If you have discolored teeth, the cause is often staining on the enamel surfaces from foods, beverages, or smoking. But tooth discoloration may also originate deep within the root of a tooth. Sometimes this happens to a tooth that had to have earlier root canal treatment because of injury or decay.

In such cases the living pulp tissue and its blood vessels and nerves had to be removed from the root canals, resulting in the death of the dentin layer, which makes up most of the tooth's body. Over time this caused the dentin to darken. The color may come from remains of blood that was left in the tissue, or from filling materials left in the root canal that are showing through.

Since these stains are caused internally (intrinsic) and not on the outside of the tooth (extrinsic) they must be whitened from the inside. This is usually done by putting a bleaching agent into the empty chamber from which the pulp was removed. Usually the bleaching agent is a substance called sodium perborate.

When it is mixed with a solution of hydrogen peroxide, sodium perborate slowly bleaches the color from the tooth's internal material. It is considered to be safe and reliable for this use.

The work begins by taking x-ray images to make sure that the root canal is correctly sealed and the bone is healthy. After this, we will make a small hole in the back of the tooth through which the root canal space will be cleaned. The root canal space will be sealed and the bleach will be applied in a putty-like form and sealed off from the rest of your mouth. Every few days this procedure will be repeated until the bleaching reaches the desired level.

At this point a tooth-colored composite resin will be used to seal the small hole that was made in the dentin to insert the bleach. After the tooth has reached the level of whiteness that matches it to your other teeth, veneers or crowns must sometimes be used to repair the surface if it is chipped or misshapen, for example.

Contact us today to schedule an appointment to discuss your questions about whitening internally discolored teeth. You can also learn more by reading the Dear Doctor magazine article “Whitening Traumatized Teeth.”

Until recently anyone who needed to repair cavities in his or her teeth ended up with a mouth full of “silver” fillings. Dental amalgam, which has a silver appearance, was the tooth restoration material of choice. Amalgam, a combination of metals including silver, mercury, and other metals, is still used — but today there are other options that mimic the original teeth they are restoring.

You may have read about some people's concerns about the mercury used in dental amalgam. According to the American Dental Association (ADA), scientific studies have found no ill effects arising from using dental amalgam in fillings for adults or children: “While questions have arisen about the safety of dental amalgam relating to its mercury content, the major US and international scientific and health bodies, including the National Institutes of Health, the US Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.” Dental amalgam is still used for molars (back teeth) that must withstand heavy pressure from chewing.

For teeth that are more visible, materials that look and perform more like the original teeth — and are thus more pleasing in appearance — are now available. Dentistry is now taking a “biomimetic approach” (from words meaning “life mimicking”). The new materials — composite resins and porcelains — look like teeth because in many ways their structure imitates the biologic structure of teeth.

Composite resins are made of a plastic material (methacrylate) combined with fillers made of silica, a form of glass. They are able to bond to natural tooth structure and resemble the dentin, the inner layer of the tooth, which has a porous structure similar to bone.

Dental porcelains are a form of ceramic. They are non-metallic materials formed by the action of heat, like the ceramics used in porcelain cups and bowls. They come in a powder form that is mixed with water, shaped, and then placed in an oven until they reach the proper hardness. The end product is translucent and very hard, resembling the densely packed crystals of calcium that make up a tooth's normal outer layer, the enamel.

The old amalgam fillings required removal of tooth material to prepare a site in which they could be placed. Composite resins and porcelains can be used to treat teeth that have small or large amounts of damage to their natural substance because the materials bond directly to the remaining dentin and enamel. Thus they end up stabilizing and strengthening the restored tooth, as well as providing a natural-looking appearance.

Contact us today to schedule an appointment to discuss your questions about tooth colored fillings. You can also learn more by reading the Dear Doctor magazine article “The Natural Beauty of Tooth Colored Fillings.”

If you believe you need a crown or if we have already confirmed this fact, you need to understand that there are several options. The most common are gold crowns, porcelain-fused-to-metal crowns and all porcelain crowns. Each has both pros and cons; thus we will work with you to determine which will work best for your specific needs. However, to help you learn more now, here are some facts.

Gold Crowns

Made from cast gold, this type of crown has been around for over 100 years and is the most successful type of crown. It can last more than 50 years and thus many dentists prefer gold restorations for their own teeth, where cosmetics is not a concern.

All Porcelain Crowns

All porcelain crowns can produce an incredible, life-like appearance. However, because they are made purely from dental porcelain (a type of glass), they tend to be more fragile than gold crowns and may be more at risk with certain high biting forces. Thus they may not be as durable. Porcelain can also cause wear to the natural teeth they bite against. Therefore they are typically preferred for front teeth, rather than back teeth. They have an aesthetic longevity of about 10 years and a functional longevity of about 20 years.

Porcelain-Fused-To-Metal Crowns

As the name states, porcelain-fused-to-metal (PFM) crowns provide the best of both worlds. They are made of natural tooth-colored dental porcelain that is fused on top of a precious or noble metal (usually gold or platinum). They are stronger than porcelain alone and are a good option for back teeth because they offer a better cosmetic result than gold crowns. This is also true for front teeth, however the gold support beneath the porcelain can compromise its life-like qualities. These crowns also have a proven track record and have been used with excellent results for over 40 years.

Learn more about crowns when you read, “Gold or Porcelain Crowns.” Or you can contact us today to discuss your questions or to schedule a consultation.

For adults with a reasonably well fitting bite, but mild to moderate crowding or spaces between your teeth, clear orthodontic aligners can be an ideal solution for straightening your teeth. This is why we offer this treatment option to our patients experiencing these issues. However, for those of you who are unfamiliar with what they are or how they work, this will give you a brief understanding.

Clear orthodontic aligners consist of a series of clear “trays” that fit snuggly over all teeth to slowly shift them into alignment. Patients are typically required to wear them 20 hours per day for about 2 weeks before progressing to the next tray. With each new tray, you are one step closer to achieving your goal of perfectly aligned teeth. The entire process usually lasts 6-18 months depending on how much movement is required to achieve the goals.

Each aligner is individually made from very precise molds of the patient's teeth to ensure proper fit. And we map out the entire alignment process using computer generation from each patient's initial molds so that we can identify the number of trays required. But best of all, clear orthodontic aligners are perfectly smooth with no rough edges like traditional braces, and you can remove them for eating, brushing, and flossing teeth as well as for brief social events.

To learn more about this topic, read the article “Clear Orthodontic Aligners.” Or you can contact us today to discuss your questions or to schedule an appointment.

What is composite resin bonding?
This term refers to a kind of tooth-colored material that is a mixture of a plastic resin and a glass filler. The glass gives the mixture, or composite, strength and translucency that is similar to a natural tooth. The composite is bonded to the tooth by slightly abrading or roughening the tooth so that the resin fills in small cuts in the tooth surface and bonds with it. The end result functions and looks like part of the original tooth.

What is bonding used for?
This technique is a good way to restore chipped or stained teeth or to change a tooth's shape or color. It can also be used to restore parts of a tooth near the gum line where the gums have receded and left the root partially exposed.

What are the advantages of bonding?
Composite resin tooth restorations have several advantages.

• They take only a single dental visit because they are done right in the dental chair rather than having to be sent to a dental lab for preparation.
• They are less expensive than many other dental restorations.
• They leave most of the original tooth intact since little tooth preparation or drilling has to be done in order to make the composite material bond to the tooth.
• They can be made in a wide range of colors and can be matched well with the teeth around them.
• Because little of the original tooth has to be removed, they are a good choice for teens, whose dental arches (upper and lower jaws) are still developing.

What are the disadvantages of bonding?
The composite resin material is not as strong as the original tooth material, so the bonded restorations may not last over a long time. If it does last, the material may also stain as it ages.

When should you choose bonding?
Composite resin bonding is a good choice for a quick and attractive tooth restoration that may be replaced later by something more permanent, such as porcelain veneers.

Contact us today to schedule an appointment to discuss your questions about bonding. You can also learn more by reading the Dear Doctor magazine article “Repairing Chipped Teeth.”