recall in my pre-coffee years having some brown discoloration on my teeth that our family dentist attributed to swimming. His kids swam with me, too. He just polished it off at every visit.

    Now I attribute the difference between "my teeth" and "pearly white" more to coffee than to the pool, although I try to keep discoloration between dentist visits to a minimum with frequent brushing. If the color on her teeth bugs your daughter, maybe brushing right after practice would help. (I know, I know; you said she is 8. But hey: internet brainstorming.)

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    Very Active Member ALM's Avatar
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    Re: Chlorine and Tooth Discoloration

    One more, from a Canadian journal:

    "Rapid and Severe Tooth Erosion from Swimming in
    an Improperly Chlorinated Pool: Case Report"


    http://www.cda-adc.ca/jcda/vol-74/issue-4/359.pdf

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    Very Active Member ourswimmer's Avatar
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    Re: Chlorine and Tooth Discoloration

    But there's a difference between "brown stains" and "severe erosion."

    I think this article from the "Academy of General Dentistry" is more on point:

    http://www.agd.org/public/oralhealth...c=S&ArtID=1324

    "Athlete swimmers, who often swim laps more than six hours a week, expose their teeth to large amounts of chemically treated water. Pool water contains chemical additives like antimicrobials, which give the water a higher pH than saliva, causing salivary proteins to break down quickly and form organic deposits on swimmer's teeth.

    The result is swimmer's calculus, hard, brown tartar deposits that appear predominantly on the front teeth. 'It's a common cosmetic condition among swimmers,' says AGD spokesperson J. Frank Collins, DDS, MAGD. Swimmers who notice the stains should talk to their dentist and perhaps increase their dental visits to three or four times a year, advises Dr. Collins."

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    Very Active Member aquageek's Avatar
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    Re: Chlorine and Tooth Discoloration

    Update - my dentist pal confirms tooth discoloration in adolescent swimmers but says it is "a surface stain that is easily polished off." He also had 4 year rounders.

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    Very Active Member ensignada's Avatar
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    Re: Chlorine and Tooth Discoloration

    Thanks to Jayhawk, ourswimmer and Geek for finding those articles and checking this out. (I googled, but got nothing other than the "Chlorine is a Poison" articles). The article by the AGD described exactly what my daughter's teeth looked like. As long as it's not permanent and can be periodically scraped off, I'm cool with it.
    "...it is but well to be on friendly terms with all the inmates of the place one lodges in."
    Melville, Moby Dick

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    Very Fetching Rump SwimStud's Avatar
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    Re: Chlorine and Tooth Discoloration

    Are you sure it's Chlorine in the pool. I know Bromine can make a brown sludge on the teeth.



    .

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    Very Active Member fanstone's Avatar
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    Re: Chlorine and Tooth Discoloration

    I don't know about teeth, but I have recently stopped using nail base due to the nails turning "yellowish". Being a metrosexual male, I used a neutral base, no coloring, so eventually I had yellow fingernails (and toenails).

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    Very Active Member ALM's Avatar
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    Re: Chlorine and Tooth Discoloration

    Quote Originally Posted by fanstone View Post
    I have recently stopped using nail base...
    Ummm, is this a Brazilian thing?

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    Re: Chlorine and Tooth Discoloration

    My father is a dentist and he says the ph of the pool causes staining. If the pool is too acidic then it causes your teeth to yellow. But it's a superficial stain so it should polish right off when you go for a cleaning.
    If the pool is too acidic it can also mottle your teeth - the enamel can get hypocalcified and it can change the surface of your teeth. Bottom line, a little yellowing from the pool is ok, but if you are getting major stains or mottling, talk to the pool manager because the ph is out of balance.

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    Re: Chlorine and Tooth Discoloration

    Quote Originally Posted by aquageek View Post
    Update - my dentist pal confirms tooth discoloration in adolescent swimmers but says it is "a surface stain that is easily polished off." He also had 4 year rounders.
    Interesting! I never would've thought that!!
    Andy Scherer
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    Very Active Member fanstone's Avatar
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    Re: Chlorine and Tooth Discoloration

    Quote Originally Posted by Jayhawk View Post
    Ummm, is this a Brazilian thing?
    Only for straight guys, the rest might use nail polish (not that there is anything wrong with that).

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    Very Active Member swimshark's Avatar
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    Re: Chlorine and Tooth Discoloration

    Quote Originally Posted by hnatkin View Post
    My father is a dentist and he says the ph of the pool causes staining. If the pool is too acidic then it causes your teeth to yellow. But it's a superficial stain so it should polish right off when you go for a cleaning.
    If the pool is too acidic it can also mottle your teeth - the enamel can get hypocalcified and it can change the surface of your teeth. Bottom line, a little yellowing from the pool is ok, but if you are getting major stains or mottling, talk to the pool manager because the ph is out of balance.
    That could explain my lack of enamel as an adult now. I have almost none left now.

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    Very Active Member pwb's Avatar
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    Re: Chlorine and Tooth Discoloration

    We have totally heard this from our dentist. He works with a couple of swimming families and each of our kids have had discoloration and the dentist has said chlorine is the culprit. Given all of the other health benefits of chlorine, I have chosen to keep my kids in the pool.

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    Re: Chlorine and Tooth Discoloration

    Quote Originally Posted by hnatkin View Post
    My father is a dentist and he says the ph of the pool causes staining. If the pool is too acidic then it causes your teeth to yellow. But it's a superficial stain so it should polish right off when you go for a cleaning.
    If the pool is too acidic it can also mottle your teeth - the enamel can get hypocalcified and it can change the surface of your teeth. Bottom line, a little yellowing from the pool is ok, but if you are getting major stains or mottling, talk to the pool manager because the ph is out of balance.
    I've been swimming since I was 8 and I've had these embarassing stains since. Due to lack of insurance I have never been to a dentist other than a couple of times. Do you think these stains are mottled- or maybe can be easily scraped off?

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    Re: Chlorine and Tooth Discoloration

    Sweet, something I can blame besides all the soda I drink

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    Very Active Member philoswimmer's Avatar
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    Re: Chlorine and Tooth Discoloration

    I get brown stains in between my two front teeth, and I had also come to the conclusion that it was from swimming, at the suggestion of my dental hygienist. I don't drink coffee or soda, and only very rarely do I drink tea. The hygienist scrapes the brown stains off at every visit. I wonder if brushing one's teeth right afterward would help?

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