Discoloured Smile

• Clinical Definition: Discolouration may result from changes at the surface of the teeth (surface films) or structural changes to the dentin underneath the enamel.

• Important Indications: If you experience a rapid darkening after trauma; if you notice grey dots; or if you have an unexplained sharp ache.

• Main Recovery Options: Professional scaling, chemical whitening, microabrasion, porcelain veneers, and direct composite bonding.

• Visible visual appearance changes in color of a tooth due to staining i.e. a once pearly white tooth is now yellow, brown, dark gray or opaque white as stains enter the dentinal tubules through microfractured areas of the enamel.

• Sensitivity to temperature increases as a result of the temperature being transmitted to the dentin through the micro-fracture area(s) of the enamel allowing the temperature to be transferred to the pulp chamber where it stimulates the nerves within the pulp.

• Visible roughness or visible plaque build-up on an area around the gumline that will not come off with normal brushing.

• When a single tooth turns black/brown/pink/red after suffering some form of trauma; this indicates there has been internal hemorrhaging/necrosis of the pulp.

• If you have discolored teeth and one of the other symptoms listed above (i.e., swelling, spontaneous bleeding, fistula), it could indicate that your infection may be spreading.

• When you notice what appears to be chalky white areas in multiple areas of your mouth, these areas are breaking down quickly into structural cavities.

• Ingestion of a high amount of dark filter coffee and black tea along with traditional curries that have been colored with turmeric.

• Chewing tobacco (pan masala) and other local forms of smokeless tobacco which leave heavy tar deposits on the teeth.

• Early childhood exposure to tetracyclines; excessive fluoride ingestion during tooth development and natural aging enamel thinning.

• Genetic porous enamel structure or acid erosive weakening of enamel through chronic gastroesophageal reflux disease.

• Poor oral hygiene routines that fail to remove chromogenic bacteria before mineralization.

• Exposure in advanced age with yellowish dentin being exposed as a protective outer layer of enamel wears down.

• Examine your teeth with an unobstructed view of a clean mirror under the bright light of day. 

• Check for roughness by running a fingernail or wooden toothpick over each tooth to see whether you are feeling a deposit of tartar or the feel of smooth enamel.

• Compare adjacent teeth to determine which tooth appears noticeably darker than its neighbors in your arch.

• Use a visual and tactile examination by means of a dental explorer and/or periodontal probe. 

• Transilluminate (using a high-intensity fiber-optic light) to distinguish between surface staining and internal structural cracks. 

• Perform electric pulp tests and take periapical radiographs to evaluate nerve vitality as well as the overall status of the roots.

• Grade 1 (Mild): Yellow color in early stages of tooth decay that can be removed through a simple cleaning process at your dental hygienist’s office.

• Grade 2 (Moderate): A brown or yellow stain on the surface of an individual's teeth which will penetrate the outer layers of the tooth enamel.

• Grade 3 (Severe): Deep gray, black or blue discoloration within a tooth as a result of medication, trauma or death of the pulp tissue inside the root canal.

• Laser Bleaching: Chemical bleaching activated immediately using high-intensity light.

• Abrasives: Using a series of abrasives to remove the topmost layers of enamel, followed by application of acid.

• Porcelain Laminate Veneers: Thin ceramic laminate veneer(s), custom-made to fit each patient's tooth so that severe, resistant-intrinsic stains are completely covered.

• The cost of professional scaling and polishing at standard clinics in Kerala is generally between INR 1500 and INR 3500.

• Chemical bleaching in an office setting can range from INR 8000 to INR 20000 based upon which type of system you use.

• A custom ceramic veneer can be anywhere from INR 8000 to INR 25000 per individual tooth.

• A general dentist will handle all your regular dental needs including routine scaling, removing stains that are visible (extrinsic) and performing the usual chemical whitening treatment.

• An endodontist is required when discoloration is due to a non-vital tooth that requires root canal therapy or when there has been trauma to the tooth with subsequent death of the pulp.

• A prosthodontist is required when you need a complex aesthetic restoration such as veneers, crowns, etc. to completely restore your smile.

Emergency appointment is needed after an accident or injury resulting in a darkened tooth, in most cases within 24 to 48 hours, so that the dentist can evaluate the pulp tissue underneath the discolored tooth.

1. Why are my teeth yellowish when I brush my teeth 2 times per day?

Only brushing removes the soft plaque. Intrinsic dentin aging and genetics along with deeply absorbed dietary pigments require professional intervention.

2. Will scaling damage my tooth enamel?

Scaling by a dentist is performed using ultrasonic technology and high frequency vibration that safely breaks off hardened tartar without damaging the tooth structure.

3. Can turmeric stains from food be completely removed?

Yes, daily accumulation of stains from local food ingredients such as spices can be prevented with routine polishings and whitening toothpastes.

• Dental Fluorosis: Tooth discoloration due to excessive ingestion of fluoridated water prior to eruption.

• Pulpal Necrosis: Tooth death as a result of infection in the pulp of the tooth; this results in the tooth turning gray or black on the inside.

• Dental Sealants: A protective coating placed over your teeth where most cavities occur that is made of plastic. This helps prevent stains & decay.

• Fluoride Varnish Treatment: A professional application to help remove acid damage & create an invisible barrier to stop stains.

To keep your smile looking its best you need to have both good at-home oral hygiene habits and regular trips to the dentist for professional cleaning. Regular cleanings every six months will remove all extrinsic chromogens that attach to the enamel layer of your teeth so they do not become embedded in your enamel and therefore allow your teeth to remain healthy and stable-looking for years to come.