A 2 year-old male presented with black stain on teeth. The mother reported that he had iron deficiency at birth without specifying the cause. He received a vitamin supplement with iron during 23 months. The oral examination showed a black stain on the exterior of his front upper teeth (Figure 1). He was diagnosed with extrinsic teeth staining associated with iron consumption. Scraping of affected teeth eliminated the extrinsic staining. The origin of this black stain is due to chemical synergy between hydrogen sulfide producing microflora with the insoluble ferric compound.

Figure 1: Black stains on upper teeth correlated with iron consumption.