This article and pictures were originally published to discuss crack tooth and immediate implant. This time we use the same pictures to discuss stain.

Mr. Weng has had habit eating something tough.  His teeth easily crack. He has a lot of crowns (Fig.1: #3,4) and implants (Fig.3: #3/I) to repair the cracks. One day, he came to our office for emergency, because another tooth cracked (#5 white arrowhead) all the way underneath gum line, causing bleeding (black arrowhead).  He could not eat with this tooth.  The loose part (*) should be removed.  You may notice that there is a lot of heavy stain, particularly between the teeth and along the gum line. 

The nerve was exposed after loose part removal (Fig.2 <).  The tooth was sensitive.  The whole tooth should be removed.  You may notice that the stain was not so bad now, because cleaning was just done when the loose part of the tooth was removed. To save time and surgical trauma, an implant was placed immediately after gentle extraction (Fig.4: I, as compared to Fig.3 before extraction).

Fig. 5 (photo) was taken one week after placement of implant (arrow).  The sutures had not been dissolved. 

Fig.6 was taken three months after implant placement.  The wound had healed around the implant (arrow); the suture had been gone.  Fig.5 and 6 do not show apparent stain, because stain is much less on the cheek side of his teeth.  Cleaning is done every time, before photos are taken.

Finally Mr. Weng has a new tooth (Fig.7 C: crown; 3 months after cementation).  The patient has had no problem in chewing with the new tooth for 9 months (Fig.8: #5), although there is light stain between the teeth (<),  The patient does not care about the latter as long as he can eat.  In fact he improves oral hygiene a lot.  Every day he uses first regular toothbrush, then floss and microbrush to clean between teeth, and last electric toothbrush.  The stain is not so bad anymore and much easier for us to clean.

Tooth stain is produced by a special type of bacteria in our mouth.  The stain is usually harmless, although it is a cosmetic issue.  It may be very tenacious and difficult to remove by the patient and the professional.  If you have heavy stain, we may have to do deep cleaning in office first and do more or less regular cleaning more frequently, i.e., every three months instead of six months.  At home you should as hard as Mr. Weng.  The more time we spend for cleaning at home and in office, the less the stain remains.  If you have tenacious stain, the professional may not be able to remove it completely due to time limitation.  Even if we have unlimited time, the patient may not be able to tolerate opening the mouth for so long.  He or she may have dislocated joint or TMJ pain.  The professional has right to stop cleaning at some point of time for mutual benefits.  Super-cleaning may do more harm than good.

Xin Wei, DDS, PhD, MS 1st edition 12/18/2011, last revision 09/27/2012