MANAGEMENT OF DISCOLORED

TOOTH
INTRODUCTION
Teeth are polychromatic so color varies among the
gingival, incisal and cervical areas according to the
thickness ,reflections of different colors and
translucency of enamel and dentin. Color of healthy
teeth is primarily determined by the translucency and
color of dentin.
WHAT IS TOOTH
DISCOLOURATION?
any change in the hue, color or translucency of a tooth
due to any cause; restorative filling materials,
drugs(both topical &systemic), pulpal necrosis or
hemorrhage may be responsible
CLASSIFICATION OF TOOTH
DISCOLOURATION
1.Intrinsic discoloration.
2.Extrinsic discoloration.
3.Combination of both.
ETIOLOGY OF TOOTH
DISCOLOURATION
Intrinsic discoloration:
a)pre-eruptive causes Disease
I. Alkaptonuria.
II. Hematological disorders.
III. Disease of enamel &dentin.
Medications like Tetracycline stains and other .
CONT.
Posteruptive causes of discoloration- -pulpal changes.
-trauma. -dentin hyper calcification. -Dental caries. -
Restorative materials and operative procedures. -Aging
-Functional and parafunctional
CONT.
Extrinsic stain/discoloration: Daily acquired stains -
plaque. -food and beverages. -tobacco use. -poor oral
hygiene. -swimmers calculus. -Gingival hemorrhage.
Chemicals- -chlorhexidine. -Metallic stains
TREATMENT OF DISCOLORED TOOTH
• Treatment varies -depending on the causes of
discoloration of the tooth.
 As example most of the extrinsic discoloration of
tooth can be removed by performing proper scaling
and polishing.
• But if Drinks or cigarettes(long time) penetrate
through the enamel and staining the dentin, it can’t be
removed by only performing scaling and polishing. In
this case the preferable treatment option will be scaling
and polishing combination with laser tooth whitening
treatment.
HOW THE LASER TOOTH WHITENING
WORKS ?
The beyond tooth whitening system is done by placing
the whitening gel on the teeth and exposing it to the
specifically tuned frequency of cold filtered blue light
which turns the whitening gel into oxygen. As this
happens it allows the whitening gel to penetrate under
the enamel to remove the stains from the dentine of the
tooth. This restores the teeth back to their natural
whiteness leaving them looking healthy and bright.
Cont.
If discoloration occur due to any developmental defect
of enamel and dentin ,the treatment will be Lamination
of the tooth with appropriate restorative material
(proper shade must be maintained)
• If there is a history of trauma & tooth is
discolored ,then there will be two types of treatment
depending on the stress bearing area- i. In non stress
bearing area(anterior tooth)- RCT combination with
proper bleaching followed by proper shade aesthetic
filling material.
Cont.
In stress bearing area(posterior tooth)- Root canal
treatment followed by crown/cap. (Any type of pulpal
involvement of tooth except reversible pulpitis in case
of posterior tooth the treatment will be the same)
WHAT IS BLEACHING?
• Bleaching is a procedure which involves lightening
of the color of a tooth through the application of
chemical agent to oxidize the organic pigmentation in
the tooth.
GOAL OF BLEACHING
Goal of bleaching is to restore the normal color of a
tooth by decolorizing the stain with a powerful
oxidizing agent ,known as a bleaching agent.
MECHANISM OF ACTION
Mechanism of bleaching is mainly linked to
degradation of high molecular weight complex organic
molecules that reflect a specific wavelength of light,
that is responsible for color of stain. the resulting
degradation products are of lower molecular weight
and composed of less complex molecules that reflect
less light ,resulting in a reduction or elimination of
discoloration.
BLEACHING TECHNIQUES
For vital teeth- -Home bleaching technique -In office
bleaching-
i. Thermocatalylic
ii. Nonthermocatalytic
iii. Microbrasion
For non vital tooth- Thermocatalylic in office bleaching
-walking bleach -closed chamber bleaching
-inside/outside bleaching
Laser assisted bleaching
CONTRA-INDICATIONS OF
BLEACHING
 Poor case selection.
 Dentin hypersensitivity.
 Extensively restored tooth.
 Teeth with hypo plastic marks and cracks.
 Defective and leaky restoration.
Cont.
Unlike olden days, dentistry in this era has various option
to treat discolored teeth. Today dental markets are full of
various teeth whitening products.
But which procedure or technique is suitable to treat which
type of discoloration that is a big responsibility on dentist’s
shoulder. Therefore proper evaluation of discolored teeth
and then selecting appropriate option to treat it plays a key
role in success of treatment.
 In addition, routine monitoring of bleaching by dentist’s
allow early detection of any possible complications.
To conclude, for a desired and favorable outcome a through
Other options to manage discolorations could be
Jacket Crowns
Veneers
REFERENCES • Nisha Garg & Amit Garg, Textbook
of endodontics(3rd edition)