A smile is one of the main ways we interact positively with others and express happiness.
If you are ashamed to smile in public due to discoloration of your teeth, you could be holding yourself back from many social situations.
There are many factors that can cause discoloration of teeth.
Teeth can develop discoloration by stains on the external surface or by changes on the tooth material. Discoloration is generally divided into three main categories:
• Extrinsic discoloration – it occurs when the outer layer of tooth (enamel) is stained by dental plaque and calculus, food and beverages, tobacco, chromogenic bacteria, topical medications, and metallic compounds.
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• Intrinsic discoloration – it occurs when inner structure of tooth (dentin) darkens or becomes yellow. It is caused by dental materials (eg, tooth fillings), dental caries, trauma, infections, medications, nutritional deficiencies and other disorders like complications of pregnancy, anemia and bleeding disorders and genetic defects and hereditary diseases which affect enamel and dentin development or maturation.
Symptoms include brown, black, gray, green, orange, and yellow stains or even metallic sheen may be present.
Rinsing mouth with water after having foods and drinks like wine, coffee that can stain your teeth is recommended. Brushing your teeth after every meal will help prevent some stains.
Effective tooth brushing twice a day with a tooth paste helps to prevent extrinsic stains. Most tooth pastes contain abrasive, a detergent and an anti-tartar agent.
Some tooth pastes may also contain tooth whitening agents. Intrinsic stains which are caused by damage to nerve and blood vessels inside the tooth (pulp) due to injury can be prevented by undergoing root canal treatment which removes the pulp before it gets decayed or darkened.
To prevent intrinsic stains in children, avoid water that contains a high fluoride concentration. You can check the concentration of fluoride in your drinking water supply by calling the public health department.
Dental treatment of tooth discoloration involves identifying the cause and implementing therapy.
• Diet and habits: Extrinsic staining caused by foods, beverages, or habits (eg, smoking, chewing tobacco) is treated with a thorough dental prophylaxis and cessation of dietary or other contributory habits to prevent further staining.
• Professional tooth cleaning: Some extrinsic stains may be removed with ultrasonic cleaning and rotary polishing with an abrasive prophylactic paste. Repeated use of these modalities is not recommended as their excessive use may lead to enamel wear.
• Enamel microabrasion: this technique involves rotary application of a water soluble paste containing weak hydrochloric acid and silicon carbide particles. It results in smooth and glazed enamel surface.
It can be used in removal of superficial intrinsic discoloration which are caused by Fluorosis and decalcification secondary to orthodontic brackets and bands.
• Bleaching: It is a safe, easy and inexpensive treatment modality. Bleaching is helpful in patients with yellow, orange or light brown extrinsic discoloration.
In-office power bleaching is done by the dentist by applying the light activated bleaching gel over the enamel of affected teeth for 30 to 45 minutes. This technique results in significant whitening effect of teeth.
Follow up treatments may be needed for this therapy.
• At home Bleaching: Stains can also be removed by applying at-home bleaching gel in a mouth guard prescribed by dentist. These gels are weaker in comparison to those used by dentists in in-office power bleaching techniques, so treatment may take longer to get desired results – usually two to four weeks.
• Nonvital bleaching: It is done after root canal treatment of the teeth which are discolored by pulp degeneration due to tooth injury. Dentist places the bleaching agent inside the tooth foe as long as one week. Two to three sittings may be needed to get the desired effect.
For generalized intrinsic discolorations partial or full coverage dental restorations (laminate veneers) may be needed. Tooth discoloration is mainly a cosmetic problem.
Call your dentist if you’re unhappy with the appearance of your teeth. Any change in a child’s normal tooth color should be evaluated by a dentist.
By Dr. Wasim Rasool Wani