Tooth discolouration is when the enamel (the hard, outer surface of the tooth) or the dentine (the layer below the enamel) becomes discoloured. Something as simple as food and drink may cause stains to appear on the teeth. Sometimes however, discolouration can indicate something more grave, such as exposure to substances that have harmed the teeth.
The appearance of the dentition is of concern to a large number of people seeking dental treatment and the colour of the teeth is of particular cosmetic importance.
There has been a recent increase in interest in the treatment of tooth staining and discolouration as shown by the large number of tooth whitening agents appearing in the market. Some of these agents are sold as 'over-the-counter' products and have no professional involvement in their application. The correct diagnosis for the cause of discolouration is important as, invariably, it has a profound effect on treatment outcomes.
The coronal portion of the tooth consists of enamel, dentine and pulp. Any change to these structures is likely to cause an alteration in the outward appearance of the tooth caused by its light transmitting and reflecting properties. Tooth discolouration has been classified according to the location of the stain, which may be either intrinsic or extrinsic.
Intrinsic discolouration occurs following a change to the structural composition or thickness of the dental hard tissues. The normal colour of teeth is determined by the blue, green and pink tints of the enamel and is reinforced by the yellow to brown shades of dentine beneath. A number of metabolic diseases and systemic factors are known to affect the developing dentition and cause discolouration as a consequence. Local factors such as injury are also recognised.
Extrinsic discolouration is outside the tooth substance and lies on the tooth surface or in the acquired pellicle. The origin of the stain may be:
Internalised discolouration is the incorporation of extrinsic stain within the tooth substance following dental development. It occurs in enamel defects and in the porous surface of exposed dentine. The routes by which pigments may become internalised are:
Depending upon the degree of staining the treatment modalities vary.
Treatment of Superficial Enamel Discolouration
Tooth bleaching can be the first step for treating certain kinds of dental staining problems. It is usually reserved for a mild, uniform, discolouration of the teeth. The bleach oxidizes the organic pigments in the tooth, breaking down the long- chain stain molecules.
| TREATMENT | ACTIVE AGENT | INDICATIONS FOR USE | POTENTIAL PROBLEMS |
|---|---|---|---|
| In-Office Vital Bleaching | Hydrogen peroxide 30-38% is applied directly on the teeth. A special light may also be used to accelerate the whitening process. | When there are only a few discoloured teeth. | Temporary tooth sensitivity and gingival irritation. |
| Overnight Vital Bleaching at home | Carbamide peroxide 10% is used in a custom tray. | When there are multiple discolored teeth. Effective for yellow, orange or light- brown discolouration in primary and permanent teeth. | Temporary tooth sensitivity in 55-75% of cases. |
| Whitening Strips for use at home | Hydrogen peroxide 6.5% or 14% is delivered via a thin, flexible polyethylene strip. | Multiple discoloured teeth. Works slightly better on upper than lower teeth. | Temporary tooth sensitivity and oral tissue irritation. |
Deep internal dental stains are due to pulpal trauma, fluorosis, hypocalcification, tetracycline, hereditary opalescent dentin or mottled enamel and require more complex treatment.
| TREATMENT | ACTIVE AGENT | INDICATIONS FOR USE | POTENTIAL PROBLEMS |
|---|---|---|---|
| Etch, Bleach, and Seal technique | Phosphoric acid 37%, sodium hypochlorite 5%, and clear sealant. | Shallow yellow- brown enamel discolourations. | Does not remove stains which are deeper than a few tenths of a millimetre |
| Microabrasion with Dental Bleaching | Abrasive slurry consisting of silicon carbide and hydrochloric acid 11%. | May not be able to remove the stain completely. | Temporary tooth sensitivity and oral tissue irritation. |
| Composite Veneers and laminates | Dental composite. | Deep tetracycline stains. | A layer of enamel must first be removed from the surface of the tooth. |
There are a number of factors associated with the development of crooked teeth e.g. eruption pattern of permanent teeth, presence of other teeth and the oral structures influencing the position of the teeth. Other common factor can be tooth loss due to dental caries which was failed to be replaced, causing drifting and movement of neighbouring teeth.
Crooked teeth hamper good oral hygiene practices. In addition, it affects a person’s personality on a physical, social and mental basis. If your crooked teeth cause you to smile a tight-lipped smile, consider one of the following options.
Braces
Braces work by putting pressure on your teeth to shift them into a more attractive position. Often, braces come in the form of metal, plastic or ceramic brackets glued to the front of the teeth. These brackets hold a tightening wire in place. The wire is in the shape your orthodontist wants to see your teeth. Once threaded through the brackets, this wire tries to get shift into shape and moves your teeth along with it. These wires are tightened once a month for a period of up to two and a half years, depending on the severity of your condition. Of these three types of braces, ceramic brackets are the least noticeable, as their translucent colour allows them to blend in with the natural teeth colour.Lingual Orthodontics
Lingual braces are a similar and less visible option—the brackets are glued to the lingual or tongue side of your teeth. Once the braces come off, you will likely have to wear a retainer for a few months to keep your teeth from shifting. This advanced method makes lingual orthodontics particularly well-suited for adults, who often want to improve the look and function of their teeth without letting anyone else know about their treatment.Invisalign
A newer option is Invisalign, a series of plastic, transparent, removable aligners that squeeze the teeth tightly into place. Like braces, invisalign shifts your teeth into a straighter position.
The most obvious advantage of the treatment is cosmetic. The aligners are completely transparent, therefore far more difficult to detect than traditional wire and bracket braces. The invisalign system also boasts improved hygiene over traditional braces. Because the clear retainers are removable, patients can brush and floss as they normally would, reducing the chances of possible staining and decay that often occur with traditional braces. But, all good things come with a disadvantage. The disadvantages of invisalign include the high cost of the aligners and the difficulty in treating more complex cases.
Accelerated Orthodontics
If you want fast results and can stand a little pain, ask your dentist about accelerated orthodontics. A team of dental specialists will perform a combination of orthodontic and periodontic work to get you the smile you want—fast. The process takes about six months, a quarter of the time it takes for traditional orthodontics. Most often, this form of orthodontics requires you to wear lingual braces. Note that some dental insurance policies will not cover the cost of this procedure.
Porcelain Veneers
Porcelain veneers are another excellent option for the correction of your crooked teeth. Veneers are thin ceramic shells that are bonded to the facial aspect or outer surface of your teeth to create a natural- looking and beautiful smile. Your dentist will first trim part of your teeth to make space for the veneers and use a mould of your teeth to create veneers. The aesthetically pleasing veneers not only will hide the shape of the teeth but will also hide any other defects.
Tooth Contouring & Reshaping
One of the few instant and inexpensive procedures cosmetic dentistry offers. This "sculpting" process usually involves a combination of scraping off a portion of the existing tooth enamel and replacing it with bonding or a veneer. Your cosmetic dentist will remove a small amount of enamel using a drill or laser, sculpt the sides of your teeth with abrasive strips and polish it.
As age advances, some of us will lose teeth due to disease, injury, or simple daily wear. In addition to bringing about unwanted changes to a person's facial appearance, missing teeth have a negative effect on that person’s confidence and self- esteem.
Patients can choose from a variety of options to replace missing teeth. There are removable partial dentures held in place by wire clips; fixed dental bridges cemented into position by crowns placed on the teeth adjacent to an empty space; traditional full dentures and the implants.
The removable partial denture is a prosthesis that is designed and fabricated to be removed by the patient.
All definitive RPDs will have the following components:
There are several types of RPD's. All of them use standard acrylic denture teeth as replacements for the missing natural teeth. The differences between them are the materials that are used to support the denture teeth and retain the RPD in the mouth.
RPD’s are made from acrylic denture base.
Cast Metal RPD's
Removable Partial Dentures with cast metal frameworks are probably one of the oldest forms of dentistry. This type of partial denture offers numerous advantages. Since they sit on the teeth, as well as being attached to them, they are extremely stable and retentive. The teeth have been altered slightly beforehand in order that the partial denture can rest upon them without interfering with the way the patient bites the teeth together.
The metal framework does not contact the gums. Thus, as the gums resorb, this type of partial does not sink with them and rarely requires relines. Because the teeth are altered, there are fewer limitations in the placement of clasps and they are less likely to be seen than the wrought wire clasps of the treatment. Modern frameworks are cast from an extremely strong alloy called chrome cobalt which can be cast very thin and are much less likely to break than the all plastic variety. They are also much less noticeable to the tongue.
The largest single advantage that cast metal framework partial dentures have over the newer flexible framework partials is that sore spots are almost never an issue since neither the framework nor the plastic extensions contact the soft oral tissues with any force.
The Flexible Framework RPD's
Valplast
The most recent advance in dental materials has been the application of nylon- like materials to the fabrication of dental appliances. This material (the most common name brand is ValPlast) generally replaces the metal and the pink acrylic denture material used to build the framework for standard removable partial dentures. It is nearly unbreakable, is colored pink like the gums, can be built quite thin and can form not only the denture base, but the clasps as well. Since the clasps are built to curl around the necks of the teeth, they are practically indistinguishable from the gums that normally surround the teeth.
Flexite
A second type of nylon partial denture base is a brand called Flexite. This polymer is also flexible and is built with tooth colored clasps, but unlike Valplast, it is much easier for the dentist to adjust making it a much more "user friendly" denture base. This type of partial denture is extremely stable, retentive and the elasticity of the flexible plastic clasps keeps them that way indefinitely.
A bridge, by definition, is a link or connection between two permanent structures. A dental bridge is very similar in that it attaches the restorative teeth (bridge) to the natural teeth on either side of the gap.
Dental bridges are false teeth, which are anchored onto neighbouring teeth in order to replace one or more missing teeth. The false tooth is known as a pontic and is fused in between two crowns that serve as anchors by attaching to the teeth on each side of the false tooth, thereby bridging them together. The two crowns that are attached to healthy, adjacent teeth are called abutment teeth.
A fixed bridge is designed to remain in the mouth and cannot be removed and replaced like removable dentures. A fixed dental bridge may be used to replace just one tooth or several teeth.
There are three main types of dental bridges :
Traditional fixed bridge
This is the most commonly used type of bridge and consists of a pontic fused between two porcelain crowns that are anchored on neighbouring teeth. The pontic is usually made of either porcelain fused to metal or ceramics. This procedure is used to replace one or more missing teeth. These are fixed and cannot be removed.
Resin-bonded bridges or Maryland-bonded bridges
These are chosen when the gap to be filled is in between the front teeth or when the teeth on either side of the missing tooth are strong and healthy without large fillings. The false tooth is fused to metal bands that are bonded to the abutment teeth with a resin which is hidden from view. This type of bridge reduces the amount of preparation on the adjacent teeth.
Cantilever bridges
Cantilever bridges are used in areas such as the front teeth that are under less stress. They are used when there are teeth present on only one side of the space, where the false tooth is anchored to one or more adjacent teeth on one side.
Bridges may be made of:
A complete denture replaces all the natural teeth and associated structures in both the maxilla and mandible. The complete denture is fabricated using maxillo- mandibular relation in function and non- function.
The upper denture covers the whole palate, making an air-tight zone. Usually with the complete upper dentures we can get a pretty good suction and retention due to the large surface area of the denture base.
The full lower denture is the one where most of the people have tremendous problems. The anatomy of the lower jaw does not allow us to get a good suction of the denture. The fact that the lower jaw is the mobile bone (we move it constantly speaking, eating, swallowing) and because there is not much of the attached gum on the bottom, it makes it almost impossible to get good retention on the lower jaw.
Dental implants are sturdy titanium posts that are anchored directly into the jawbone and topped with realistic replacement teeth which provide the security and usability of permanently placed teeth.
Dental implants are a restorative dentistry option that allows patients to replace missing teeth with ones that look, feel and perform like their own. During the first step of this procedure, a doctor skilled in implant dentistry surgically places a titanium screw or post in the patient's jaw. After the gums have healed around the embedded post, a replacement tooth is attached to the top of it.
An implant restoration is made up of 3 main parts:
A gummy smile is a smile showing an excessive amount of gingival (gum) tissue above the front teeth when smiling. Large gums or short teeth can give your mouth an imbalanced "gummy" look. Fortunately, various treatment options are available depending on the cause for gumminess.
A number of factors can lead to gummy smile :
Gummy smiles can also be caused by attrition, a condition where the teeth have been severely worn down. This case is one where the teeth seriously are too short. Bad habits such as night-time teeth grinding can cause this wear.
Different options available for reducing a gummy smile are :
Gingivectomy/Gingivoplasty :
In this excess gum tissue is surgically excised. The underlying bone is not exposed. A periodontal dressing covers the teeth and gums post-surgery to protect them while healing. The patient may experience pain during the procedure, but usually not after. Occasionally dental veneers can be used as part of this procedure to help increase the amount of tooth show.
Flap surgery :
In this surgery some of the underlying bone is removed. This surgery is required in cases of gummy smiles due to thick or irregular bone contours. Post-operative care includes sutures or stitches and a periodontal dressing to cover the healing gums. This surgery tends to bring more discomfort than a gingivectomy.
Crown lengthening :
In this procedure your gums are shifted to a position that reveals more of your teeth and less of your gums. This procedure can also be called gum lift or gum re- contouring and may involve cutting out gum and bone around the teeth. In cases where the tooth is badly damaged or decayed, the goal of the crown lengthening procedure may simply be to expose enough of the tooth so that a restoration procedure can be performed.
Laser gum surgery :
In this procedure a laser is used to remove excess gum tissue. The results are similar to a gingivectomy. The use of laser to resize the gums is a painless and fast healing procedure.
Lip surgery :
Another option to reduce a ‘high lip line’ is an upper lip lowering procedure. This minor operation is done under local anesthesia and involves the re- attachment of the gum tissue under the lip at a level that is closer to the teeth. This results in not only lowering the lip line at rest but also limiting how much it moves upward when smiling. This procedure shortens the depth of the vestibule (space between the upper lip and gum tissue high up under the lip) to help bring the lip down.
