Dental Education Lecture: Bleaching for Tetracycline Teeth
Mr. Wang has Tetracycline teeth as shown on your right side. One of them (bottom front tooth) is particularly yellowish (Fig.1, white arrow). The tooth had injury when he was in high school and had root canal done several years ago. To make the situation worse, Mr. Wang does not floss regularly. Tartar (black arrow) and stain (red arrow) develops between the teeth, 5 months after deep cleaning. The portion of our teeth is the most yellowish near the gum line, i.e., below the red arrow in Fig.1. With the aid of a large reflecting mirror, more tartar and stain is visible on the tongue side of the bottom teeth (Fig.2). There is a white filling (F) on the most yellowish tooth. There is a big gap as indicated by arrow (Fig.2). Bacteria may enter the gap to re-infect the tooth. So we need a new filling. Besides it is the best time to whiten the tooth after taking out the old filling and before placing the new filling. The most important of all is that we need to do cleaning again. The patient agrees the treatment plan.
Here we go. We clean all the teeth in the mouth thoroughly, take out the old filling and start in-office internal and external bleaching on this particular tooth. The result is shown in Fig.3.
To get maximum results, Mr. Wang is doing at home internal bleaching for the bottom tooth and external bleaching for the front teeth for 2-3 weeks. We keep the hole on the tongue side open (Fig.4) while he is doing his homework. Finally we fill the hole with a white filling. The final results are shown in Fig. 5 (front view) and Fig.6 (front view plus back view through a mouth mirror). It is the most striking that after the filling, the used-to-be most discolored tooth is the brightest as viewed from the back, Fig.6).
Since discoloration of Tetracycline teeth is from the inside the teeth, we sometimes need to do elective root canal, internal bleaching and white filling for the involved teeth. Although it is a little aggressive treatment, results are dramatic and certain.
Xin Wei, DDS, PhD, MS 1st edition 03/20/2010, last revision 04/01/2010