Tooth Discoloration II

Dr. Ghada Maghaireh

Treatment Options for Discolored Teeth

 Mechanical removal of surface stains.

 Resin infiltration
 Tooth Bleaching (whitening).
 Tooth surface abrasion.
 Veneers
 Crowns.
Mechanical Removal of Surface stains

 Scaling and professional cleaning of discolored teeth are

common procedures for removing of the majority of
extrinsic stains.

 The most commonly accepted procedure to remove

discoloration from tooth surface is by using abrasives
such as prophy pastes or a combination of abrasives
and surface active agents found in tooth pastes.
 Tooth Surface Abrasion
 This technique involves the use of a moderate
concentration of hydrochloric acid with pumice that is
rubbed on enamel surfaces .

 It dissolves the superficial enamel stains like brown-

white fluorosis.

 It is indicated for superficial and not deep stains.

 It may involve using a composite finishing diamond bur

followed by polishing with an abrasive rubber points.
 Tooth Bleaching

 Bleaching has been used to achieve a lighter

and more desirable tooth color for over a
century.

 The active ingredient common to all of the

materials used for bleaching was an oxidizing
agent that oxidize the inorganic matrix.
 Type and Nature of
Stains/Discoloration
Cause of staining:

 High Success: Yellow, brown (aging, smoking,

coffee).

 Moderate success: Fluoresced teeth (brown &

orange).

 Low success: Tetracycline stain (blue and

gray), white fluorosis.
 Patient Examination

1. Cause of discoloration

 Extrinsic: can be removed with prophylaxis.

 Intrinsic: Trauma, aging, non-vital, fluorosis,

discolored or leaking restorations,
tetracycline staining, developmental defects,
single dark tooth.
2. Radiograph
Caries, periapical lesions, pulp size
differences, internal or external
resorption, and other dental disease.
3. Clinical exam
Caries, cracks, exposed dentin, wear,
abfraction, erosion, abrasion, tooth
vitality, translucency of teeth, soft
tissue and periodontal exam.
4. Restorations
Restorations that need to be
replaced after tooth whitening
(crowns, composites, veneers).
5. Shade

Initial shade (value) overall

and individual tooth variation.

Be sure to document pre and

post color change with shade
tab for documentation and
standardization of your patient
record chart.
 Indications
 Patient dissatisfaction with tooth
color.
 Conservative esthetic procedure.
 Pre-restorative whitening.
 Treating single dark teeth that are
vital or nonvital.
Patient dissatisfaction with tooth color
Pre-restorative Whitening
 Contraindications

 Superficial or extrinsic stains.

 Teeth hypersensitivity.

 Pregnant and lactating women or persons allergic to

the ingredients of the carbamide peroxide
preparations.

 Patients with existing esthetic restorations (???).

 Whitening interfere with the bonding process (???).

Types of Tooth Bleaching

 Vital tooth bleaching

 Non-vital tooth bleaching

 Vital Tooth Bleaching

 In-Office Technique for Vital Teeth

 At-Home Technique
 In-Office Technique for Vital
Teeth
 35% hydrogen peroxide.
 The oral/ perioral structure must be protected.
 This technique quickly produce the bleaching effect.
 Limited need for patient compliance.
 The fee is higher.
 Possibility of tissue injury.
 Results may be not as good as the slower at-home
method.
In-Office Technique for Vital Teeth

 Teeth should not be anesthetized.

 Two to six appointment of 45 minutes to 1 hour
each.
 The development of sensitivity is the single most
important limitation to the number of application per
appointment.
 Appointments are scheduled 1 week apart.
 At-Home Technique
Night-guard Vital Bleaching (NGVB)

 More commonly performed (easy and less expensive).

 10 to 20% carbamide peroxide in a custom-fit tray.

 Based on the manufacturer's directions, the patient

wears the tray until the teeth are whitened to the
desired degree.

 The result is dependent upon the concentration of

bleach and most importantly the patient’s compliance.
 TOOTH WHITENING PROCEDURES
Night-guard Vital Bleaching (NGVB)

FIRST APPOINTMENT:

 Make full arch alginate

impression of the arch (s)
you plan to bleach.
SECOND APPOINTMENT:
 Deliver Bleaching Tray (s).

 ONLY one arch should be

treated at a time. Patient
Instructions.
 Patient Instructions
1.Keep the bleaching agent in a cool place (refrigerator best)
to increase shelf life (12-18 months).

2.Brush and floss teeth prior to prescribed time of wear.

3. Place a strip of bleaching material from incisal to gingival on

facial surface of each tooth to be

treated and spread out with syringe tip.

4. Dry teeth before inserting tray to

remove excess saliva.

 Patient Instructions
5. Bleach teeth for 6-8 hours.
6. If whitening agent inflames the gingiva or a tooth
becomes sore, contact the dentist. Reduce hours of
wear as needed (minimum of 2-4 hours).
7. Remove tray at end of bleaching session, clean out
excess gel, rinse and brush with toothbrush (Not hot
water) Store in container provided. Clean teeth as
usual.
 Reappoint Patient

 The older the patient and darker the teeth

the more time it will take to lighten the
teeth.

 Patients with tetracycline stains may

require 4-6 months.
 "Touch-up" treatment

 Occasional “touch-ups” may be necessary after

1-3 years to return to initial whitening.
 Patients should keep their tray when bleaching
is completed. Further bleaching treatment
should not be started unless the patient is re-
examined.
 Dental supervision is important for the safety
and success of tooth whitening.
 Home Whitening, Results
 Dependent on patient compliance/type of stain,
concentration, frequency & time of whitening.
 Noticeable results with night time wear.
 Age discoloration 1-3 days.
 Other stains 7-10 days.
 Total whitening time 2-6 weeks usual per arch.
 Tetracycline stain (4-6 months).
 Tooth Sensitivity
 Occurs frequently (2 out of 3).
 Only predictor is history of sensitivity.
 Concentration & frequency of application.
 Advise patient (usually transient, diminishes).
 Sensitivity during treatment can be treated by having the
patient use fluoride, desensitizing agents in the tray, or
brushing with desensitizing toothpaste.
 Whiten every other day or shorter time.
 Desensitizing agents helpful.
 Desensitizing Agents

3% potassium nitrate and

0.11% fluoride ion
desensitizing gel for home
use.
 Non-vital tooth Bleaching

 The primary indication for non-vital bleaching is to

lighten teeth that have undergone root canal therapy.

 This discoloration may be a result of bleeding into the

dentin from trauma before root canal therapy,
degradation of pulp tissue left in the chamber after such
therapy, or staining from restorative materials and
cements placed in the tooth as a part of the root canal
treatment.
 "Walking" Bleach Technique

 Place a rubber dam to isolate the discolored tooth and

remove all materials in the coronal portion of the tooth
(i.e., access opening).
 Remove gutta-percha (to approximately 2 mm apical of
the clinical crown).
 Place a light-cured glass-ionomer cement liner to seal
the gutta-percha of the root canal filling.
 After this seal has hardened, trim any excess material
from the seal so that the discolored dentin is exposed
peripherally.
 "Walking" Bleach Technique

 Mix one drop of saline with enough sodium perborate to

form a creamy paste.

 Use a spoon excavator or amalgam carrier to fill the pulp

chamber with the bleaching mixture.

 Use a cotton pellet to blot the mixture.

 Place a temporary sealing material (e.g., Intermediate

Restorative Material [IRM] or Cavit) to seal the access
opening.
"Walking" Bleach Technique

 The mixture may be changed weekly and usually one

to three treatments are required to achieve optimal
tooth lightening.

 Remove the temporary restorative material, rinse

away the bleaching material, and dry the pulp
chamber.

 Restore the tooth with a light-cured composite.