Certain foods and drinks such as black coffee, red wine and turmeric can quickly build up stain on the teeth. Whilst this can be largely cleaned off by the hygienist, some of this staining may become part of the tooth. This is called intrinsic staining. Smoking can have a similar effect, with heavy smokers experiencing significant levels of intrinsic staining. Whilst the results of teeth whitening are only transient, perhaps lasting for up to 18 months, this treatment can be a powerful incentive to give up smoking. Other dietary factors that cause discolouration are acidic foods and drinks such as citrus fruits, fizzy drinks (including sparkling water) and fruit juices. Persistent ingestion of citrus, carbonic and phosphoric acids contained in fruits and fizzy drinks wear down the enamel, revealing more of the dentine layer underneath which has a naturally yellow colour. Exaggerated enamel loss from tooth grinding or substance abuse will also allow the dentine layer to show through causing a yellowing appearance of the teeth. As we get older, ageing will also affect the colour of your teeth as the level of enamel changes. Yellowing enamel is straightforward to whiten at home in about 3 weeks with standard home whitening kits using 10-16% carbamide peroxide gels.
If there is excessive fluoride ingestion (usually in drinking water) during the formation of teeth, white, yellow, orange or brown stains can appear in some teeth, a condition known as fluorosis. In fluorosis, the enamel of the tooth might also look pitted, which can be a surface feature of the condition. Teeth whitening with 10-16% carbamide peroxide over the course of 4 weeks can help to lighten the staining. The deeper the staining the harder it is to lighten, so a slightly more prolonged course of whitening may be required.
These bright white ‘freckle’ type spots are usually most noticeable on the front teeth and can be associated with chronic infections, high temperatures and medications during early childhood, or in the developmental stages of a baby. This can in turn, affect how the enamel of the tooth forms. White spots can be successfully treated at home approximately over the course of 3-8 weeks depending on the severity.
Tetracycline is a commonly prescribed antibiotic often used for the treatment of acne and other skin conditions. Patients with this type of staining range from mild to severe discolouration which can vary in colour from grey, blue, yellow and brown. The colour and pattern of discolouration depend on the type of medication, dosage and duration, relating to when the teeth were at the developmental stages. A reasonable improvement can be achieved for these patients with by completing home whitening for up to 6 months depending on the severity.
Accidents such as falling off a bicycle as a child, sporting injuries or swimming pool accidents can all lead to a tooth becoming significantly discoloured as a result of trauma. It is important to determine if the tooth is alive (vital) or dead (non-vital) before treatment can be recommended. The dentist can establish this by testing the tooth with extremes of temperature or a small biopsy of the tooth. If the tooth is alive, home whitening in stages is recommended. Firstly with a tray and gel concentrated on the discoloured tooth, followed by a new tray to whiten the rest of the teeth to give an even appearance.
Root Canal Treated Teeth
Teeth that have been root filled (had root canal treatment), can become discoloured over time. Internal bleaching is a technique which can be carried out in an attempt to whiten the tooth whilst avoiding the need for invasive dental work such as crowns or veneers. By clearing out the filling at the back of the tooth (placed to seal the root canal treatment) space can be made to place some high strength carbamide peroxide gel inside the tooth which is then covered with a temporary filling. The gel then sits inside the tooth for 2 weeks bleaching the enamel ‘inside out’. Results can vary, but this treatment may need topping up every 2 weeks until the colour of the tooth matches the rest of the teeth.
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