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Advanced cosmetic and general dentistry

What are my options for whitening one gray tooth?

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My upper left incisor is getting grayer each year. My dentist referred me to an endodontist who says the x-ray shows a possible horizontal fracture. She recommended a root canal, but I am wondering about cosmetic options. Will regular teeth whitening or internal bleaching help? – Thank you. Irina

Irina,

Thank you for your question.

Dr. Szarek would need to examine your x-rays, but root canal treatment is unnecessary unless you have a tooth infection, and it will not lighten the tooth. If you have a tooth fracture, root canal files that clean out the tooth might worsen a horizontal fracture.

What Else Can Cause a Dark Tooth?

If your tooth is not infected, it might be turning dark from trauma to the tooth that happened years ago. As your body responds to tooth trauma, it builds secondary dentin beneath your tooth enamel, which can darken a tooth.

Whitening a Dark Tooth

Teeth bleaching gel applied to teeeth

A cosmetic dentist can determine how bleaching gel will affect your teeth

Internal bleaching, dental bonding, and porcelain veneers are ways to whiten teeth, but their purpose varies.

  • Internal bleaching – The procedure follows root canal treatment for a tooth that a dentist has already opened from the crown. If you do not need root canal treatment, opening your tooth for bleaching is not recommended.
  • Teeth whitening – Bleaching gel breaks down stains from external factors that darken your teeth, like smoking or drinking coffee or tea. But if your tooth is dark from the inside out, bleaching gel may have limited results. A cosmetic dentist can explain the results you can expect with this option depending on the cause of the discoloration.
  • Dental bonding – A trained cosmetic dentist can blend dental composite (resin and glass), layer it on your tooth, harden each layer, and conceal the discoloration. Only a cosmetic dentist can perfectly match the bonding to your natural tooth color.
  • Porcelain veneer – A custom-made shell of porcelain covers the front of your tooth. An artistic cosmetic dentist and master ceramist must create the veneer to mimic the natural translucence of your teeth while hiding the gray beneath it.

Any treatment option that hides discoloration within a tooth is challenging for most general dentists to achieve beautiful results. We recommend looking for an advanced—preferably accredited—cosmetic dentist for natural-looking results.

Michael Szarek, DMD, an accredited cosmetic dentist in Lowell, MA, sponsors this post.

Should Your Cosmetic Dentist Use a Crown or Veneer After Root Canal?

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When I received a root canal from my cosmetic dentist in 2018, she wanted to place a porcelain veneer over the toot, but I declined. The tooth is dark now, and I’ve relocated to Burlington, which is 400 miles from my former dentist. My new dentist recommended a crown for the tooth because he said a veneer wouldn’t work anymore. I didn’t realize that he would have to file down the tooth for a crown. I know it’s probably too late, but was my dentist too aggressive in recommending a crown? Elyssa from Burlington, VA

Elyssa,

Dental schools train dentists to restore a tooth with a crown after root canal treatment. Your dentist was likely doing as he was taught. Crowns require shaving your tooth to ensure it fits without negatively affecting your bite.

When Do Cosmetic Dentists Use Crowns After Root Canal?

  • Extensive damage – If a tooth has a lot of its structure missing, dentists place a crown. After root canal treatment, a tooth can become brittle, and the risk of fracture increases. A crown protects the tooth.
  • Back teeth – Daily, back teeth are subject to the pressure of biting, chewing, and grinding food. If a back tooth is severely damaged, broken, or split, a crown will prevent further damage and withstand the forces of biting and chewing. Less pressure is exerted on the front teeth.

Do Front Teeth Need a Crown?

An impact on your front teeth is usually lateral. So front teeth are most likely to snap off at the gumline. A dental crown removes about a millimeter of structure around the entire tooth and can weaken it.

Although most dentists prepare teeth more aggressively, the photo below shows very conservative preparation for a dental crown. The tooth will be stronger and less likely to break.

What About a Porcelain Veneer After Root Canal Treatment?

After root canal treatment, some cosmetic dentists choose to restore a front tooth with a porcelain veneer whenever possible. Only 0.5 mm of the enamel is removed.

Most general dentists don’t place veneers on front teeth after root canal treatment because it requires more skill. The dentist and the laboratory technician must understand how to conceal the darkness of the tooth and make the veneer look natural. Most general dentists like the skill and artistic ability to provide aesthetic results.

The photos below are an example of the amount of tooth structure that dentists with conservative porcelain crown preparation vs. conservative porcelain veneer preparation.

Photo of prepared tooth that was shaved for a dental crown

Dental crown preparation

Photo of a tooth that was conservatively prepared for a porcelain veneer

Porcelain veneer preparation

What Causes Discoloration After Root Canal Treatment?

Rather than darkness from the tooth drying out, root canal filling materials inside the tooth can darken it. Advanced cosmetic dentists prevent premature darkening with the following steps:

  • Clean out the filling materials
  • Place a white fiberglass post into the root
  • Seal the opening with tooth-colored composite

The technique delays discoloration for five or ten years and prevents the need for a veneer until then.

 

Michael Szarek, DMD of Lowell, MA sponsors this post.