Tags Posts tagged with "Discolored Teeth"

Discolored Teeth

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Root Canals Stain Teeth
©Warren Goldswain/Shutterstock.com

Last week, Pam left a comment asking whether or not root canal treatment can darken a tooth.  I gave her a short answer, telling her that sometimes root canals can discolor teeth.

If you want to know about the four different ways that a root canal can darken your tooth, this article is for you.

4 Ways Getting a Root Canal Can Discolor or Stain Your Tooth

Pink Rubber Dental Dam1 – The tooth can get discolored if any pulp tissue is left inside the tooth.  If you’ve read this post about the anatomy of a tooth, then you know that the pulp is the center layer of the tooth.

It can be easy for a dentist to accidentally leave some pulp tissue inside of the tooth because sometimes the pulp isn’t all together in the middle of the tooth.  Sometimes there are little offshoots of pulp tissue in little tunnels that branch away from the main pulp chamber known as pulp horns.

The book Esthetic Dentistry by Aschheim states, “Elusive pulp horns and lateral extensions of the pulp chamber often remain untouched during routine endodontic access preparation…Careful removal of tissue and debris from these areas may help prevent subsequent tooth discoloration.”

If any pulp tissue is left inside of the tooth after the root canal is completed, it can decompose and eventually discolor the tooth.

How to fix discoloration caused by pulp tissue: Usually internal bleaching can remove any discoloration that was caused by pulp remnants left inside of the tooth.

2 – A tooth with a root canal get get discolored if root canal filling materials are left in the crown portion of the tooth.  When dentists do root canals, they remove the pulp tissue from the tooth (hopefully enough so that it doesn’t discolor the tooth – see above) and replace it with a liquid sealer and a solid rubber filling material called gutta percha.

This study showed that all root canal sealers can cause tooth discoloration when remnants of the sealer are left in the crown portion of the tooth.  Certain sealers may stain the tooth more than others.  Gutta percha is also believed to be able to discolor teeth.

Prevention is the best approach for this type of root canal discoloration.  The dentist can prevent this by removing any root canal filling materials that are in the crown portion of the tooth and keeping them isolated to the root portion of the tooth.

How to fix discoloration caused by root canal filling materials: Internal bleaching is the best method to remove this type of root canal discoloration.  However, if the staining was caused by a sealer with a high metal content, bleaching may not be extremely successful and if it is, the tooth may discolor again in the future.

3 – Medications that are put into the root canal can discolor a tooth with a root canal.  Sometimes dentists add certain medications when they do root canals to help increase the chances that the root canal will be successful.

The book Endodontics: Principles and Practice by Torabinejad says, “Several medicaments have the potential to cause internal discoloration of the dentin.  Phenolic or iodoform-based…medications, sealed in the root canal space, are in direct contact with dentin, sometimes for long periods, allowing for their penetration and oxidization.   These compounds have a tendency to discolor the dentin gradually.”

How to fix discoloration caused by root canal medications: A majority of root canal discoloration caused by medications can be reversed by simply bleaching the tooth.

4 – A tooth with a root canal can get discolored depending the material that is put inside of the crown.  If an amalgam (silver metal) filling is used to build the crown of the tooth back up after completion of the root canal, the amalgam filling can stain the tooth a dark gray color.

You can prevent this staining by asking your dentist to not use amalgam to fill any of your front teeth so that your smile remains aesthetically pleasing.

How to fix a discoloration in a tooth with a root canal caused by an amalgam filling:  Metallic discoloration caused by an amalgam filling is hard to remove, but some experts say that internal bleaching may work depending on how discolored the tooth is.  Sometimes, replacing the metal filling with a white composite filling can help gradually reduce the staining caused by the amalgam filling.

Conclusion

As you can see, there are a variety of ways that root canals can discolor your teeth, but they are usually reversible.

This doesn’t mean that root canals will always discolor your teeth.  I had a root canal on a tooth four years ago.  I had it filled with a white composite filling and it hasn’t discolored.

In fact, many times a root canal can turn a discolored tooth white again!

Do you have any comments or questions about tooth discoloration due to root canal treatment?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

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Smokers Have Less Teeth Than Non-Smokers
©V.gi/Shutterstock.com

It’s common knowledge that smoking has many awful effects on your health.  Since I try to deal with oral health on this blog, I won’t go into all of the systemic health risks of smoking.  I’ll just talk a little bit about the oral health risks.

Smoking Isn't Good for Your Oral HealthSmoking puts you at greater risk for oral cancer, such as lip, mouth, tongue, and throat cancers.  Smoking is strongly associated with gum disease, a leading cause of tooth loss.

Cosmetically, smoking can discolor your teeth (causing some smokers to fall for online teeth whitening scams) and cause bad breath.

What many people may not know is that smokers, on average, have less teeth than non-smokers.

Smokers Have Less Teeth, On Average, Than Non-Smokers

This study published in the April 2007 issue of the Journal of Dental Research looked at 43,112 male health professionals in the United States.  It found that those who smoke 5 to 14 cigarettes per day are two times more likely to lose teeth than a non-smoker.  People who smoke more than 45 cigarettes per day have three times the risk of losing teeth than a non-smoker.

An interesting conclusion of that study was that if you used to be a smoker, but hadn’t smoked in ten years, you still were 20% more likely to lose teeth than a non-smoker.  Quitting smoking can lower your risk of losing teeth to nearly that of a non-smoker.

A Study of Americans’ Oral Health Found That Smokers Are Missing More Teeth

The National Health and Nutrition Examination Survey (NHANES) conducted from 1988 to 1994 and from 1999 to 2002 found that on average, smokers had lost more teeth than former smokers, and former smokers were missing more teeth than those who had never rouched a cigarette to their lips.

Here’s a graph I created using the data from the NHANES study:

Smoking Is Associated With Tooth Loss

As shown above, smokers are missing more teeth.  Interestingly, people are keeping their teeth for longer, as shown by the lower numbers at the turn of the century as compared to the numbers from 1988 to 1994.

Why Do Smokers Have Less Teeth than Non-Smokers?

The reason that smokers have less teeth is probably due to multiple factors.  It could be an interaction with the chemicals or smoke from the cigarettes and the mouth.  Some say that because smoking decreases bone density in the whole body, it decreases the strength of the bone that holds the teeth into place, thus causing more smokers to lose teeth.

The National Health and Nutrition Examination Survey found that “[Adults with teeth] who were current smokers had a higher prevalence of untreated tooth decay (35.0%) than did those who never smoked (18.6%) and former smokers (17.7%).”

Perhaps those who smoke aren’t as concerned about taking care of their teeth.

What are your thoughts?  Please leave any comments and/or questions that you may have below in the comments section.  Also, if you know someone who might like this article, please don’t hesitate to share it with them.

Tetracycline Teeth Staining Cause and Treatments
©Gordana Sermek/Shutterstock.com

When I was a little boy, I remember seeing my brother in the bathroom trying to bleach his teeth.  He tried many different formulations of bleaching agents to try to remove the staining on his teeth.

Tetracycline Teeth StainingI asked him about it recently, and he told me he wasn’t sure how it happened.  We suspected that my mom unknowingly took some sort of antibiotic that stained his teeth when she was pregnant with him or that he had taken something as a kid.  He couldn’t remember.

Tetracycline Teeth Staining Close-Up ViewThen, I called my mom.  She said that she didn’t take anything during her pregnancy and the discoloration came from a drug that was prescribed to him at a young age.  Whatever the reason, nobody likes to have discolored teeth.

To the right is a close-up view of the same patient in the photo above.  As you can see, the tetracycline has changed the color of his teeth.

Tetracycline Tooth Staining

Tetracycline can stain the teeth anywhere from a bright yellow shade to dark brown.  Usually the staining starts out as a yellow color.  Over time, as the tooth is exposed to light, a chemical reaction occurs and the yellow turns to a dark brown color.  For this reason, many people with tetracycline tooth staining have brown teeth in front (the teeth that are exposed to the most light) and yellow teeth in the back (where not as much light reaches.)  Under ultraviolet light, tetracycline staining can appear bright yellow.

However, it’s not just tetracycline that stains the teeth – there are many other drugs as well.

Other Drugs That Cause Staining of Teeth

Many of tetracycline’s homologues (similar drugs) are all associated with discoloration.  Chlortetracycline, demethylchlortetracycline and oxytetracycline can all cause brown/gray/yellow staining of the teeth.

Ciprofloxacin is an antibiotic that can be given intravenously to infants for treatment of a Klebsiella infection.  It can stain the teeth a green color, but the staining is usually more mild than tetracycline staining.

Minocycline hydrochloride is an antibiotic used to treat acne and rheumatoid arthritis.  It is believed that minocycline binds to the tooth and then oxidizes it, producing a discoloration.  Minocycline is able to stain teeth even after they are fully developed, unlike the tetracycline family of antibiotics and ciprofloxacin.

Prevention

Tetracycline can cross the placental barrier and incorporate into the developing tooth.  It should be avoided (if possible) by mothers who are pregnant and also in kids until they are at least seven or eight years of age.

The book Oral Pathology: Clinical Pathologic Correlations by Regezi says the following about how tetracycline staining is caused:

Because tetracycline can cross the placenta, it may stain primary teeth if taken during pregnancy. If it is administered between birth and age 6 or 7 years, permanent teeth may be affected. Only a small minority of children given tetracycline for various bacterial diseases, however, exhibit clinical evidence of discoloration. Staining is directly proportional to the age at which the drug is administered and the dose and duration of drug usage.

Since there are many other antibiotics available that are as effective as tetracycline without the discolored teeth as a side-effect, tetracycline is usually not prescribed to children except in rare circumstances.  Your doctor will be able to explain the reasoning if your child is ever prescribed tetracycline.

Treatment of Tetracycline Stained Teeth

It is very difficult to treat internal staining of teeth because it affects the dentin layer underneath the enamel.

For an overview of the layers of the teeth, check out this article on the anatomy of a tooth.

There are a variety of ways to treat tetracycline stained teeth depending on the severity of the staining.  The most conservative is bleaching the tooth.  If the tooth has undergone root canal treatment, it may be more effective to use an internal bleaching technique where the dentist puts a bleach inside the tooth to bleach it from the inside out.  Internal bleaching is not possible with teeth that have not undergone root canal treatment because there is still living pulp inside the tooth where the bleach would be put.

If bleaching doesn’t work, there are more invasive treatments.  The dentist can shave off the outer layer of the tooth and put an aesthetically-pleasing tooth-colored filling on the front-facing surface of the tooth.

Another treatment option is putting veneers (a thin layer of tooth-colored porcelain) over the teeth.

The most drastic treatment would be to cut around the whole tooth and put an aesthetic crown over the tooth.  This may end up being the most aesthetic option for severe tetracycline-stained teeth, but it is also the most expensive.  I believe my dental school would charge somewhere around $500 for this procedure, which means it is probably near $1,000 if you get it done in private practice.

Conclusion

I hope this article helped you to better understand why antibiotics stain the teeth and what you can do to prevent it.

Are your teeth stained due to a medication such as tetracycline?  Have you done anything about it?  Don’t hesitate to share your experience in the comments so others who have the same problem can see what worked for you.

If you have any questions or comments, go ahead and leave those in the comments section below as well.  Thanks for reading!

I want to thank Dr. James R. Donley, DDS for kindly allowing me to use his photos (the bottom two photos) in this article.