Do your teeth stain easily? Are you worried that your new white fillings won't remain white for very long? Staining generally falls into one of two categories — extrinsic (external) staining, which affects the outside of the teeth, and intrinsic (internal) staining, which is discoloration of the tooth structure itself. The good news is that both can be treated and, once we determine the exact cause, there are a number of options to remedy it. You can have whiter teeth in almost no time!

External staining is generally caused by beverages or foods like red wine, tea, coffee and some spices, or even substances like tobacco. Stain that is brown, black or gray can become even worse in the presence of dental bacterial plaque and when the mouth is dry. On the other hand, internal tooth staining can make the teeth appear more yellow as a natural result of aging, or after root canal treatment when tooth structure can become more brittle and dry.

Treatment for external (extrinsic) staining includes:

• Lifestyle modification: You can help put a stop to your staining problem by reducing or eliminating the habits that cause it, such as smoking and drinking red wine.
• Practicing efficient oral hygiene: Preventing extrinsic staining can be as simple as brushing twice a day with toothpaste that contains tooth-whitening agents or other solutions to reduce the appearance of stains. Don't be embarrassed to ask our office about brushing and flossing because most people do it wrong until they're properly instructed.
• Professional Cleaning: We can remove some extrinsic staining with ultrasonic cleaning followed by polishing with an abrasive prophylactic paste.

Other treatment options to reverse either intrinsic or extrinsic staining include:

• Whitening by bleaching: Bleaching for extrinsic stains can be performed either in our office or at your home using a whitening kit. Bleaching for internal (intrinsic) stains can only be conducted in our dental office because it typically involves bleaching the tooth or teeth from the inside.
• Fillings and restorations: For teeth that have been stained due to decay, or for fillings that are old and discolored we can remove the decay and restore the teeth, which will restore them to their natural brighter color.

If you are ready to say goodbye to your stained teeth, call our office today to make an appointment. For more information about treating stained teeth, read the Dear Doctor magazine article “Tooth Staining: Getting To The Cause Of Tooth Discoloration Is The First Step Toward Successful Treatment.”

Dental professionals sometimes use specialized words, and you may not be clear about exactly what we mean. Test yourself on some of the specialized vocabulary concerning tooth whitening. How many of the following can you define correctly?

1. Bleaching?
A method of making yellow, discolored teeth whiter. It is relatively inexpensive and safe, with few side effects.

2. External or extrinsic staining and whitening?
Extrinsic staining mainly results from diet and smoking. For example, foods such as red wine, coffee and tea can produce extrinsic stain. Teeth with these stains are bleached by placing whitening substance in direct contact with the living tooth surface.

3. Internal or intrinsic staining and whitening?
Intrinsic tooth discoloration is caused by changes in the structure of enamel, dentin, or pulp tissue deep within the root of the tooth. When the discoloration originates with the pulp tissue, root canal treatment may be needed to whiten the tooth from the inside.

4. Chromogenic material?
Color generating material that may get incorporated into the tooth's substance. It can be a result of wear and aging, or can be caused by inflammation within the tooth's pulp.

5. Carbamide Peroxide?
A bleaching agent discovered in the 1960s and frequently used for tooth whitening. When used, carbamide peroxide breaks into its component parts, hydrogen peroxide and urea, which bleach the colored organic molecules that have been incorporated between the crystals of the tooth's enamel.

6. Power Bleaching?
This technique is used for severely stained tooth. It uses a highly concentrated peroxide (35 to 45 percent) solution placed directly on the teeth, often activated by a heat or light source. This must be done in our office.

7. Tetracycline?
An antibiotic used to fight bacterial infections. It can result in tooth staining when taken by children whose teeth are still developing.

8. Rubber Dam?
Use of strong bleaching solutions requires protection for the gums and other sensitive tissues in your mouth. This is done using a rubber dam, a barrier to prevent the material from reaching your gums and the skin inside your mouth. Silicone and protective gels may also be used.

9. Whitening Strips?
Strips resembling band-aids that you can use in your home to whiten your teeth. They generally contain a solution of 10 percent or less carbamide peroxide gel. When using them, be sure to read the directions and follow them strictly to avoid injury or irritation.

10. Fade Rate?
The effects of bleaching may fade over time, from six months to two years. This is called the fade rate. It can be slowed down by avoiding habits such as smoking, along with food or drink that causes tooth staining.

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

Teeth whitening is a great way to improve your smile. For best results and to ensure your safety, teeth should be bleached under professional supervision. We can help you choose the whitening method that's right for you, and monitor the effects of your treatment. Here are some answers to frequently asked questions about this relatively inexpensive cosmetic procedure:

Is teeth whitening safe?
A lot of research has been done on teeth whitening, so we know that specific bleaching formulas, from a reputable source, are safe if used as directed and after a proper dental examination. You should be aware that tooth sensitivity is a common side effect of bleaching, but brushing with a desensitizing toothpaste containing potassium nitrate for two weeks prior to bleaching can reduce sensitivity. Using potassium nitrate during the bleaching process can also help.

Is it effective?
Professional bleaching is very effective. Peroxide goes through tooth enamel (the outermost layer) and the dentin (middle layer) to the pulp (the innermost layer) in 5 to 15 minutes. The bleach actually changes the color of the enamel and dentin, and removes stains.

How is teeth whitening done?
Basically there are three options: in-office whitening (done by a dentist), at-home bleaching with custom-made flexible plastic trays (with prescription bleach), and over-the-counter (OTC) products. Not all OTC products are equal, and the results will take longer to achieve than with professionally supervised procedures.

How long does it take?
That depends on what method you choose and, in the case of at-home whitening, how conscientious you are about following through with your course of treatment. One study found that a six-shade change required either: three in-office applications of 38% hydrogen peroxide; one week of 10% carbamide peroxide used at home nightly in a custom-made tray; or 16 daily application of 5.3% hydrogen peroxide on a whitening strip.

Will it last?
It really depends on the individual. No bleaching method can whiten teeth permanently, though some people's teeth remain white for over 10 years with no touch-up treatment. More typical results vary from six months to two years. Keeping up with your regular oral hygiene routine at home and your professional cleanings at the dentist's office will help maintain the results; so will avoiding tobacco and beverages that stain, such as red wine, tea and coffee. You can also consider a bleaching touch-up once or twice a year at home or here at the dental office.

I want to go for it! What's the first step?
Step one is a pre-bleaching dental examination to determine the cause of your tooth discoloration. We want to make sure that your discoloration is not the result of an oral health-related problem. For example bleaching will mask but not resolve issues such as abscessed teeth, decay, and root canal problems. We want your teeth not only to be beautiful, but healthy, too!

If you are interested in learning more about teeth whitening, please contact us today to schedule an appointment for a consultation. For more information on teeth whitening, please see the Dear Doctor magazine articles “Important Teeth Whitening Questions Answered” and “Tooth Whitening Safety Tips.”

When you have your teeth bleached in a dental office, the results almost seem like magic. Let's push aside the magician's cape and see what is really happening in professionally-applied, in-office tooth whitening.

How do teeth become discolored?
A tooth's enamel covering is mostly composed of mineral crystals. At a microscopic level, you can see a framework or matrix of organic (living) matter interspersed between the crystals of enamel creating a very irregular surface capable of retaining stains. Chromagenic (color generating) organic compounds can become part of this organic matrix resulting in tooth staining. They can be bleached without affecting the mineral structure of the tooth's enamel.

As people get older and their teeth wear, the enamel loses its youthful translucency and the underlying layer, called dentin, thickens and becomes more yellow. Such changes to the actual tooth structure are called intrinsic staining. Other causes of intrinsic discoloration are exposure to high levels of fluoride or tetracycline antibiotic administration during childhood, tooth decay, or root canal problems, among others. Discoloration can also be caused by external staining from certain foods, drinks, or tobacco products. Such surface stains are called extrinsic staining.

Behind the Magic
Materials used for tooth bleaching are hydrogen peroxide and carbamide peroxide. Peroxides are commonly used as bleach, and you may have seen them used as hair bleaches, for example. Hydrogen peroxide is a strong oxidizing agent that attacks the organic molecules responsible for tooth discoloration, bleaching them until they lose their color. Carbamide peroxide also contains urea, which is a compound that permits the peroxide to remain in contact with the teeth for longer amounts of time without harming them.

Often called power bleaching, the in-office technique uses a high concentration of peroxide solution (35-45% hydrogen peroxide), placed directly on the teeth in the form of a gel. A heat or light source may enhance the peroxide release. The gel is applied with trays custom fitted to your mouth, and specific barriers are applied to protect sensitive gum tissue from the solution. Results show teeth becoming up to ten shades lighter in about an hour.

In-office bleaching under the supervision of my staff and me is recommended if you have severely stained teeth, and particularly if you are about to have veneers or crowns made. It's a way to rediscover the pearly translucency of your youthful smile.

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

Your smile is one of the first things people notice, but if your pearly whites have lost their luster, chances are you might be hesitant to show them. As we age, our teeth naturally darken, and certain substances can leave teeth stained or discolored, making you appear older. One easy way to turn back the clock is to have your teeth whitened; a safe, painless, and non-invasive way of achieving a young, healthy-looking smile.

Causes of Tooth Discoloration: Exposure to high-levels of fluoride and taking tetracycline antibiotics during childhood can stain the teeth's structure. Smoking cigarettes and using chewing tobacco can also cause tooth discoloration, as well as foods containing tannins such as red wine, coffee and tea. In addition, poor brushing techniques and not flossing regularly cause bacteria to build on teeth resulting in yellow stains.

The Whitening Process: Our office can help you to achieve a brighter smile using either an in-office procedure or an at-home whitening kit. We can help determine the best treatment for your budget, time frame and individual needs. If you choose to have professional whitening done in our office, we will utilize a prescription strength gel sometimes even activated by a concentrated light source. This procedure offers immediate and long-lasting results in less than an hour. After a single treatment, teeth are typically six to ten shades lighter and with proper maintenance, can last five years or longer.

At-Home Results: For those seeking more gradual results, another option is to use custom-fit trays, which our office will make for you to use at home to whiten your teeth. This is generally less expensive, and is very effective at lightening teeth several shades, although it may take a week or longer to see optimal results.

Choosing the Best Procedure: For some people, teeth whitening may not offer adequate results. If you have thin enamel, chipped, uneven or crooked teeth, we may recommend applying porcelain veneers to restore your damaged teeth. Veneers are bonded to the front of teeth to give your smile a straighter, more uniform appearance.

Contact us today to schedule an appointment to discuss any questions you may have regarding teeth whitening. Read more about this topic in the Dear Doctor magazine article “Teeth Whitening: Brighter, Lighter, Whiter.”