Treatment Options

Accept discolouration:

This may be a possibility if the discoloration is minimal and/or alternative treatments are unlikely to produce the desired results, and the patient or dentist rejects more intrusive procedures.

Micro-abrasion:

Is the process of applying acid to the surface of the tooth to remove the stained/discoloured enamel surface. It still entails the permanent loss of enamel, while being less intrusive than the alternatives (restorations, veneers). The depth of staining determines how much enamel must be removed to get an acceptable shade, and this amount is difficult to predict beforehand. It is important to note that it solely addresses surface staining, it is inappropriate if the cause of the staining is within.

Whitening Toothpastes, MouthRinses and Chewing Gum:

There are specific whitening toothpastes on the market many “multifunctional” or “all-in-one” toothpastes claim whitening effects. These frequently have special abrasives and/or whitening agents in them.

The most crucial component in toothpaste formulas for effective stain removal is abrasives. Whitening toothpastes frequently (though not always) contain harsher abrasives and a greater quantity of these than regular toothpastes to effectively remove surface stains. Alumina, Al2O3, calcium carbonate, and hydrated silica, SiO2 in H2O, are all common abrasives. There are an increasing number of commercially available toothpastes with activated charcoal. Heating organic materials like wood or coal can be used to prepare it. There hasn't been much research done on activated charcoal's use in whitening toothpastes. Recent in vitro research, evaluated toothpastes from several manufacturers that had various whitening formulas, such as those that contained activated charcoal, blue covair, hydrogen peroxide, or polythene microbeads. It was determined that the toothpastes containing blue covarine and polythene microbeads were the most successful in whitening teeth.

Low concentrations of sodium hexametaphosphate and hydrogen peroxide (1.5%) have been used in whitening mouth rinses with varying degrees of efficacy. Additionally, since mouthwashes don't include any abrasives, their stain-removing capabilities typically fall short of those of toothpaste.

Abrasive silica-coated whitening dental floss has been introduced to the market, although no clinical studies have been released as of 2009. Normal chewing gum performed no better than whitening gum that contained sodium hexametaphosphate.

In the literature, there is heated discussion on the therapeutic effectiveness of whitening toothpastes. However, the whitening impact may not be clinically meaningful. At the moment, it appears that whitening toothpastes can prevent extrinsic dental stains. Given their strong abrasives and potential impact on enamel, prolonged use of them should be minimized.

External Bleaching:

Professionals in a dental clinic ("in-office") can whiten teeth, but patients can also whiten their own teeth at home ("OTC") with over-the-counter ("OTC") products. Chemically, the most popular choices for bleaching include calcium peroxide (CaO2; Ca2+ "O-O"), hydrogen peroxide (H2O2; H-O-O-H), and other peroxides.

In-office bleaching (sometimes known as "power bleaching") is carried out using concentrated H2O2 in water solutions (usually 35 wt percent) for 30 to 60 minutes. A concentrated hydrogen peroxide solution is extremely oxidising and should be handled with caution since it can destroy soft tissue. Therefore, appropriate measures must be taken to protect the tongue and gingiva (e.g., rubber dam, water-soaked gauze). For in-office teeth whitening, dental pulp discomfort has occasionally been observed. Additionally, peroxides are antimicrobial substances that might result in the dysbiosis of the oral microbiome. Irradiation using a heat lamp is occasionally used to promote the oxidative activity and increase it. Chemically speaking, this irradiation should not alter the oxidative impact of hydrogen peroxide, although the local temperature increase may speed up the process.

Overnight (“nightguard”) bleaching is accomplished by application of a 10–20% carbamide peroxide-containing gel in a patient-specific mouthguard. Due to the lower concentration of hydrogen peroxide, a number of overnight treatments are necessary to achieve visible effects. Both power bleaching and nightguard bleaching have been shown to produce long-lasting whitening results. Paint-on gels and whitening strips, both of which use peroxides, are further bleaching choices.

Risks:

Whitening could lead to a mechanical weakening of the tooth due to a decreasing integration of the calcium phosphate crystals. Applying very concentrated hydrogen peroxide solutions can lead to changes in the tooth's surface structure and an increase in sensitivity. There are additional instances of structural damage to enamel surface prisms following the application of carbamine peroxide at a 35 percent concentration. The concentration of peroxide will enhance the likelihood of negative effects.

After power bleaching, there is an increase in tooth sensitivity (bleaching sensitivity), which remained for a few days. Due to the whitening chemicals' role in the development of tiny flaws and subsurface pores, bleaching sensitivity frequently develops following bleaching (peroxide). This sensitivity is caused by reversible pulpitis, leading to thermal tooth sensitivity. Use of oral care products containing particulate hydroxyapatite or potassium nitrate is one potential method to lessen tooth sensitivity after bleaching.

Strong (hard) abrasives, such as perlite and alumina, can harm the gingiva in addition to the enamel and exposed dentin when used to remove stains, especially when applied with high pressure during tooth brushing. These materials are harder than the tooth mineral hydroxyapatite.

It is unknown if bleaching causes long-term harm to the teeth because the organic chemicals that make them up oxidise. The mechanical integrity of a tooth might be impacted by this injury (enamel and dentin). Additionally, a typical adverse effect of using peroxides is increased tooth sensitivity (bleaching sensitivity).

 

Internal Bleaching:

Internal Bleaching involves applying bleach (Sodium Peroborate) to the inside of the discoloured tooth. This is a specialized treatment of bleaching and isolated to teeth that have single discolouration. The tooth has either been or going to be Endodontically treated. (Root canal treated)

Restorations:

Composite Veneers:

This process requires the placement of composite resin onto the outer layer of the tooth. This procedure removes little to no tooth structure as it is an additive procedure. It is relatively reversible. The process might not be able to cover up severely discoloured teeth. Over time it can stain more easily than the other treatment options, it involves a long time in the dental chair. It is prone to chipping which may require additional repairs in the future which may look different to the original. It is crucial that patients comprehend the long-term maintenance of this procedure connected with the tooth once the restoration cycle has begun.

Porcelain Veneers:

This process requires the placement of a porcelain restoration and the permanent removal of tooth structure. These might not be able to cover up severely discoloured teeth and may require the removal of more tooth tissue to make a thicker veneer. It is hard to stain porcelain and is less likely to chip compared to composite. It requires multiple appointments. Additionally, it is crucial that patients comprehend there will be ongoing biological and financial expenses connected with the tooth once the restoration cycle has begun.

Crowns:

A significant portion of tooth tissue must be permanently removed during this treatment. Although their removal may weaken the tooth's remaining structure and increase the risk of catastrophic failure in the future, they may help safeguard the severely restored tooth's remaining tooth structure. It is harder to stain crowns than composite resin. Again, this advances the restoration cycle of the tooth, so patients must be aware that there will be ongoing biological and financial expenditures related to the tooth.

(click here to see the restoration cycle)

More on Internal Bleaching

Internal Bleaching involves applying bleach (Sodium Peroborate) to the inside of the discoloured tooth. This is a specialized treatment of bleaching and isolated to teeth that have single discolouration. The tooth has either been or going to be Endodontically treated. (Root canal treated)

The treatment involves removing part of the old filling in the tooth, placing bleach inside the tooth near the root canal, then sealing with a temporary restoration for a few days to weeks to allow the bleach to have its affects. The Oral Health Practitioner then re-assesses the tooth and colour, it may need to be done multiple times to get the desired effect. Once you and the oral health practitioner are happy with the result the bleach is removed and a permanent restoration is placed back.

This treatment does have the following risks:

Chemical burns of the soft tissues (Gums & lips). This risk is reduced when your dentist uses a rubber dam at the time of treatment.

The colour change depends on the cause, extent & duration of discolouration. Sometimes the bleaching can wear off after a few years, which may require re-bleaching.

There is small chance of root resorption (which refers to the eating away of the tooth by your body's defence mechanism). This may result in the need for surgical intervention or removal of the tooth. This is controversial in the research & heavily debated in regards to whether it is related to internal bleaching or just due to random chance. More research is required to determine if this is a connection.

(click here to see the picture above)

Watch This Space

Teeth whitening has started to gain more popularity in the recent decades partly due to celebrities, media and social media. This has developed a big industry for companies and their products, the benefit of this is that there is more funding going into research to find new products that may be safer and better.There are few new avenues where researchers are exploring to help combat discolouration:

The incorporation of polyaspartate into whitening formulas is a relatively recent strategy. In vivo testing revealed superior stain-preventing abilities for a toothpaste containing sodium polyaspartate than for a control toothpaste. There are several carboxy groups in sodium polyaspartate. These could interfere with the tooth surface or the pellicle, changing the way colours absorb light and reflect it.

Colorants are particular dyes used to make the teeth seem white. Whether they will adhere to the teeth after cleaning is yet unknown. However, studies have shown that new whitening toothpastes containing the blue dye covarine, which causes teeth to reflect less yellow light and more blue, successfully whiten teeth.

Future bleaching agents may be made from enzymes (proteases) that selectively break down proteins by hydrolyzing peptide bonds.

Phthalimide peroxy caproic acid (PAP) based composite gel is a possible alternative to hydrogen peroxide. It is still very new and early studies are limited but appear to be showing less effect on hardness of enamel.

While researching novel whitening procedures, it's essential to keep in mind that not all claims are supported by reliable scientific data, the whitening market has a sizable economic volume, and manufacturer rivalry is fierce. The choice of population-representative inclusion criteria is often a major difficulty for organising and carrying out clinical research in the field of teeth whitening since teeth staining is significantly associated to the diet and other factors (like smoking, chlorhexidine). The prevention and elimination of stains on restoration materials, like as polymer-based composites, is another key area of study in addition to natural tooth whitening.