If you have discolored teeth, the cause is often staining on the enamel surfaces from foods, beverages, or smoking. But tooth discoloration may also originate deep within the root of a tooth. Sometimes this happens to a tooth that had to have earlier root canal treatment because of injury or decay.

In such cases the living pulp tissue and its blood vessels and nerves had to be removed from the root canals, resulting in the death of the dentin layer, which makes up most of the tooth's body. Over time this caused the dentin to darken. The color may come from remains of blood that was left in the tissue, or from filling materials left in the root canal that are showing through.

Since these stains are caused internally (intrinsic) and not on the outside of the tooth (extrinsic) they must be whitened from the inside. This is usually done by putting a bleaching agent into the empty chamber from which the pulp was removed. Usually the bleaching agent is a substance called sodium perborate.

When it is mixed with a solution of hydrogen peroxide, sodium perborate slowly bleaches the color from the tooth's internal material. It is considered to be safe and reliable for this use.

The work begins by taking x-ray images to make sure that the root canal is correctly sealed and the bone is healthy. After this, we will make a small hole in the back of the tooth through which the root canal space will be cleaned. The root canal space will be sealed and the bleach will be applied in a putty-like form and sealed off from the rest of your mouth. Every few days this procedure will be repeated until the bleaching reaches the desired level.

At this point a tooth-colored composite resin will be used to seal the small hole that was made in the dentin to insert the bleach. After the tooth has reached the level of whiteness that matches it to your other teeth, veneers or crowns must sometimes be used to repair the surface if it is chipped or misshapen, for example.

Contact us today to schedule an appointment to discuss your questions about whitening internally discolored teeth. You can also learn more by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”

Having a whiter, brighter smile can do wonders for improving self-confidence, career opportunities, and interpersonal relationships, as demonstrated in numerous scientific studies. In fact, according to a poll conducted on behalf of the American Academy of Cosmetic Dentistry (AACD), the following was revealed:

• 99.7% of Americans believe a smile is an important social asset.
• 74% feel an unattractive smile can hurt chances for career success.
• 50% of all people polled were unsatisfied with their smile.

These statistics demonstrate why you should have a solid understanding about any cosmetic procedure — even teeth whitening — before making your decision to proceed. To help you ensure that you have the facts, we created the following list of questions.

• Am I a good candidate for tooth whitening?
• How much will the entire process cost?
• Does my insurance cover the cost (or any portion of the cost)?
• How does teeth whitening work?
• Is bleaching teeth safe?
• Will the bleaching agents damage tooth enamel?
• Can whitening treatments make my teeth sensitive?
• How does your professional bleaching differ from home whitening?
• What type of bleach and strength will you use?
• How long can I expect the results to last?
• What will the bleach do to my gums, filings, crowns, veneers, and/or bridgework?

Please note that we may cover most or all of these questions during your initial consultation; however, we encourage you to bring this list with you to ensure you get the answers you need so that you can make the best decision. To learn more now, continue reading the Dear Doctor article, “Teeth Whitening: Brighter, Lighter, Whiter....” Or, you can contact us to discuss your questions or to schedule an appointment.

If you don't like your smile when you look in the mirror, or feel self-conscious because your teeth are discolored, there are a variety of whitening procedures that can help you obtain the smile of your dreams.

Choosing the Right White: With strips, trays and toothpastes all claiming to be the best tooth whitening systems, it can be hard to choose how to whiten your teeth. Our office can help you decide the best approach based on your individual needs, time constraints and budget. Whiteners may not correct all types of discolorations.

Whitening in Our Office: This procedure is called chair-side or professional bleaching and may require more than one office visit. Each visit may take from 30 minutes to one hour. We use an in-office whitening gel that is professionally applied to your teeth and activated by a light source, giving you significantly whiter teeth in less than an hour. Typically, teeth with a yellowish hue respond best to whitening.

Whitening Your Teeth at Home: If you are an adult who practices good oral hygiene and doesn't suffer from periodontal disease, our office can help you decide whether an at-home whitening system, or having your teeth whitened in our office best meets your needs. If you decide to go with an at-home system, you will wear a custom-made whitening tray that looks like a thin, transparent night guard. You fill the tray with a mild whitening gel and need to wear the gel filled tray for a specified period of time each day (per our office's instructions). This procedure must be continued over a period of time that generally extends from 2-4 weeks.

Whitening Products Found in Stores: If you are considering over-the-counter whitening products we can also recommend products that will offer you the best results. Whitening toothpastes that have the American Dental Association (ADA) Seal of Acceptance contain special chemical or polishing agents that generally provide some stain removal effect.

Contact us today to schedule an appointment or to discuss any questions that you may have regarding teeth whitening. Read more about this topic in the Dear Doctor magazine article “Teeth Whitening.”

Time to tune up the brightness on your teeth? Here are six modern methods of whitening and brightening your smile.

• In-office “power” bleaching under the supervision of my staff and me is recommended if your teeth are badly stained, or if you are about to have veneers or crowns made. It's quick, safe, and effective. Gels containing high concentrations of bleach are applied to your teeth in our office, often with the enhancement by heat and light to make them act faster. Results show teeth becoming up to ten shades lighter in about an hour.
• “Take home” whitening solutions and trays are designed to fit your mouth and can also be provided by my office. The technique is easy to perform and is less expensive than in-office power whitening system, although it takes longer to see the same results. General recommendations are for 30 minute applications twice a day. You can usually see a change after two to four sessions. This requires patience, because it is important not to exceed recommended exposure in order to avoid damage to your teeth, gums, and the inside skin of your mouth. After two weeks of use, teeth can be expected to be about eight shades lighter.
• Whitening strips look like clear Band-Aids that are applied to the tooth surfaces. They should be worn twice a day for 30 minutes each time, for seven days. On average, they claim to lighten teeth more than three shades. They take about two weeks to work at 30 minutes per day.
• “Paint on” or “Brush on” whitening formulas are also available. These are gels that are painted onto the teeth every night at bedtime, for two weeks. Some claim that this line of home whitening can whiten teeth two to five shades. These gels may make your mouth feel goopy, but they are relatively inexpensive. Some gels come with a small brush to scrub them onto the teeth.
• Over-the-counter “mouth-tray” whiteners use mouth trays that are not designed for your particular mouth, so they may not fit well and may be messy or uncomfortable. They are filled with gel and worn 45 minutes a day for one week. On average, teeth become two shades whiter.
• Whitening gum is a relatively new product. It requires chewing two pieces for at least 20 minutes, four times a day, to see an effect.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”

If you are pleased with your smile except for that one front tooth that appears darker, then we have good news for you. Often a tooth appears darker as a result of trauma that may have occurred years ago. Your tooth may need root canal treatment or may have already had root canal treatment in the past. Regardless, you can whiten this tooth via a process called internal bleaching. And as the name suggests, the tooth can be bleached from the inside out. Here's a brief summary of how this entire process works:

1. Performing an x-ray exam: The first step is to take a radiograph (x-ray) to make sure that your root canal filling is intact adequately sealing the root canal and the surrounding bone is healthy.
2. Making an access hole: To apply the bleaching agent, a small hole will need to be made in the back of your tooth to apply the bleach. However, before doing that, the area must be thoroughly cleaned and irrigated.
3. Sealing above the root canal filling: This step is critical to prevent the bleach from leaking into the root canal space.
4. Applying the bleach: To obtain the whitening needed, it typically requires between one and four office visits for additional bleaching.
5. Applying a permanent restoration: Once your tooth has lightened to the desired color, a permanent filling will be placed over the small hole to seal your tooth's dentin. This is then covered with tooth-colored composite resin (filling material) so that the access hole is undetectable to the naked eye.

To learn more about this procedure and see amazing before and after images, continue reading the Dear Doctor article, “Whitening Traumatized Teeth.” Or, you can contact us to discuss your questions or to schedule an appointment.