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                                                        DR. DAN PETERSON

                                                                      1415 SAGE STREET ~ GERING, NEBRASKA 69341 
                                                             
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STAINED-AGED TEETH AND WHITENING

     Some of the things we eat and drink "age" our teeth.  Learn more about these tooth assassins:

Compare the color of your teeth to this "shade" guide.
Tooth color shade guide

Tooth Whitening Video

General Staining:

bulletSoda: Pop can be your teeth's worse enemy.  The acid in pop can "eat" your tooth's enamel to cause cavities.  If you must drink pop try sugar free or use a straw.  A straw allows less sugary, tooth staining liquids to reach you front teeth.
bulletCoffee and Tea.:  It stains teeth destroying your naturally white smile.  The heat from the coffee can also cause small fractures in your tooth's surfaces.  Try drinking cooler coffee and use a straw or brush your teeth after drinking coffee or tea.

 A life time of bad habits can age our teeth!

Whitening effect is entirely
dependent on peroxide concentration x time in contact with teeth

bulletSmoking will cause a build up on teeth that can cause a yellow to orange color staining.  These stains can take longer to lighten.

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Types of Stains

Extrinsic stains are stains on the exterior of the tooth surface or, at most, penetrating microcracks and fissures, and can thus be removed by dental polishing.

Many extrinsic stains are pigments embedded in the calculus or plaque that has become colored from interaction with food debris, tobacco smoke, wine or other sources. It should be emphasized that, although coffee, tea, wine, fruit juice, and tobacco are all well known for their ability to cause staining, the color that develops is from a chemical reactions occurring in the plaque and does not necessarily imply anything about the color of the food
itself.

Most common are yellow-brown to dark brown stains that probably caused by an accumulation of dental plaque, food stain and poor oral hygiene.   Aging or inherit discoloration usually occurs in 9 out of 10 people. These stains usually bleach quite readily as due yellowish discoloration, whether due to aging or tobacco smoke, likewise responds well to bleaching.
Staining from aging
takes about 1-6 weeks to whiten.
Nicotine staining
takes 1-3 months to whitening through nightly use. 

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Black line stain, most frequently found on the lingual surfaces one millimeter above the gingival (gum) margin. It is a metabolic stain and is frequently found in clean mouths.

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Green stain is often found on the cervical surface of the anterior teeth of children and is a remnant of Nasmyth's membrane and accumulated food debris. Green stain may also be the result of exposure to some metals, including copper and nickel. Metallic stains can be absorbed into plaque by inhaling the fumes of metallic salts. The color varies from green to bluish-green to brown according to the metal the individual was exposed to. Green stains can also be the result of decomposed hemoglobin and inorganic elements like calcium, potassium, sodium, silicon, magnesium, phosphorous and other elements in small amounts. This type of stain often overlies demineralized tooth structure.

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Orange and red stains are usually found on the cervical third of anterior teeth, and are caused by chromogenic bacteria.

Repeated use of stannous fluorides can result in a light brown or yellowish stain. Chlorhexidine and alexidine are also problematic in this regard, forming a browning stain as well.

Once extrinsic stains are removed, oral hygiene techniques will be reinforced to minimize extrinsic stain reoccurrence.

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Intrinsic Stains or stains located within the tooth anatomy, can be of varied origin. Intrinsic stains may result from pre-eruptive or post-eruptive causes.

Hereditary conditions
Hereditary conditions such as porphyria and phenylketonuria (if untreated, which is rare these days) can also result in a deposition of colored materials in the teeth.

Other pre-eruptive staining resulting from hereditary conditions include amelogenesis imperfecta and dentinogenesis imperfecta. These both affect tooth structure in ways that can alter the color, but that also lead to rapid loss of enamel from the tooth surface. Enamel hypoplasia is hereditary condition that may contribute to extrinsic staining. The teeth erupt with whit spots or pits that may discolor or pick up food pigments over time.

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Tetracycline Staining
Use of tetracycline during the period of tooth formation - including the last half of in utero development - leads to its incorporation into the tooth structure. The resulting appearance depends both on intensity of use and the type of tetracycline employed. Tetracycline can be transferred through the placenta and enter fetal circulation. Often, however, the outcome is a bluish-gray stain affecting only the part of the tooth that was being formed during the period of use. After eruption these teeth may fluoresce under UV light, but this is a property that is generally lost with age and exposure. The discoloration may be generalized or limited to a specific part of the
individual teeth that were developing.

Tetracycline stained teeth

Tetracycline stains are difficult to bleach, but will usually respond to prolonged treatment. When only part of the tooth is affected, however, patients are often disappointed with the results: While the tooth is lightened overall, and the difference in shade between the stained and unstained regions is diminished, the difference never entirely disappears. It was thought staining of the teeth from tetracycline was only an issue while teeth were being formed, but many  have noticed that the tetracyclines (minocycline in particular) will stain the erupted tooth due to salivary concentrations & crevicular fluid too.IDF Rick Be patient when whitening these teeth, because good results will take some time, and your teeth may initially look worse, as their more normal enamel lightens more quickly than the discolored areas.
 

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Minocycline Staining
Minocycline is a semi-synthetic derivative of tetracycline often prescribed for the treatment of acne or rheumatoid arthritis. Unlike tetracycline, however, it can stain teeth even after tooth eruption. Although the mechanism of action is not well understood, there is some evidence that a corresponding protocol of Vitamin C may help prevent this discoloration from occurring. Predicted whitening results are similar to those for tetracycline: Prolonged bleaching is usually successful, but may be less than satisfactory when banding is severe.

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Ingestion of fluoride
Ingestion of excessive amounts of fluoride during tooth formation can lead to areas of lighter appearing enamel. These spots are chalky white in appearance and, obviously, cannot be bleached to match the surrounding enamel. It is often referred to as 'mottled enamel'. Whitening does not remove the white spots but lightens background so they are less noticeable. Secondary stains that occur around these white areas are readily bleached to produce an appearance that, while not normal, may be less noticeable. Sometimes fluorosis is accompanied by pitting and other surface defects that may suggest veneering or bonding, perhaps following an initial bleach.
Whitening use takes 1-6 weeks.
Brown Fluorosis will take 1-6 weeks to whiten.  About 80% will respond to this procedure while the rest may need polishing and composite restoration to follow.

Fluorosis

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Natural Tooth Color Variation
In addition to acquired discolorations, teeth naturally vary in
color. Enamel is more or less translucent, allowing the underlying dentin color to show through. Normal variations in dentin structure can result in more or less light being reflected. Variations in dentin structure can also, to a small extent, affect the color of the reflected light, as can materials that may be incorporated into the tooth structure. These natural variations can make teeth look old. The teeth may yellow over time due to pulp recession. Aging teeth develop secondary dentin over time which also makes the teeth appear
darker.

Prolonged jaundice early in life can impact a yellow or greenish discoloration to the teeth. Erythroblastosis fetalis (Rh incompatibiity) can leave a green, brown, or blue hue to the teeth.

Post-eruptive intrinsic staining to some extent reflects the process of enamel and dentin maturation. This includes tubule mineralization and secondary dentin formation. A variety of stains present either in the systemic circulation or locally in the tooth, can become incorporated during these processes.

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Trauma
Perhaps the most common cause of post-eruptive intrinsic staining is trauma. Trauma is usually accompanied by hemorrhage, producing a rise in pressure within the pulp cavity that forces the extravasated blood into the dentinal tubules. This will initially produce a pink color. As the hemoglobin breaks down, however, it is converted to black iron sulfide. Even though this is an inorganic pigment, it responds well to bleaching.

Trauma may also produce necrosis of the pulp, with or without accompanying hemorrhage. Various by-products of protein degradation will migrate into the tubules, producing a grayish-brown color that is less intense than that due to hemorrhage. The stain will be lighter when the necrotic material is removed promptly. This stain will usually respond well to non-vital bleaching techniques. Note however that not all pulpless teeth will discolor.  It will take 1-6 week to whiten.

Discoloration due to trauma responds to 10% carbamide peroxide bleaching in 47 hours.***

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Iatrogenic discoloration.
Dental materials can also result in tooth discoloration. Sometimes this can be as simple as the color of the restorative material showing through the translucent enamel. It is possible for restorations to discolor adjacent tooth surfaces as they deteriorate and release various metal ions. The presence of recurrent decay beneath the old or leaking restoration can also result in a darkening of the tooth. Once the defective restorations are replaced, any remaining stains should respond well to bleaching. Various other materials used in dentistry, such as amalgam (gray/black); silver nitrates (black stain), iodine (brown); essential oils (yellow/brown); aureomycin (yellow), and  silver-containing root canal sealer (black) can also cause stains under some circumstances.

[phdservices] Digest Number 80, 6 Dec 2001 10:26:28 -0000

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Teeth Staining Health Updates

Teeth staining in children
Liquid Iron preparations taken by themselves can cause staining of children's teeth. Certain foods will also cause stains such as drinking iced tea or possibly apple juice. Some stains will arise through the use of antibiotics allowing resistant chromogenic bacteria to "overgrow" and cause the stain. This kind of stain is usually on more than just the tongue side of the lower bottom teeth. The surfaces of the tongue sides of the lower teeth are bathed by the sublingual duct, which can lead to little hard deposit buildup  because of porosity of this area to pick up stain.

 

     Try using whitening floss-it lightens between the teeth, where 70% of stains occur.

     A recent survey showed 80% of Americans aged 18-49 want whiter teeth, with women leading in this area at 85%.  6 out 10  believe a whiter, brighter smile would boost their self confidence especially in the 18-24 age range.  However, these same people are NOT willing to give up their tooth staining items like coffee, soda and cigarettes.

  
***An Update on Tooth Whitening, Woman Dentist Journal, pg 10-22, Jan/Feb 2003
Dentistry Today, August 2002.

February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
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