A healthy smile improves self-image and confidence and projects an aura of good overall health to others. Today's dentist has at hand many treatment modalities to improve a smile. These range from conservative treatments to lighten teeth to more involved procedures such as porcelain veneers, bonding or dental crowns. In this article I will cover the easiest, less expensive procedures.
Tooth stain is found in two categories: extrinsic (external) and intrinsic (internal). Intrinsic staining occurs while the tooth is forming due to medications (tetracycline), fever, excess minerals (fluoride) or any of many other irregularities in tooth formation. Extrinsic staining starts when the tooth erupts and is caused by coffee and tea, tobacco, foods, metals, drugs and salivary deposits and reactions. Obviously extrinsic stain is most accessible to bleaching. Intrinsic stains may require "power bleaching." This is a combination of in-office and at-home treatments.
At home tooth bleaching has progressed from an uncomfortable, difficult process to an easier, affordable option. There is no harm inflicted to the teeth in a supervised bleaching program. All but the most stubborn stains are susceptible to bleaching. I emphasize "supervised" because before bleaching is undertaken it is important to be sure the mouth is healthy. That means no tooth decay, leaking fillings, or unhealthy gums. The teeth must be free of tartar or plaque, therefore a dental cleaning is necessary.
The mostly widely used bleaching program consists of custom fitted trays that fit over the teeth and contain small spaces built to hold the bleaching gel in contact with the teeth with minimal contact on gum tissue. This is an important difference between a dentist-made tray and the do-it-yourself, boil and bite tray system. It very important that you use a dentist approved bleaching gel. The strengths range anywhere from 10-25 percent carbamide peroxide. Some mail-order gels are said to be too acidic in their formulations and acidity removes enamel needlessly.
The trays are worn three to four hours each day or night depending on the severity of the stain for two weeks, maybe longer. This will remove the extrinsic stain that has developed over the years since those teeth came in from 6-12 years of age. After that the patient can use the trays for touch-ups for one night every one to three years. For deep tetracycline stains patients can wear trays up to six months!
We like to monitor the lightening by checking at two weeks and comparing to the color we saw at the start. Often other cosmetic dental treatment is done to finish the cosmetic case. Examples of this include: minor grinding of teeth edges to improve the smile line (cosmetic contouring), or bonding materials to close gaps and improve tooth contours. Very often upper bicuspids show a lot of gray due to silver fillings. If this is something the patient wants to correct I suggest bleaching and replacement of the silver with a tooth colored material.
The only downside to the tray bleaching method is that occasionally some people get sensitive to cold or sweets. This always stops when the treatment stops. Your dentist has methods to correct this temporary condition of it arises.
The most common stain is made up of yellow-brown-orange colors. This is also the easiest and fastest to remove. Blue-gray stains in translucent teeth respond poorest.
Enamel Microabrasion is used for superficial surface discolorations like white or brown spots that cover limited areas. Dentists use a rubber cup with a paste of hydrochloric acid and abrasive particles. Usually with five minutes of abrading, the spots are removed. If the stain keeps going deep into the enamel microabrasion may need to be halted to avoid changing the shape of the tooth, and another technique is undertaken.
Laser bleaching and in-office bleaching are two power bleaching treatments. In both cases a rubber dam is used to protect the gum tissue from the strong bleaching solution applied to the teeth. A heat source is applied for about 1/2 hour and fast results are obtained. There is more rebound of color with this method so follow-up with home tray bleaching is recommended. The laser treatment is touted as the most effective. The laser beam is "dragged" over each tooth slowly. This activates the applied peroxide with light and heat speeding the breakup of stain molecules. It has good results on very stubborn discoloration and takes some extensive chair time and is costly.
Porcelain veneers are a proven excellent treatment to treat even the most discolored teeth. The shape can be improved also.
Often a combination of the above procedures may be appropriate depending on the nature and degree of discoloration. Consult with your dentist.
If you need a dentist for teeth whitening, call us at 1-866-970-0441. We'll put you in touch with a great dentist today!