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Rubber Dam

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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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Rubber Dental Dam Advantages
©Hightowernrw/Shutterstock.com

Have you ever gone to the dentist and had them put a big rubber blanket over your mouth?

In 1864 (nearly 150 years ago), a New York City dentist by the name of S.C. Barnum invented the rubber dam for use in dentistry.  He was looking for an easy way to isolate the particular teeth that he wanted to work on during procedures.

The rubber dam is simply a thin sheet of rubber that is clamped around the tooth or teeth that will be worked on.  There are many advantages to using a rubber dam, some of which are listed below.

9 Advantages of Dental Rubber Dams

Pink Rubber Dental Dam1 – The dentist is better able to visualize the tooth or teeth that he is repairing.  By providing a contrasting background, the rubber dam makes the tooth easier to visualize.  If the dentist can see better, chances are you’ll get a better filling.

2 – It helps keep the tooth dry.  Amalgam fillings aren’t as good if they are used in a wet tooth.  Bonding composite fillings to the tooth also doesn’t work very well if it is wet.  So rubber dams lend to the success of such procedures by keeping teeth dry.

3 – It protects the patient in several ways:

  • It prevents the patient from breathing in the debris associated with drilling teeth.
  • It protects the patient from irritating chemicals used in dentistry such as those used to disinfect a root canal or the acids used to etch teeth to prepare them to be filled with a composite resin filling
  • It protects the patient’s tongue and cheek from the dental drill

4 – It helps isolate the tooth from the bacteria in the mouth – this is especially important in a root canal treatment and when restoring very large cavities that are close to the pulp.  It is important to keep the pulp shielded away from the many bacteria that live in your mouth.

Green Rubber Dental Dam - Photo Courtesy of Produnis

5 – It can shorten the duration of a procedure. When using a rubber dam, there isn’t a tongue constantly in the way and it is easier for the dentist to drill with no other distractions in the mouth visible.  This increases the dentist’s efficiency, which means you can leave the dental office sooner!

An interesting side effect of rubber dam is that they discourage the patient from talking.  If the dentist wants to get a rubber dam on you as soon as you walk into the office, it could be a sign that you’re pretty talkative!

6 – It can calm down a patient. With the rubber dam on, it may not feel like the dentist is really inside your mouth.  It kind of adds a layer of separation between your body and the dentist.  This is helpful for patients who become anxious during procedures.

7  – It can help in the administration of nitrous oxide (this is especially true with children ) since it forces the patient to primarily breathe through their nose.

8 – It protects the dentist and dental assistants from any diseases that the patient may have. Did you know that if a dentist drills on one of your teeth for 30 seconds, the dentist is exposed to as much bacteria as he or she would be if you sneezed right in their face?  Here’s the source for that fact. For more on how dental dams prevent the spread of infection from the dental patient to others, here’s a study, another one, and yet another one.

Rubber Dental Dam Isolating Six Front Teeth

9 – Rubber dams give you a higher quality tooth restorationA study by Dr. Gordon Christsenen concluded that rubber dams allow the dentist to perform better, thus creating a higher-quality restored tooth in the end.

Why Some Dentists Don’t Use Rubber Dams

Rubber Dental Dam Clamps
Rubber dam clamps that can be used to anchor the dam around various teeth.

Some dentists think that rubber dams take too much time to place or that the patients dislike them.  To be honest, it does take some time to put a rubber dam on a patient.  You have to punch a few holes in the rubber dam for each tooth and put a clamp around the tooth to stabilize the dam.  To make sure that the clamp doesn’t fall down the patient’s throat when you put it in, you have to wrap floss around it.  Finally, you have to stretch the rubber dam around the clamp and floss it between all of the teeth that you want to be visible through the rubber dam.

At my dental school, they usually require us to put a rubber dam on our patients when we are doing fillings.  After doing this so often, it has become easy to put a rubber dam on a patient.  Plus, there is usually a period of a few minutes that the dentist has to wait for the anesthesia to begin working.  Those few minutes are the perfect opportunity to put a rubber dam on, and as I mentioned above, using a rubber dam can shorten the duration of a procedure overall.

Do You Like Rubber Dams?

Have you ever had a rubber dam?  Was it a good experience?  Some patients I’ve talked to say they like it, and others find it uncomfortable.

If you have any questions or comments about rubber dams, please leave them below in the comments section.