In today’s appearance and youth-conscious society, the dull, stained effects of tooth discoloration represent a common dental complaint. Beyond the professionally managed teeth whitening, people are using new, everyday products in their ongoing struggle against yellow teeth and other forms of discoloration. From whitening strips and take-home trays to whitening toothpaste and chewing gum, people are going to various lengths to achieve and maintain a white, attractive smile.
Types of Discoloration
Tooth discoloration falls into two main types: extrinsic and intrinsic.
- Extrinsic discoloration occurs in the outer layer of the tooth, called the enamel; enamel stains can range from white streaks to yellow tints or brown spots and pits.
- Intrinsic discoloration occurs in the inner structure of the tooth, called the dentin, when the dentin darkens or displays a yellow (or gray) tint.
Whereas extrinsic staining can be effectively treated using various whitening techniques, intrinsic staining may be more stubborn, potentially requiring alternative cosmetic treatment such as veneers.
What Causes Discoloration?
In order to effectively manage tooth discoloration, it is important to recognize the causes. These include:
- Foods/Drinks: Coffee, tea, colas, wines and certain foods (e.g., potatoes, cherries, blueberries) can cause extrinsic tooth stains.
- Tobacco Use: Smoking or chewing tobacco can result in discolored teeth.
- Poor Dental Hygiene: Inadequate brushing and flossing to remove plaque and stain-producing substances can cause tooth stains.
- Disease: Diseases affecting enamel and dentin can lead to tooth discoloration. Certain infections in pregnant mothers can cause discoloration in the baby by affecting enamel development.
- Medications: Antihistamines, antidepressants and high blood pressure drugs can discolor teeth. Maternal use of tetracycline antibiotics during the second half of pregnancy may result in discoloration of the baby’s tooth enamel. Children who take tetracycline and doxycycline antibiotics during permanent tooth development (before age eight) may experience intrinsic discoloration of the permanent teeth.
- Dental Work: Procedures requiring certain dental materials, such as silver amalgam restorations, can produce a grayish-black cast to teeth.
- Ageing: As you age, the outer layer of enamel on your teeth wears away, revealing the dentin’s natural, yellow color. Additionally, over the years your teeth accumulate more stains and tartars, causing them to darken and discolor.
- Genetics: Some lucky individuals have naturally brighter and/or thicker enamel than others.
- Environment: Excessive fluoride from environmental sources, such as high fluoride levels in drinking water, or from excessive use of fluoride applications, rinses, toothpastes and oral fluoride supplements, can cause discoloration.
- Medical Treatments: Certain treatments can adversely affect the color of enamel and dentin layers. For example, chemotherapy, and head and neck radiation are two such treatments.
- Trauma: A fall or any other injury that damages the nerves or chips/cracks the teeth can lead to discolored teeth in adults and children.
Treatment options for discolored teeth vary depending on the cause. Before a custom treatment plan can be developed to combat discoloration, a comprehensive oral health evaluation must first be performed. Common problems such as tooth decay and gum disease will require treatment before esthetics can be considered.
Treatment options may include the following:
- Good Hygiene: Practice proper dental hygiene by brushing and flossing daily, and getting professional teeth cleanings every six months or more frequently, depending on your dentist’s recommendation, to help remove surface stains and bacteria. Use an ultrasonic toothbrush, which more effectively removes stain-causing foods from tooth surfaces.
- Whitening Procedures: Tooth whitening procedures fall into four categories: In-office Tooth Whitening: Your dentist can easily remove extrinsic and some intrinsic tooth discoloration caused by foods/drinks and other causes by applying a bleaching peroxide gel to the tooth enamel. The process typically takes an hour and costs an average of $650 per visit. People with particularly stubborn staining may need to return for one or more additional whitening sessions, or be advised to continue with an at-home use whitening system provided by their dentist. Dentist-dispensed At-home Bleaching: Many dentists believe that professionally dispensed take-home whitening kits may produce the best results over time. More suitable for extrinsic tooth discoloration, home whitening usually is done with teeth whitening kits, gels or strips. Typically, a custom-fit or standard mouth tray and a whitening gel are used. The gel, which is a lower-concentration peroxide-based formulation of in-office versions, is put into the mouth trays and worn daily for an hour or longer (sometimes overnight) for about two to four weeks, depending on the desired shade. Take-home teeth whitening kits cost on average between $100 and $500. Consumer-purchased/Over-the-counter (OTC) for At-home Use: OTC whitening products offer a convenient and low-cost alternative to bleaching teeth without dentist supervision. Featuring a lower-concentration bleaching agent, OTC products — available in supermarkets, drug stores or through the Internet — include rinses, paint-on liquids, toothpastes, chewing gums, dental floss and whitening strips. Toothpastes, chewing gums and dental floss remove superficial stains. Rinses and paint-on brushes with low levels of hydrogen peroxide have some whitening effect; strips present similar esthetic results. Costs will range between $4 and $100. Other Non-dental Office Options: An emerging tooth whitening trend is the availability of whitening treatments or kits in retail venues such as mall kiosks, salons and spas, and even cruise ships and airports administered by non-dental professionals. Prices can range from around $99 in mall kiosks and airports to around $200 at salons, spas and cruise ships.
Composite Bonding, Crowns and Veneers: For teeth severely discolored by excessive fluoride, root canal treatment, or consumption of tetracycline or other drugs, your dentist may recommend covering the tooth’s outer surface with a color-matched composite bonding material, porcelain veneers or porcelain crowns instead of bleaching. Composite resin veneers, which cost about $250 per tooth, are applied directly to your teeth and sculpted in the desired shape and shade. Porcelain veneers, which are thin porcelain shells bonded over the front of your teeth, cost $900 to $2,500 per tooth. Lumineers, an alternative porcelain veneer made from Cerinate porcelain, cost $700 to $1,000 per tooth. Porcelain crowns, also called caps, average $600 to $3,100 per tooth.
Consult with your dentist for the best treatment options for your individual case.
Prevention and Maintenance
Certain lifestyle choices can help prevent tooth discoloration, as well as keep your teeth white after whitening. For example, avoid stain-causing foods and beverages, as well as overexposure to fluoride. If you are a coffee drinker and/or smoker, quit or cut back. Rinse your mouth with water after having wine, coffee or other drinks/foods that can cause tooth stains. Intrinsic stains caused by damage to a nerve or blood vessel in a tooth may be prevented with root canal treatment to remove the inner part of the tooth, called the pulp, before it decays and darkens.