3 October 2017

Kuliah Pakar 15: Tooth Discoloration – 1 (Treatment)

(drg. Ahmad Faudzi Muharriri, Sp.KG)

Enamel and Dentin Staining

Most of extrinsic stains are located in enamel only, except for certain cases like stains caused by
dye with betel nut juice, the stains could be penetrating deeply to dentin zone. Another example
is stain caused by leakage of existing restorations, if the restoration is involving dentin, then the
stain must be also within dentin.
For intrinsic stains, they are mostly involving dentin because the discoloration occur when the
crowns are forming. For endo-related stains, the source of discolorations are from the pulp,
therefore discoloration must first be affecting dentins.

What Should You Do for Treatment of Tooth Discoloration

When patients require a whitening treatment, the procedures comprise several steps:
1. Dentists must decide whether the whitening procedure is worth a try. Tooth’s color is
sometimes a matter of one’s perception rather that its original color. Teeth will look much
whiter when compared to the surrounding facial features such as darker makeup or lispstick
because of increase of contrast between them.
2. Before designing a treatment of choice, a dentist must analyze all the related factors such as:
the causes and natures of the discoloration, extrinsic and intrinsic factors, and also prognosis
of the treatment, whether the color of teeth can be improved as expectation or not.
3. Treatment of choice designed must start from the most conservative approach. Most surface
stains (extrinsic) can be removed by routine prophylactic procedures, these are stains caused
by poor oral hygiene, or presence of chromogenic microorganisms.
4. In principle, treatment approach must refer to the aetiology of the disease. For stains caused
by metallic restoration for example, the treatments are to remove the metallic restoration,
and replace the restoration with tooth-colored materials.

Microabrasion and Macroabrasion

Microabrasion and macroabrasion are for the reduction or elimination of superficial
discoloration, the stains or defects are debraded away. These techniques are indicated for stains
or enamel defects that do not extend beyond a few tenths of a millimeter in depth (pict.1 & 2)

1
 Pict. 1: Fluorosis Stains Pict. 2: Superficial Enamel Defects

Technique of Microabrasion: The use of pumice or silicon carbide particles with 11% hydrochloric
acid to form a water-soluble gel paste. This agent is swabbed on teeth for removal of the
superficial stains. The mechanism is that stained enamel surface is dissolved by the acid, along
with the abrasiveness of the pumice that removes the ‘softened’ superficial stains. Pictures 3.b –
3.h.

3.a 3.b 3.c

3.d 3.e 3.f

g

3.g

3.b & 3.c) Under rubber dam isolation and protective glasses, water soluble gel paste is swabbed on
the tooth by rubber cup with fluted edges, 3.d) Gel paste is reapplied with hand applicator, 3.e) After
microabrasion, stains has been removed, 3.f) Enamel surface is polished with prophylactic paste, 3.g)
Topical fluoride application, 3.h) Final esthetic result.

2
The nature and extent of the enamel defect must be analized before starting a microabrasion.
Non hereditary developmental dysmineralization defects (white of light brown fluoretic enamel,
and idiopatic opaque white or light brown spot) has intact, smooth, and hard surface. It can be
attempted for correction by microabrasion first. However, if microabrasion is not successful
because the depth of the defects exceeding 0.2 to 0.3 mm, then restoration with tooth-colored
materials are then indicated.

Technique of Macroabrasion: The use of composite finishing bur or fine grit finishing diamond in
a high speed handpiece to remove the defects, with final polishing is accomplished with an
abrasive rubber point. Pictures 4.b – 4.e.

Care must be taken to use light, intermittent pressure and to monitor removal of tooth structure.
Air-water spray is recommended, as a coolant and also to facilitate the tooth in a hydrated state.

4.a 4.b 4.c

4.d

4.a and 4.b) Composite finishing burs are used to remove the stains, and to recontour the tooth,
4.c) Polishing with abrassive rubber point, 4.d) Completed treatment.

3
Comparison of Micro – and Macroabrasion.

Microabrasion:
 Better control of the removal of tooth structure.
Macroabrasion:
 Technique sensitive, can have catastrophic results if clinician is not really careful
 Faster, no need rubber dam.
 Defect removal is easier, if air-water spray is used to maintain hydration of tooth.

However, combination of macroabrasion and microabrasion may also be considered. Gross

removal of the defect is accomplished with macroabrasion, followed by final treatment with
microabrasion.

Reference:
1. Sturdevant’s art and science of operative dentistry. 5th ed. St. Louis, Missouri, USA: Mosby
Elsevier; 2006. p. 623-85.
2. Bleaching discolored teeth: Internal and external. In: Torabinejad M, Walton RE, editors.
Endodontics: Principles and practice. 4th ed. St. Louis, Missouri, USA: Saunders; 2009. p. 391-
404.