Whitening Traumatized Teeth

Do you have a front tooth that has turned dark over the years? As we age, our teeth naturally become more yellow, and in some instances more grayish due to the natural wearing of enamel. There are certain situations where a tooth can become dark very quickly, its cause being trauma or a root canal.

In a healthy tooth with a healthy pulp (the nerve), blood is cycled in and out. In a tooth that has lost the vitality of the nerve, blood is no longer able to be cycled in and out and so the expired cells become to accumulate leading to the dark color.

In the past, many would immediately restore these rather unaesthetic presentations with a conservative veneer or a crown. In many situations, dependent on the amount of healthy tooth structure available, these are still the preferred methods of treatment for root canaled or traumatized teeth. In situations where the teeth are preserved, the root canal treatment is done conservatively, then the treatment options to address color issues can be even more conservative.

In this situation, we have elected to whiten the tooth from within. The process is as easy as two or three visits. The first visit is an evaluation after the tooth has been seen by an endodontist (a root canal specialist). Once the tooth is determined healthy enough to proceed to bleaching or "restoring", can we begin the process. For internal bleaching, we will make a small access hole without the need for anesthetic so we can place a special type of bleaching material. Depending on how dark the tooth is, there may be a need to have multiple follow-up appointments to reapply the bleaching material inside the tooth.

Once the tooth color has become stable, we flush all of the bleaching material out, place a temporary and wait for 10 days before placing a final filling. The reason we need to wait between flushing out the bleaching material and placing a filling is to allow for all of the bleaching material to stop oxidizing, as this can interfere with the adhesion of the bonding system. If the bonding is unable to be at its maximum strength, we run the risk of decreasing the life of the restoration. The following is a video of our latest case that outlines the steps involved. Enjoy!

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Less Is More

“Wearing a veneer of perfection never did me any good.” -Liz Phair

I frequently get asked by friends and patients what I think about veneers. Before I go into my answer, let me define what a veneer is. A veneer is a thin shell of medical-grade ceramic (or resin) that is traditionally attached to the front surface of a tooth. Veneers are individually crafted by a skilled lab technician who uses man-made materials to mimic a natural tooth. Dentists use veneers for a variety of dental issues including  color correction and orthodontic adjustments.

Due to Hollywood, veneers are synonymous with cosmetic dentistry. (Literally, in the 1920’s, Hollywood actors and actresses were known to get false front teeth.) Generally, when a patient comes to my office inquiring on how to improve their smile, they always ask about veneers. But are veneers really the best choice for everyone in every situation?

Honestly, it depends on the situation. If it's a color modification you seek, a simple course of teeth whitening may be all that is needed. If the goal is to correct the alignment of your teeth, a visit to your orthodontist is a much more conservative option. Although veneers are a conservative alternative compared to crowns, in most cases you still need to give up some tooth structure for the veneer to properly bond.

In summary, more is not always better. Ask your dentist to explore less invasive options before you begin an irreversible procedure. Keep in mind that in some cases, ultimate results can be achieved with a blend of the veneer alternative treatments discussed above. There are instances where good intra-professional collaboration of teeth whitening, orthodontics, and good planning can yield optimal cosmetic results as conservatively as possible.

So Many Choices

I am frequently asked "What toothpaste do you recommend?"  To be honest, there is no single toothpaste that serves everyone's needs. When deciding, there are a few things to keep in mind.

Cavity Protection
Does the product contain fluoride?  Fluoride is a mineral that occurs naturally in water sources, it’s really unavoidable unless you want to consume only deionized water for life. Fluoride has garnered a bad rep lately, kind of unfair if you ask me. Fluoride is actually pretty cool; if Fluoride were a person, we’d definitely hang out. Research has shown that fluoride not only reduces cavities, but it also helps repair and potentially reverse the early stages of tooth decay. Pretty cool, right? 

Whitening
Whitening toothpastes are formulated with a higher abrasive content, sometimes in conjunction with hydrogen peroxide. If you have sensitive teeth or have been told by your dentist that you have gum recession, you may want to use these with caution.

Desensitizing
For sensitive teeth, these operate on the opposite mechanism as your whitening toothpaste. They contain less abrasives and use ingredients which help locally sedate the tooth surface. An ingredient to look for would be potassium nitrate. Little known fact: sodium fluoride also has desensitizing properties.

Antibacterial
For those who are trying to keep the bugs that cause gingivitis and periodontitis at bay, some brands are incorporating antibacterial ingredients into their toothpastes. Triclosan and stannous fluoride (told you fluoride was amazing) are two ingredients with antibacterial properties.

At the end of the day, when in doubt, consult with your general dentist for any professional recommendations. You can clearly tell from my casual writing style that these are my own off-the-cuff opinions.

For more of my opinions, check us out on http://siliconbeach.dental or shoot me an email at hello@siliconbeach.dental.

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