How to whiten a discoloured tooth

Our case of the month for July involves a treatment to whiten a discoloured lower front tooth. We will often come across darker teeth when they have undergone a root canal treatment due to the loss of the nerve and blood supply. Often the degradation of blood products from the pulp tissue within the dentinal tubules cause the tooth dentine to be gradually discolour and give that inherent grey/ dark appearance. This can be quite unsightly especially on a front tooth. For back teeth, in almost every case, we will need to place a crown once a tooth has been root filled to maintain function. This will also improve the colour as the ceramic cover the dark dentine. However, for front teeth, crowns are not always needed as the access for the treatment is on the inside of the tooth and when done under microscope, can be extremely minimal. So how do we whiten the tooth?

The technique that we have used for many years is called inside/ outside whitening. It is very simple but requires great compliance over 2-3 days. Once we are happy the tooth is stable and the root canal treatment has been successful, the access will be re opened to allow a tooth whitening syringe tip to be inserted inside. The root filling material will be sealed from the top so that the root is protected. We will then ask you to place the whitening gel internally and replenish is every 3-4 hours over a few days, usually the weekend. Tooth whitening trays will have been made prior to the appointment to lock in the gel. Obviously, after eating we ask you to clean your teeth thoroughly and then replenish the gel and place the whitening tray back. This is where we need super compliance!

In almost every case we have treated, the colour improves drastically within 2-3 days. The tooth will then be re sealed with a white composite filling and then the whitening trays can be used for outside whitening of all the teeth or as needed.

Our patient was unhappy with the very obvious dark discoloured lower left lateral incisor. A classic case for inside outside whitening.

If the answer is yes, please arrange a free video call with Dr Nissit Patel or Dr Kunal Shah and they will answer any questions that you may have and guide you through the process.