Fluoride is the dental marvel of our lifetime and a definite benefit to the oral health of our nation. But too much of a good thing can cause problems! Fluorosis of the teeth and mottled enamel can occur when there is too much fluoride uptake by the teeth while the teeth are forming. Prescription fluoride vitamins of the proper dosage are normally given to children. But a child can get too much fluoride if it’s available from multiple sources. Children with access to a public water system containing fluoride may also be prescribed fluoride supplements or they may swallow fluoride-containing toothpastes, mouthrinses, or certain fruit drinks, which may increase their fluoride intake above recommended levels. Fluorosis is a condition in which teeth form with unsightly dark spots on them. Some medications and illnesses can also cause a similar problem. These dark spots, most often seen on the permanent teeth, are not more prone to decay, just unattractive. One, several, or all of the teeth can be affected. The color change (usually brown/ orange or flat/opaque white) can be mild, moderate, or severe.
Generally speaking, three solutions are possible. Sometimes the stain is very superficial and can be merely polished off. It does not return. There is no pain involved in this procedure. The enamel is simply polished and made smooth again.
Many times it is quite easy to whiten the brown spots to match the surrounding tooth color. This is most often an in-office procedure (as opposed to whitening yellow teeth, which can be done at home with custom-made tooth-whitening trays). Strong whitening chemicals are placed on the dark area and activated by light or heat or both. Several applications (in the same visit) are done, and the spot usually disappears in one visit!
If the spot is very dark or goes deep into the enamel, the whitening may work, but not enough to remove the total discoloration. In this instance, a combination of whitening and a bonded composite tooth-colored restoration will solve the problem. The tooth is whitened, and then the remaining dark area is prepared (drilled) to receive a bonded-type filling. The natural color of the tooth is matched and a resin is bonded into the prepared section. The color match can be nearly perfect, and patients see a big improvement over what was there before.
White spots on teeth can also be caused by too much fluoride, illness, medication, or an interruption of the proper enamel formation. The spots may be barely visible, or they may contrast with the surrounding tooth. If the teeth dry out, as in the case of a patient who routinely breathes through his or her mouth, the white spots become quite prominent. Most of the time, these spots can be simply polished off. If they go too deep into the tooth, however, they must be restored with tooth preparation and bonding of a tooth-colored material. Once removed, they do not return. White spots affect the permanent teeth more than baby teeth. While they cannot be bleached out, as can fluorosis discolorations, whitening of all the teeth may make them less noticeable.
When the permanent teeth are forming in a young child’s jaw (before they come through the gum tissue and can be seen), they can be positively affected by controlled systemic fluorides (made stronger and more resistant to dental decay). They can be adversely affected by high fevers, malnutrition, and prescription medications, most notably, the antibiotics in the tetracycline class. Tetracyclines are given to children who have shown a reaction to penicillin or who have a medical problem that can be treated best with the tetracyclines.
Depending on the age of the patient, the stage of development of the permanent teeth, and the type and dosage of the medication, the change in the tooth color (both dentin and enamel) can be slight, moderate, or quite disfiguring. The color of the teeth can change from the normal homogeneous yellow/white to light or dark gray, brown, yellow, or even purple/blue. Most often, the color is not uniform throughout the tooth. There may be horizontal bands or stripes of color that are visible. If you have ever seen a photograph of the planet Jupiter, with the brightly colored horizontal bands that mark the different wind zones, it would be similar to the tetracycline bands and colors seen on the permanent teeth.
The color change due to tetracycline staining is not a superficial or surface problem. The dentin (the layer of tooth underlying enamel) is usually darker than the enamel and gives the tooth its color. Brushing harder or using a whitening toothpaste will not improve the color. Today the appearance of discolored teeth can be improved through tooth whitening, bonded porcelain or ceramic veneers, resin veneers, or full crowns.
What is right for you depends on the amount and type of discoloration, the speed with which you want them improved, and your finances. For mild to moderate discolorations, a whitening process can significantly improve the appearance of the teeth. A combination of in-office and at-home whitening works well. In the in-office “power” whitening process, a solution is applied to your teeth. The solution is activated by light energy and allowed to remain on each tooth to be whitened for several minutes. If we believe it is appropriate for you and you will need even more whitening, we may suggest that you continue the whitening process at home with a mouthguard whitening technique. In this technique, special mouthguard-like trays are custom fabricated to fit your teeth. You will be given a whitening solution to place in the trays and wear nightly until the desired color change occurs. The time required to achieve the desired effect depends on the degree of discoloration. Usually the at-home whitening procedure will need to be done nightly for 6 months at least to be effective. This is the least invasive and least costly method for improving the tooth color.
Custom porcelain veneers require preparation of the tooth and processing by a dental laboratory. Veneers are much quicker but more costly and maintenance requirements are more involved. Veneers can be expected to last 8 to 15 years, perhaps longer. Direct resin veneers are placed onto the teeth in one visit. They are less expensive than laboratory-processed veneers. Direct resin veneers can look almost as nice as laboratory-processed resin but are not as natural looking as porcelain. They will last about 5 years before needing replacement or touch up. If you are considering veneers, we may still recommend some degree of tooth whitening before they are made because the darker the teeth are, the harder it is to opaque or mask out the underlying color, which is the point of placing the veneers in the first place. The veneer that can transmit some underlying tooth color tends to look better than a fully opaque veneer. Alternatively, more tooth preparation can be made to permit an opaque layer to be covered by thicker esthetic porcelain. Each case is different, but an improved appearance is possible. In the case of the darkest discolorations, the only effective cosmetic solution may be full-coverage crowns.
If you have any questions about treating discolored teeth, please call to schedule a free consultation at a location convenient for you.