While traditional dentistry focuses on oral hygiene and preventing, diagnosing and treating oral disease, cosmetic dentistry focuses on improving the appearance of the teeth, mouth and smile. In other words restorative, general and/or family dental practices address dental problems that require necessary treatment, whereas cosmetic dentistry provides elective – or desired – treatments or services.
Cosmetic treatments may also provide restorative benefits. For example, dental fillings are a common procedure used to treat decayed teeth. Previously, most dental fillings were composed primarily of gold, amalgam and other materials that left visible dark spots on the teeth.
Today’s dental fillings may be considered cosmetic to a certain extent because you can select fillings made of porcelain or composite materials that closely match the color of your teeth, thus maintaining the natural appearance of your teeth and smile. Many people may choose to have their older fillings replaced with newer, tooth-colored fillings to enhance their oral appearance.
Technological advancements in natural-looking, tooth-colored dental materials make today’s cosmetic dental treatments more durable and predictable than in years past. Additionally, dentists are now using more conservative techniques to preserve as much of your natural tooth structure as possible, depending upon your specific clinical situation.
Dentists may also use such technologies as lasers in order to perform some procedures necessary for cosmetic treatments in their own offices – without the need for referrals to specialists. This makes procedures such as smile makeovers more comfortable and convenient for patients, as well as helps to reduce recovery time.
Finding the Right Cosmetic Dentist
Finding a qualified cosmetic dentist requires careful consideration. Although there technically is no recognized cosmetic dentist specialty, there is an increasing number of dentists offering cosmetic treatments. Combine this with the wide variety of procedures to choose from and the possible need for inter-disciplinary care beforehand, your choices can be staggering.
There is no referral system in place or third party insurance administrator involvement to assist with the selection of a cosmetic dentist. So what you should know in making your selection?
Obtaining Referrals: What to Know
Your general/family dentist’s recommendation is a primary consideration. If you have been receiving regular check ups, your general dentist has a picture of the current status and condition of your mouth.
If your dentist finds that your teeth, gums, supporting bone structure and occlusion (bite) is in need of further evaluation prior to cosmetic treatment, he/she may refer you to a periodontist, prosthodontist, endodontist, orthodontist or oral maxillofacial surgeon. The condition of your teeth, gums, supporting bone structure and occlusion has an impact on the longevity of any dental procedure. You may require additional care for these conditions before cosmetic treatment begins. In some cases a full mouth reconstruction may be part of your procedure plan.
Ask your friends, neighbors, and business colleagues who have undergone a smile makeover whom they would recommend.
Narrowing Your Choices
It is important to do your homework and investigate the level of cosmetic dentistry experience for each dentist you consider before setting up a consultation. You may want to ask if the dentist is skilled in providing full mouth reconstruction, or if he/she refers patients to another specialist if such treatments are needed. You may also want to ask if he/she is a member of the American Academy of Cosmetic Dentistry, which requires adherence to rigorous study, ethical standards and examination to qualify as an accredited member.
Other criteria for narrowing your choices include:
How long has the dentist been practicing?
Are the results shown in before and after photos of previous patients to your liking? Are the photos of actual patients that the dentist has treated?
How extensive is the practice? Does he/she offer study models, imaging technology and/or bonding previews when recommending and demonstrating procedure options?
What dental technologies (lasers, caries detection devices, CAD/CAM restoration, intra oral imaging, etc.) are used in the practice that may help serve your needs?
What patient comforts are provided through the practice – such as headphones that provide calming music, comfort chairs, spa services or sedation dentistry – that will make the treatment process a more relaxing and anxiety-free experience?
Emergencies are unlikely, but do find out what provisions the practice offers. Is the emergency service provided by the dentist or a staff member? Is communication over the phone or in person?
What to Expect at Your Consultation
Your initial consultation is an opportunity for you to learn about the practice that you’ve narrowed down your search to, as well as discuss what you like and don’t like about your smile. It’s also an opportunity to establish realistic expectations for your treatment.
Cosmetic consultations typically include records gathering. Because these records are important for developing a unique and precise treatment plan that will satisfy your needs, a significant amount of time may be spent for this purpose. Records gathering involves, but is not limited to:
tooth-shaped hanging dentist sign
A comprehensive intraoral examination and inspection of any existing dental work.
Impressions of your upper and lower teeth (models and study casts will be made later).
Looking through smile design books that show an assortment of before and after photographs of different procedures.
Reviewing different tooth shapes and sizes to see what appeals to you.
Discussing tooth color
Using a computer monitor, reviewing your smile tooth by tooth so you can thoroughly understand what can be changed and how.
Your consultation may also include a meeting with a patient coordinator. The patient coordinator’s role is to help you with scheduling appointments and follow-up care.
You may also meet with the practice’s office manager to discuss the types of financing or payment options available to help you manage the cost of your treatment – dental insurance does not typically provide coverage for cosmetic treatment as it is elective. If not, remember to ask about what the financing options are. While payment plans are available through a number of dental loan providers, your dentist may offer in-house payment options as well.
Considerations for the Consultation
During your consultation, make note of how you feel about the practice’s ambiance. Specifically, are you comfortable with the dentist’s chair-side manner? Is the staff friendly, welcoming and quick to address your concerns? Since treatment can take time, it is important to establish a rapport with all individuals involved.
If the dentist provides you with a diagnosis and treatment plan during the consultation, it is important that he or she share that information with you in detail. Make sure that you understand your diagnosis and any viable treatment alternatives. Make sure that you feel completely comfortable with the level of detail and thoroughness of the explanations you are given so that you can make an educated decision about your treatment plan.
Likewise, when providing you with a treatment plan, your dentist should be able to tell you about the type of materials that will be used in the fabrication of your restorations. Be sure to ask about how long the results are expected to last and the type of maintenance required in order to sustain the benefit of the procedures. For example, teeth whitening must be repeated every three to six months – depending upon the procedure you choose – in order to maintain the benefits. Similarly, you may be required to wear a protective mouth guard at night to help maintain your veneers.
Since most procedures include restorations made in a dental laboratory, ask about the dental laboratory technician your dentist plans to involve in your treatment. Is the laboratory technician or ceramist a Certified Dental Technician or an accredited member of the AACD? Has the dentist worked with this laboratory technician for many years and/or on similar cases in the past?
When you select a cosmetic dentist, you are selecting a dental professional who will help you change your appearance by changing the look of your teeth and your smile. It is a very personal and important choice. Most procedures are not reversible, so you will want to take your time, ensure that you feel comfortable with the dentist, and that you feel confident with his/her skills and capabilities. When you do, you will likely be happy and completely satisfied with the results that are achieved with the treatment you receive.
If your teeth are stained, discolored, worn, chipped, broken, misaligned, misshapen, or have gaps between them, modern cosmetic dentistry can give you a better smile. A “smile makeover” improves the appearance of your smile through one or more cosmetic dentistry procedures. Cosmetic dentists work with you to develop a treatment plan. Below you’ll find some information that can help you learn more about the various types of cosmetic dental procedures available.
Types of Cosmetic Dentistry
Teeth whitening can be one of the simplest and least expensive ways to improve your smile. Teeth can be bleached with in-office products in your dentist’s office for about $500, or you can buy a mold and gels from your dentist to bleach your teeth at home. There are also whitening products available over the counter at retail stores for convenient at-home whitening: whitening toothpastes, rinses, and whitestrips. These products together run about $3 – $50.
Dental veneers are wafer-thin, custom-made shells of tooth-colored porcelain or resin that cover the front surface of the teeth. After removing about a half-millimeter of enamel from the tooth surface, these thin shells are bonded (cemented) to the front of the teeth, changing their color, shape, size, or length. Veneers are often called “Hollywood teeth.” Living up to that name, this process can cost up to $500-$1,300 per tooth.
In dental bonding, a tooth-colored, putty-like resin, which is a durable plastic material, is applied to the tooth and hardened with an ultraviolet or laser light, bonding the material to the tooth. Your dentist then trims, shapes, and polishes it. Bonding can repair decayed, chipped, cracked, or misshapen teeth; it is also a good cosmetic alternative to, or replacement for, amalgam or silver fillings. Bonding takes about 30 to 60 minutes, and $100 to $400, per tooth.
A dental crown, also called a cap, fits over and replaces the entire decayed or damaged tooth above the gum line, restoring its shape, size, strength, and appearance. Crowns keep a weak tooth from breaking or hold a cracked tooth together; they can be used cosmetically to cover misshapen or severely discolored teeth. Crowns can be made from metal, porcelain-fused-to-metal, resin, or ceramic, and cost about $500 to $900 each.
Inlays and Onlays
Inlays and onlays, also called indirect fillings, are made from gold, porcelain, or composite materials and fill decayed or damaged teeth. Dental fillings are molded into place during an office visit; however, inlays and onlays are created in a dental laboratory and bonded into place by your dentist. The filling is called an “inlay” when the material is bonded within the center of a tooth; it is called an “onlay” when the filling includes one or more points of the tooth or covers the biting surface. Inlays and onlays preserve as much healthy tooth as possible and are an alternative to crowns. This cosmetic dentistry procedure costs about $650 to $1,200 per tooth.
Dental implants are titanium replacement tooth roots inserted into the bone socket of the missing tooth. As the jawbone heals, it grows around the implanted metal post, anchoring it securely in the jaw and providing a foundation for a replacement tooth. This procedure can cost anywhere from $1,250 to $3,000.
A bridge is made of crowns for the teeth on either side of a gap with false teeth in between. A denture is a removable replacement for missing teeth. Dental braces can straighten crooked or misaligned teeth and works by applying continuous pressure over a period of time to slowly move teeth in a specific direction.
Anatomy of a Smile
A bright, attractive smile creates a winning first impression. Without saying a word, your smile can convey a confident, optimistic and friendly personality. An esthetically pleasing smile is an attractive quality that lures people to you, making them respond positively.
Aside from the physical effects of your smile, it also can have major psychological and emotional influences on your personality. If you are self-conscious and unhappy about your smile, it can seriously affect how others perceive you, making you appear timid, hesitant, withdrawn, sad and/or angry. You may feel unattractive, inadequate and insecure.
Fortunately, advances in cosmetic dentistry allow a growing number of people to benefit from smile makeovers capable of transforming their dental characteristics to produce dramatic results with positive influences on their lives.
Smile Design Principles
The principles involved in a smile makeover are known as smile design. Combined, they influence the overall esthetic impact of an individual’s smile. The principles of smile design are divided into four parts:
Facial Esthetics: Facial and muscular considerations vary from patient to patient and are studied through visual and photographic analysis. They include how the lips frame your smile when you speak, smile or laugh.
Gingival (Gum) Esthetics: The health and appearance of your gums are essential elements in smile design. Excessive gingival display (gummy smile), uneven gum contours, inflammation and exposed root surfaces are common gingival-based esthetic complaints that detract from your smile’s appeal.
Microesthetics: This involves the subtle characteristics that make your teeth look the way they do, such as how they reflect light and unique marks or colorations. The ideal restoration is one with qualities closely resembling those of natural teeth. The anatomy of natural teeth is unique from person-to-person and specific to each tooth.
Macroesthetics: This analyzes the relationships and proportions between front teeth, surrounding tissue landmarks and facial characteristics, in order to ensure natural and attractive restorative care and smile makeover treatment. Working in collaboration, your cosmetic dentist and dental laboratory technician combine their technical and artistic abilities to create a natural and esthetically pleasing appearance in which the shapes, sizes and arrangement of individual teeth blend with and complement your particular features.
Components of a Smile
Smile esthetics involve applying certain rules, tools and strategies to the assessment of teeth and gum conditions in order for your dentist to decide on cosmetic and restorative procedures to correct and/or enhance your appearance.
Some key components of a “pleasing” smile include:
The lips have been compared to a frame that sets off the image of your smile, encompassing your teeth and gums. Enhancing or correcting the shape, fullness and symmetry of your lips can make your smile seem fuller.
For optimal esthetics, your facial features should line up to your teeth and lip lines. When your lips form a broad smile, an imaginary line can be drawn through the corners of the mouth, from one side to the other. The amount of upper front (maxillary anterior) tooth revealed below this line helps create a vibrant, youthful image. In a youthful smile, the upper front teeth should fill between 75 to 100 percent of the space between your upper and lower lips in a full smile.
The starting point of any smile design is the facial midline, an imaginary vertical line drawn between the front two upper teeth. For optimal esthetic value, the facial midline should be in the middle of the face.
Prominent facial features – such as the eyes, nose and chin – can be misleading when locating the midline. For instance, your eyes may be at slightly different levels, or your nose may be off-center, lessening their usefulness when trying to find the midline. A more accurate approach to determining the facial midline focuses on two facial landmarks: a point between the eyebrows and the Cupid’s bow in the center of the upper lip. By drawing a line between these landmarks, dentists can locate the position of the facial midline while also determining the midline’s direction.
Whenever possible, the midline between the upper front teeth (central incisors) should coincide with the facial midline. In cases where this is not possible, the midline between the central incisors should be perpendicular to the imaginary line that could be drawn through the corners of the mouth.
Your smile line is the line created by the top of your lower lip. In an ideal smile line, the edges of your upper teeth should be parallel to your lower lip when you smile. The bottom of your lower lip should have the same line as the gums of your lower jaw. This should always be a standard, regardless of the size or shape of your smile. Once your dentist has determined the orientation of your smile line, he or she can design its curve, or shape, and determine the length of your new restorations.
Attractive smiles have various things in common, such as teeth that are white, unstained, straight, evenly spaced with no gaps between them and not crowded or overlapping.
When you smile, your top teeth show fully in a good proportion to your gums. The line where the gums and teeth meet is smooth and even. The smile line of the upper teeth follows the curve of the lower lip. The midline of the upper front teeth ideally is in the center of the face. “Tooth reveal” is a term that describes the amount of tooth structure that shows during different views and lip positions.
Other significant considerations for teeth that influence a person’s smile include:
Incisal (Biting) Embrasures: The spaces between the edges of the teeth (embrasure spaces) follow a pattern that develops between the central incisors and then progress sideways. These silhouette patterns, created by the edges and separations between the upper front teeth against the darker background of the mouth, help accentuate an attractive smile. The size and volume of the incisal embrasures between teeth increase as the teeth move away from the midline.
Color: Typically, the upper central incisors are the lightest and brightest teeth in your smile. The upper side teeth are similar in color (hue) to that of the central incisors, but generally slightly lower in brightness (value). The canines (third teeth from midline) have greater intensity or saturation of color (chroma). First and second premolars (teeth behind canines), which are lighter and brighter than the canines, are similar in color to that of the lateral incisors.
When evaluating the color of your teeth, your dentist examines how closely matched your upper and lower teeth appear. Both sets of teeth should look similar and complement your hair, skin and eye color. For best results, color/shade reproduction in anterior restorative and cosmetic treatment should come close to natural esthetics, rather than merely opting for the lightest, brightest shades. Shade guides are used to evaluate optimal color prior to teeth whitening.
Tooth Proportion: Most people perceive a pleasing smile as one in which the two central front teeth are dominant and have a width-to-length ratio of 75 to 80 percent. This proportion guides the length and width of other teeth in the esthetic zone (the section of upper and lower teeth that show when you smile), making your smile appear balanced or symmetrical.
Long teeth equate to a younger-looking smile. Over the years, normal wear and tear has a shortening or aging effect on your teeth and overall appearance. Teeth length also may play a role in facial contouring. For instance, long, square-shaped teeth on a plump, round face creates a slimming effect.
Tooth Texture and Characterization: Cosmetic dentists can use their artistic skill and clinical experience to characterize restorations to create a more feminine (meaning, smaller, smoother, oval- or round-shaped) or masculine (meaning, larger, square-shaped, blunt) appearance. Apart from matching or enhancing the look, feel and function of your natural teeth, cosmetic dentists also can correct imperfections, such as chips or cracks.
Teeth Angulation: Your teeth should have a symmetrical appearance in the front and a balanced appearance in the back. Teeth should not jut out too much or be set too far in; they should not be crooked, overgrown or uneven. When the upper front teeth tip toward the midline, the overall esthetic effect is a harmonious one in relation to the lower lip and, more importantly, to the midline.
Proper occlusion: the relationship between your upper (maxillary) and lower (mandibular) teeth when they come into contact when you bite, chew or bring your jaws together – is critical. In addition to affecting your looks, the way your teeth’s chewing surfaces come together also impacts your other teeth, gums, neck and head, jaw muscles and joints and your overall oral health.
Incisal Edge Position
The incisal edge position – how far down/long the top two middle teeth are – sets the stage for the proportions of the rest of your smile and smile line. Apart from serving an important esthetic function, the incisal edge position is vital to proper function, in addition to speech and making sounds that start with “F” and “V”, for example.
Gum (Gingival) Tissue
Gum tissue should look healthy (meaning, no red, puffy or bleeding gums). Gingival contour is the shape or form of the gums around the necks of the teeth. The “ideal” smile should not show more than three millimeters of gums between the top of your tooth and the bottom of your upper lip. The shape of the gums of the lower incisors and the upper laterals should be a symmetrical half-oval or half-circular shape. The upper centrals and canines should show a more oval, or elliptical, shape to the gums.
The buccal corridor is the dark space visible between the corners of the mouth and the upper teeth. Research indicates that, under most circumstances, individuals with considerably smaller buccal corridors (broader smiles) are thought to have the “best” or “most attractive” smiles. Women, in general, have significantly broader smiles, increased tooth arcs and reduced tooth/lip arc differences than men.
A tooth’s emergence profile is the angle at which the tooth emerges from the gums when viewed from the side. This can affect the fullness of a person’s smile, as well as provide lip and cheek support. Greater fullness avoids a caved-in look to the face, giving a more youthful and attractive appearance.
Other Smile Anatomy Considerations
A smile’s impact cannot be determined just by the beauty of individual teeth and gums. Each patient is unique, varying by age, sex, looks, personality traits, and esthetic needs and expectations.
The “ideal” smile also must take into account individual considerations such as facial features, skin tone, hair color, and how the size, color and condition of your teeth, as well as gum tissue and lips, fit in with your overall physical appearance. In addition, occlusal and functional considerations may influence the smile design in both natural and restored teeth, and may affect the longevity of cosmetic treatment.
Macroesthetic concepts provide only guidelines and reference points for beginning esthetic evaluation, planning and treatment. The artistic component of dentistry – especially for cosmetic dentistry – can be applied and perfected by dentists who understand the rules, tools and strategies of smile design. With today’s modern technology, such as digital imaging, lasers, whitening procedures and the like, dentists can create smile design makeovers with procedures and techniques that range from minimally invasive whitening and composite bonding, to porcelain veneers, crowns and dental implants. Additionally, they can use soft tissue augmentation via dermal filling agents to correct facial aspects such as thin lips and asymmetrical facial appearances to increase a smile’s attractiveness. Advances in dental spa dentistry and sedation dentistry make it possible to do these procedures with less patient anxiety and pain.
Yet smile makeovers, like beauty, ultimately are in the eyes of the beholder. Just because they can be done does not mean they need to or should be done. The esthetics of cosmetic dentistry are highly subjective in nature and practice, and in many cases, when they do not cause physical, mental and/or psychological damage, are best left to the discretion of the individual patient, who may think that his or her unique dental quirks are characteristics to be embraced rather than “corrected.”
Tooth Discoloration: Causes and Treatment of Stained Teeth
In today’s appearance and youth-conscious society, the dull, stained effects of tooth discoloration represent a common dental complaint. Beyond the professionally managed teeth whitening options like Britesmile, Opalescence and Zoom whitening, people are employing new, everyday products in their ongoing struggle against yellow teeth and other forms of discoloration. From whitening strips and take-home trays to whitening toothpaste and chewing gum, people are going to various lengths to achieve and maintain a white, attractive smile.
Types of Discoloration
Tooth discoloration falls into two main types: extrinsic and intrinsic.
Extrinsic discoloration occurs in the outer layer of the tooth, called the enamel; enamel stains can range from white streaks to yellow tints or brown spots and pits.
Intrinsic discoloration occurs in the inner structure of the tooth, called the dentin, when the dentin darkens or displays a yellow (or gray) tint.
Whereas extrinsic staining can be effectively treated using various whitening techniques, intrinsic staining may be more stubborn, potentially requiring alternative cosmetic treatment such as veneers.
Teeth Whitening vs Dental Veneers
Whitening and veneers are two popular smile makeover treatment options. Weigh their pros and cons with your needs.
What Causes Discoloration?
In order to effectively manage tooth discoloration, it is important to recognize the causes. These include:
Foods/Drinks: Coffee, tea, colas, wines and certain foods (e.g., potatoes, cherries, blueberries) can cause extrinsic tooth stains.
Tobacco Use: Smoking or chewing tobacco can result in discolored teeth.
Poor Dental Hygiene: Inadequate brushing and flossing to remove plaque and stain-producing substances can cause tooth stains.
Disease: Diseases affecting enamel and dentin can lead to tooth discoloration. Certain infections in pregnant mothers can cause discoloration in the baby by affecting enamel development.
Medications: Antihistamines, antidepressants and high blood pressure drugs can discolor teeth. Maternal use of tetracycline antibiotics during the second half of pregnancy may result in discoloration of the baby’s tooth enamel. Children who take tetracycline and doxycycline antibiotics during permanent tooth development (before age eight) may experience intrinsic discoloration of the permanent teeth.
Dental Work: Procedures requiring certain dental materials, such as silver amalgam restorations, can produce a grayish-black cast to teeth.
Ageing: As you age, the outer layer of enamel on your teeth wears away, revealing the dentin’s natural, yellow color. Additionally, over the years your teeth accumulate more stains and tartars, causing them to darken and discolor.
Genetics: Some lucky individuals have naturally brighter and/or thicker enamel than others.
Environment: Excessive fluoride from environmental sources, such as high fluoride levels in drinking water, or from excessive use of fluoride applications, rinses, toothpastes and oral fluoride supplements, can cause discoloration.
Medical Treatments: Certain treatments can adversely affect the color of enamel and dentin layers. For example, chemotherapy, and head and neck radiation are two such treatments.
Trauma: A fall or any other injury that damages the nerves or chips/cracks the teeth can lead to discolored teeth in adults and children.
The Spectrum of Staining
The color of a tooth stain is influenced by what causes it. Factors that can cause tooth discoloration, and the type of stains they produce, include the following.
Tetracycline Antibiotics: Tetracycline and other antibiotics causes stains that are generally blue-gray or yellow-brown in color, often in a horizontal striped pattern. Porcelain veneers are the treatment of choice for tetracycline-caused stains.
Fluoride: Fluorosis, the overconsumption of fluoride during the tooth-forming years, frequently results in chalky white or brown spots, patches or lines on a tooth’s surface. Although brown stains respond well to bleaching, white stains remain unchanged, though the background may be lightened to make the white areas less noticeable. Occasionally, in order to address the problematic white areas, bleaching may need to be combined with bonded restorations or abrasion techniques. For example, enamel microabrasion, a treatment involving the rotary application of tooth-safe acid and super-fine, gritty paste, is used to remove superficial intrinsic discoloration caused by fluorosis and decalcifications resulting from orthodontic brackets or bands.
Foods/Drinks & Tobacco: Coffee, tea, colas and red wine, when consumed over time, produce stains on teeth that can result in yellow, brown, green or orange discolorations. Typically, these types of tooth staining can be removed by regular professional cleanings and regular home dental care, which includes brushing, flossing and rinsing after meals, as well as by eliminating or cutting down on the stain-inducing foods and beverages. These types of stains also respond well to peroxide-based teeth whitening treatments; at-home whitening products such as whitening toothpastes, rinses, strips and gums may be recommended to help maintain and supplement in-office whitening procedures and treatments.
Ageing: Over time, a person’s teeth will take on yellow or brown hues. In-office and at-home bleaching treatments will produce significant whitening effects. Periodic re-treatments are recommended for the best long-term results.
Genetics: Like your complexion or the color of your eyes, your teeth may appear yellower, browner or grayer due to inherited genes. Teeth whitening treatments may have little or no noticeable effects on teeth that have natural discolorations. In such instances, your dentist may recommend the use of veneers or composites.
Poor Oral Hygiene/Tooth Decay: These can cause your teeth to have stains that are white, gray, brown, yellow, or even black and green. Teeth whitening products will not resolve these types of stains. In such cases, the person’s dentist must repair the damage caused by the neglect and tooth decay with dental restorations, such as fillings, dental crowns, or veneers.
Dental Restorations: Failed or deteriorating dental restorations can produce gray, brown, black, yellow or green stains. Additionally, it is normal that white fillings experience staining as time passes. Metal fillings, even if not directly visible, can show through translucent tooth structure. For example, blue, gray or black stains are often associated with restorations involving amalgam, glass ionomer or acrylic, and porcelain fused to metal crowns. Teeth whitening products will not change the color of existing dental work. In such cases, your dentist might recommend the placement of new dental restorations after the completion of teeth whitening procedures.
Trauma/Root Canal Treatments: Traumatic events, such as an accident or a fall, as well as root canal treatments, can result in nerve tissue damage that can cause gray or brown tooth stains. Stains only form on the tooth or teeth directly affected by the incident. In some cases, this discoloration may be an indication that the nerve inside the tooth has died. While the use of a teeth whitening product may lighten the color of a nerve-dead tooth, it will not resolve the underlying problem, which should be treated to avoid the possibility of more severe pain and/or tooth problems. If your tooth has darkened after a root canal, bleaching the enamel won’t help. Your dentist can apply a bleaching material to the inside of the tooth, or suggest a crown or veneer. In cases when the tooth is chipped or badly damaged, your dentist may recommend covering it with a crown or veneer.
Treatment options for discolored teeth vary depending on the cause. Before a custom treatment plan can be developed to combat discoloration, a comprehensive oral health evaluation must first be performed. Common problems such as tooth decay and gum disease will require treatment before esthetics can be considered.
Treatment options may include the following:
Good Hygiene: Practice proper dental hygiene by brushing and flossing daily, and getting professional teeth cleanings every six months or more frequently, depending on your dentist’s recommendation, to help remove surface stains and bacteria. Use an ultrasonic toothbrush, which more effectively removes stain-causing foods from tooth surfaces.
Composite Bonding, Crowns and Veneers: For teeth severely discolored by excessive fluoride, root canal treatment, or consumption of tetracycline or other drugs, your dentist may recommend covering the tooth’s outer surface with a color-matched composite bonding material, porcelain veneers or porcelain crowns instead of bleaching. Composite resin veneers, which cost about $250 per tooth, are applied directly to your teeth and sculpted in the desired shape and shade. Porcelain veneers, which are thin porcelain shells bonded over the front of your teeth, cost $900 to $2,500 per tooth. Lumineers, an alternative porcelain veneer made from Cerinate porcelain, cost $700 to $1,000 per tooth. Porcelain crowns, also called caps, average $600 to $3,100 per tooth.
Whitening Procedures: Tooth whitening procedures fall into four categories:
In-office Tooth Whitening: Your dentist can easily remove extrinsic and some intrinsic tooth discoloration caused by foods/drinks and other causes by applying a bleaching peroxide gel to the tooth enamel. The process typically takes an hour and costs an average of $650 per visit. People with particularly stubborn staining may need to return for one or more additional whitening sessions, or be advised to continue with an at-home use whitening system provided by their dentist.(Read more about in-office whitening)
Dentist-dispensed At-home Bleaching: Many dentists believe that professionally dispensed take-home whitening kits may produce the best results over time. More suitable for extrinsic tooth discoloration, home whitening usually is done with teeth whitening kits, gels or strips. Typically, a custom-fit or standard mouth tray and a whitening gel are used. The gel, which is a lower-concentration peroxide-based formulation of in-office versions, is put into the mouth trays and worn daily for an hour or longer (sometimes overnight) for about two to four weeks, depending on the desired shade. Take-home teeth whitening kits cost on average between $100 and $500.(Read more about at-home whitening)
Consumer-purchased/Over-the-counter (OTC) for At-home Use: OTC whitening products offer a convenient and low-cost alternative to bleaching teeth without dentist supervision. Featuring a lower-concentration bleaching agent, OTC products — available in supermarkets, drug stores or through the Internet — include rinses, paint-on liquids, toothpastes, chewing gums, dental floss and whitening strips. Toothpastes, chewing gums and dental floss remove superficial stains. Rinses and paint-on brushes with low levels of hydrogen peroxide have some whitening effect; strips present similar esthetic results. Costs will range between $4 and $100.
Other Non-dental Office Options: An emerging tooth whitening trend is the availability of whitening treatments or kits in retail venues such as mall kiosks, salons and spas, and even cruise ships and airports administered by non-dental professionals. Prices can range from around $99 in mall kiosks and airports to around $200 at salons, spas and cruise ships.
Consult with your dentist for the best treatment options for your individual case.
Prevention and Maintenance
Certain lifestyle choices can help prevent tooth discoloration, as well as keep your teeth white after whitening. For example, avoid stain-causing foods and beverages, as well as overexposure to fluoride. If you are a coffee drinker and/or smoker, quit or cut back. Rinse your mouth with water after having wine, coffee or other drinks/foods that can cause tooth stains. Intrinsic stains caused by damage to a nerve or blood vessel in a tooth may be prevented with root canal treatment to remove the inner part of the tooth, called the pulp, before it decays and darkens.
Bleaching is indicated primarily for patients with generalized yellow, orange or light brown extrinsic discoloration, including chlorhexidine staining. Bleaching also may be helpful in improving mild cases of tetracycline-induced intrinsic discoloration and fluorosis. In-office “power bleaching” involves the use of a light-activated 15 to 40 percent hydrogen peroxide solution and must be performed by a dental professional; at-home bleaching systems, which may be used alone or in combination with in-office bleaching, are less concentrated and produce gradual results over a longer period of time.
Whitening toothpastes, containing one percent or less peroxide, are minimally effective on milder discolorations. For darker stains, the best results are achieved by using a combination of in-office and at-home bleaching systems. Periodic re-treatments are also usually required.
Some extrinsic stains may be removed with ultrasonic cleaning, rotary polishing with an abrasive prophylactic paste or air-jet polishing with an abrasive powder. Keep in mind, though, that these methods can lead to enamel erosion, so their frequent use is not advised.
Consultation with and treatment by medical professionals may be required if the underlying cause of tooth discoloration is related to a systemic disease. Endodontists, prosthodontists, periodontists, and oral and maxillofacial surgeons may be needed to assist with therapies.
Cosmetic dentistry costs vary widely, but you’ll find approximate costs in our articles on particular procedures. For example, professional in-office teeth whitening costs approximately $450 to $650, whereas over-the-counter whiteners range in cost from $4 to $100.
Usually dental insurance doesn’t cover cosmetic dentistry. But some dental plans may cover part of the cost of certain procedures, such as crowns, especially when the main purpose is to repair a structural problem that could affect the overall health of your mouth. Usually, functional and restorative dentistry is covered in part by insurance, while elective cosmetic treatment is seldom covered.
If treatment is not covered by your dental insurance policy, or if you don’t have insurance, you may be able to enlist the services of a third-party financing company like CareCredit or Capital One. Qualified candidates can work with a financing company to develop a monthly payment plan that best fits their budget.
Cosmetic Dentist Irvine Dr. Jeevan Ghatnekar, has practiced dentistry for over 25 years with an emphasis on cosmetic, implant, and micro-dentistry. Understanding the advancing technology and science behind dentistry, Dr. Ghatnekar continually researches and implements new techniques for various procedures through advanced dental programs, master classes, and seminars. His memberships include: Orange County Dental Society, the California Dental Association, the American Dental Association, the American Academy of Implant Dentistry, and the Academy of General Dentistry.