Dental Education Lecture: Silver Stain
Mr. Chen has an abscessed front tooth (Fig.1: #8). The arrowhead points to the abscess at root tip. The tooth is yellowish as compared to its neighboring relatively normal-looking tooth, #7. Exam shows that the nerve of tooth #8 is dead. Root canal is needed for this tooth. The other neighbor, #9, has silver stain. Fig.2 shows that silver stain is band-like (pointed by double arrowheads). When he opens his mouth, we can see that the tooth #9 has silver filling on the tongue side. Silver filling has two major parts: mercury and silver. The small black molecules of mercury and silver may penetrate the tooth and cause the tooth, i.e., #9 in this case, to turn black and dark. We plan to address discoloration issue of the teeth #8 and 9.
First, we finish root canal for #8, and remove discolored white filling (arrowhead) from the tooth #8 and silver filling from the tooth #9 (compare Fig.2/3 with Fig.4/5). It looks like that both #8 and 9 improve in color. Spaces (* Fig.5) are made for so-called internal bleaching.
Second, in office external and internal bleaching further lightens the teeth #8 and 9. At this moment, the shade of #8 appears to be lighter than #7 (Fig.6 as compared to Fig 1).
Third, white filling (F and arrowheads, Fig.7/8) is used to close the spaces and voids. Silver stain seems to be very difficult to get rid of. So we should try to avoid using silver filling for the front teeth and remove it as soon as possible before damage is done. Cosmetic crown is most likely the best solution for the case introduced here.
Xin Wei, DDS, PhD, MS 1st edition 03/30/2010, last revision 03/31/2010