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Tooth Discoloration

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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!

Why Your Child Has a Dark Tooth
©Tatyana Vyc/Shutterstock.com

If you have kids, you know that they can get themselves into a lot of interesting accidents.  Many times when kids get a head injury they knock out a tooth.  Other times, they simply hit the tooth really hard and injure it.

It has been estimated that 8-30% of kids under 7 suffer an accident that injures one of their baby front teeth.

Dark Tooth - Tooth DiscolorationAny time a tooth suffers an injury, there is a possibility that it may turn a different color.  If you’re wondering what it means if your child’s tooth has turned pink, red, gray, black, brown, or yellow, then you’re the reason I wrote this article!

Tip – I will use words like pulp, dentin, and enamel in this article. If you don’t know what those mean, you might want to brush up on The Anatomy of a Tooth.

When Your Child’s Tooth Turns Dark (Gray, Brown, or Black) After a Tooth Injury

When blood leaks out of blood vessels after a tooth injury, blood by-products such as iron can make their way into the small tubes inside the dentin layer of the tooth.  As the blood breaks down, it can make the tooth appear to be gray, dark gray, brown or even black.  This color change doesn’t usually occur until 2-3 weeks after the tooth has been injured and can occur after a tooth has turned red (see below.)

The book Paediatric Dentistry by Welbury states that “although the reaction is reversible to a degree, the crown of the injured tooth retains some of the discoloration for an indefinite period.  In cases of this type, there is some chance that the pulp will retain its vitality, although the likelihood of vitality is apparently low in primary teeth with dark gray discoloration.”

Basically, the author is stating that even if a tooth has a dark color, it may still be able to return to health.  Some experts have said that the darker the discoloration, the more likely it is that the nerve of the tooth has died.  For example, this study “found that 33 of 51 traumatized teeth with gray-black discoloration were necrotic.”  However, other experts state that the shade of darkness doesn’t reflect the health of the pulp.

If your child’s tooth has turned dark, the best thing to do is to have your child’s dentist look at it.  If there are other signs that the tooth is dead such as swelling or an infection that shows up on the x-ray, then your child’s dentist will probably choose to do something about it such as performing a root canal treatment or removing the tooth.

If there is no sign of infection in a dark tooth, the dentist may choose to not do anything and let the tooth eventually fall out on its own when the permanent tooth is ready to take on its role in the mouth.  A study by Sonis showed that 72% of darkened teeth fell out normally without any bad effects on the permanent tooth.

Also, if there are no other signs of infection, this study showed that there is no need to do a root canal.  The researchers concluded that “Root canal treatment of primary incisors that had change their color into a dark-gray hue following trauma with no other clinical or radiographic symptom is not necessary as it does not result in better outcomes in the primary teeth and their permanent successors.”

When Your Child’s Tooth Turns Red or Pink After a Tooth Injury

If a tooth is going to turn red after an injury it can turn red shortly after the injury, or it can wait anywhere from a few weeks to months before it begins to turn a pinkish red color.

Red and Pink Teeth Immediately After the Injury

If a tooth turns red shortly after being traumatized, it usually means that the blood vessels inside the pulp broke.  When the blood vessels rupture, blood leaks inside the whole pulp area of the tooth resulting in a reddish pink color.  This condition is known as pulpal hyperemia.

Sometimes pulpal hyperemia is difficult to detect.  You may have to shine a light on your child’s tooth and look at the tongue side of the tooth with a mirror to detect this color change.

The pink/red color may take a long time to go away or it may never go away and the tooth may start to darken to a shade of gray.

Red and Pink Teeth Weeks after the Injury

As a result of trauma, sometimes cells inside the tooth start eating away at the hard layers of the tooth through a process called internal resorption.  These cells are called odontoclasts and in certain cases they can eat away to the outside of the tooth within a few short weeks.  The tooth looks pink because as the pulp layer of the tooth gets bigger, its red color more easily shines through the thin layer of remaining tooth structure.

A man named James Howard Mummery first noticed this “pink spot” that appears on teeth, which is why it is typically referred to as pink tooth of Mummery.  Pink tooth of Mummery can start occurring anywhere from a few weeks to months after a tooth is injured.

These teeth are usually kept until the crown of the tooth is dissolved.  Then the tooth root can either be removed or it can be left to get dissolved spontaneously as the permanent tooth comes into your child’s mouth.

When Your Child’s Tooth Turns Yellow After a Tooth Injury

The dentin layer of a tooth under the enamel is normally a yellow color.  If a tooth reacts to an injury by laying down a lot more dentin, it is known as pulp canal obliteration (Also called calcific metamorphososis, progressive canal calcification or dystrophic calcification.)

The increase in the amount of dentin and the concurrent decrease in the amount of pulp gives the tooth a yellow, opaque color.

The book Pediatric Dentistry by Pinkham states that “although pulp canal obliteration is a pathologic process, it has no known deleterious effects and therefore does not necessitate any treatment except follow-up.”

It is important to regularly follow-up with your child’s dentist about any teeth that have turned yellow after an injury.  The book Paediatric Dentistry by Welbury notes that “a small percentage [of yellow teeth] demonstrate pathologic change many years after the injury.”

Conclusion

Many times parents want to rush treatment when their child’s tooth changes color.  It is important to understand that “in the primary dentition of a healthy child, color change alone does not indicate a need for pulp therapy or extraction of the tooth (Pinkham.)”

Basically, if your child’s baby tooth has changed color, often the best treatment is no treatment.  As long as an infection doesn’t develop, simply waiting it out and seeing what happens could mean that your child doesn’t have to go through unnecessary dental treatment.  And that’s a good thing, especially after they’ve already been through a traumatic tooth injury.

Do you have any stories, questions, or comments about tooth discoloration?  Do you still have a question that I didn’t answer?  Feel free to write your thoughts in the comments section below so that we can all learn from each other – Thanks for reading!

Submitted Photos

Krista from The Muminator blog shared the following photos of her daughter after she had an accident in 2012:

Here’s a photo not too long after her daughter was playing on the furniture and fell:

Dark Tooth Following Traumatic Accident

Here’s a photo a few weeks after that.  The tooth continued to get darker:

Dark Tooth Continues to Get Darker Following Accident

And a final photo of the tooth returning almost back to its normal color:

Dark Tooth Getting Light Again Following Accident

You can read all about her daughter’s experience on this thorough blog post that she wrote about the entire experience.

The following photo is from Jennifer, who has left some very informative comments below regarding her daughter’s dark tooth.  She states:

Its not white completely but is a lot better than what it was… The left side of the photo is around 3-4 weeks after the trauma.. and the right side of the picture was taken a few days ago, around 8 weeks after the trauma, It has also moved back into alignment a bit more as well, as it was knocked back with a blunt blow.
Dark Tooth Turned White Again

If you have a photo of your child who had an injury that caused a tooth to discolor, please send them to me using this form and I can post them here to help others who are going through this same experience.

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Whitening Toothpaste Not Working
©Lana K/Shutterstock.com

Many people buy so-called “Teeth Whitening” toothpaste hoping to get whiter teeth.  For many people, these toothpastes do not provide whiter teeth.  Is this a form of false advertising?  Actually, it’s not.

ToothpasteThe confusion lies in the definition of teeth whiteningTeeth whitening in its strictest sense means to whiten the teeth to their natural shade.  Teeth bleaching, on the other hand means to whiten your teeth beyond their natural shade.

The reason there is so much confusion is because the phrase teeth bleaching isn’t very attractive.  So, companies that offer teeth bleaching, have started to refer to it as teeth whitening to make it more attractive to the average consumer.

In order for a toothpaste, mouthwash, or gum to be certified by the ADA as tooth whitening, it simply has to be able to remove surface stains off of your teeth.

How Teeth Get Stained

When our permanent teeth come in, they are a shiny white color.  However, as we grow older (and eat lots of teeth-staining foods), our teeth get more and more yellowish-brown.  Teeth Whitening toothpaste can remove tobacco stains, coffee stains, and other stains that we get as we go through our everyday lives.

Unfortunately, tooth whitening toothpastes can only return our teeth back to their original color. The toothpaste contains very gentle abrasives that rub against the stain and gradually remove it.

Why Teeth Whitening Toothpaste May Not Whiten Your Teeth

If you don’t drink coffee much or chew tobacco, there’s a good chance that your teeth aren’t stained at all.  In this case, if you use tooth whitening toothpaste, you probably won’t notice a difference in how white your teeth are.

Also, in the last ten years, it seems that all toothpastes are “teeth whitening”.  Chance are, you’ve already been brushing with “tooth whitening” toothpaste.  Continuing to brush with “tooth whitening” toothpaste isn’t going to make your teeth any whiter since you’ve already removed the stains with previous tubes of “teeth whitening” toothpaste.

How to Whiten Your Teeth

If you truly want whiter teeth, you will probably want to use a form of teeth bleaching.  Teeth bleaching is designed to whiten your teeth beyond their natural shade.

You should talk to your dentist about teeth whitening options such as in-office gels, Zoom teeth whitening, and take-home teeth whitening gels.

Have you been trying to get your teeth white with toothpaste?  Let us know in the comments.