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?
 

One of the main aesthetic challenges we face as dentists, is a dark discoloured front tooth. This usually results from after a root canal treatment which may be needed for a variety of reasons but is usually from trauma. The reasons for the discolouration do vary. This could be from remnants of the pulp tissue being left within the root canal system and then decomposing within the tooth permeating into the dentine. There can also be rupture of the blood vessels within the pulp allowing blood products to seep into the dentinal tubules and discolour the tooth as this degrades. Another common reason is not so well known. Studies have shown that another factor could be the result of not removing all of the root canal sealant material once the tooth has been treated. van der Burgt TP, Mullaney TP, Plasschaert AJ. Tooth discoloration induced by endodontic sealers. Oral Surg Oral Med Oral Pathol. 1986;61:84–9. [PubMed] [Google Scholar] [Ref list]

The chromophores resulting from the disintegration of root canal sealer remnants penetrate through the dentinal tubules into the coronal tooth structure gradually causing progressive discoloration. The key factor is that most root treated teeth do appear darker than non root treated teeth and when this is on a front tooth, it is a major aesthetic issue.
 

Patients with stained teeth who come to see us in the quest for whiter teeth ask us about the professional treatments on offer to fulfil their wish for whiter, cleaner looking teeth.

Patients also frequently ask what causes staining and how to avoid it. Most staining is easily removed during a routine scale and polish, but some things that cause staining can also cause long-term damage to natural teeth as well as fillings and veneers.

- Cigarettes, as well as cigars and betel nut/tobacco chewing. Stoptober has started, it's never too late quit smoking. 

- Some mouthwashes, in particular Corsodyl. After around a week of use, will start to cause a brown/yellow stain on the teeth. This mouthwash should only be used on your dental professionals advice. Try Peroxyl as an alternative to help tackle gum disease, its oxygen producing formula is great for killing off bacteria. Any strong mouthwash should be used in the short-term only, and doesn't replace the effectiveness of brushing/flossing.

- The mixture of tannin and acid in Red Wine is a well known stain producing drink. White anyone?

- Tea and Coffee both contribute to staining. Try swapping espresso for a milkier alternative to avoid heavy staining and add milk to tea. Beware of some Herbal Teas, they are some of the worst offenders. We notice that good quality (preferably organic) herbal tea will cause less staining than cheaper options

- Richly coloured sauces and spices

- Beware of sports drinks, they are highly acidic, which makes teeth more susceptible to taking on the colouring in the drink. Drink water to avoid this problem, or coconut water after exercising which will help to naturally hydrate you as it is full of natural electrolytes.

If you have any questions regarding stained teeth or how to whiten your teeth, please do not hesitate to contact us.