WHEN TO SEE YOUR DOCTOR
* One tooth or several teeth darken or turn gray or yellowish brown.
* A tooth turns reddish pink.
What Your Symptom Is Telling You
Perfectly white teeth may be just another Hollywood fantasy, but a lot of people are going around with teeth that could be whiter. The discoloration might be harmless and superficial, indicating nothing more than too much coffee, too much blueberry pie and too few visits to the dental hygienist. Or it might be a sign of tooth decay. It could also be the result of a pervasive (yet harmless) stain deep inside the teeth.
You might think that more brushing means whiter teeth. Not true, says Van B. Haywood, D.M.D., an associate professor in the Department of Operative Dentistry at the University of North Carolina School of Dentistry in Chapel Hill. Brushing cleans but doesn't remove stubborn stains. Scrubbing too hard and too frequently (particularly with abrasive polishes) can actually erode the white enamel covering your teeth, exposing the darker dentin beneath.
But other factors may steal the sparkle from your smile. Age is one that affects us all. Teeth quite naturally darken as you age. Over the years, the soft pinkish pulp at the core of teeth disappears, replaced by the darker dentin, Dr. Haywood says.
Age, just like blueberry pie, will alter the color of your teeth uniformly. If, though, a single tooth or a couple of teeth side by side turn darker (usually gray or yellowish brown), you probably have developed an abscess, a pus-filled infection. It is very likely that a root canal can be performed and the tooth can be saved, says Lisa P. Germain, D.D.S., M.Sc.D., an endodontist (a specialist in root canals) in private practice in New Orleans. If left to fester, an abscess can erode the bone holding the tooth in place and the tooth may have to be pulled.
Abscesses, which blacken the pulp inside a tooth, occur either because of a blow to the mouth or advancing decay. The blow doesn't even have to be recent, Dr. Germain says. "You could have been hit when you were a child and 20 years later suffer the effects." And there may not be accompanying symptoms—like a toothache or sensitivity to hot or cold foods.
A tooth also could begin to dissolve itself without reason, a process called internal resorption. If that occurs, Dr. Haywood says, the tooth likely will appear pink or reddish.
And what if all your teeth are dark? Chances are they're not all decayed, says William R. Howard, D.D.S., an assistant professor of dental hygiene in the Department of Allied Health at Western Kentucky University in Bowling Green. Besides stains from food and drink, the discoloration could be caused by certain medications.
"Antibiotics, especially tetracylines, are a really big problem," he says. If taken frequently in childhood or early adolescence, as they often are for infections and acne, tetracycline will color the dentin inside your teeth gray. And that grayness will show through the enamel. Children of women who take tetracyclines in the later stages of pregnancy also may have grayish teeth, Dr. Howard says.
Some people actually choose to have root canals done to whiten their teeth, Dr. Haywood says. "That certainly is a creative way to do it, but root canals should be used only as a final resort when the health of the tooth is at stake." Here are better ways to put a white wink on your smile.
Don't flub the scrub. Use a wet soft-bristle brush and a gentle touch when you clean your teeth, Dr. Haywood recommends. And don't forget to floss. While regular hygiene only minimizes, not eliminates, tougher stains, it will keep your smile looking good because it keeps your gums healthy.
"No matter how white your teeth are," says Dr. Haywood, "when your gums look unhealthy, your smile looks unhealthy."
Find promise in pumice. The most basic whitening job available from the dentist or dental hygienist is a pumice polish, which is applied with a small rotary rubber cup. While effective against superficial coffee and
Ask the dentist to reach for the bleach. The best way to whiten teeth is a bleaching system you can obtain through your dentist for use at home. At the office, you'll be fitted with a mouth guard (dentists call them splints) and given a prescription bleaching gel. You squeeze a couple of drops of the gel into the guard, which you wear several weeks for an hour or two each day or while sleeping. There's a small chance that the gel, which contains carbamide peroxide, similar to hydrogen peroxide, may burn or sting soft tissue in your mouth, but the treatment is generally safe and effective. But the cost is expensive—more than $200.
"The results can be dramatic," Dr. Haywood says. Teeth stained by tetracycline don't respond as well, though. "They definitely do get lighter, but it's a lighter shade of gray," he says.
Don't try this at home. You can buy over-the-counter whitening kits, but most dentists recommend that you don't try them. The active ingredient is hydrogen peroxide or something that breaks down into hydrogen peroxide in your mouth, Dr. Howard says. Repeated use of hydrogen peroxide may speed the development of oral cancers, especially in smokers. "Some of the stronger solutions also can really burn your mouth," he says.
Another ingredient, titanium dioxide, is little more than whitewash for your teeth, Dr. Haywood says. And in informal tests he has done, the commercial home kits "couldn't get teeth white even with 60 applications in some cases."
Put a cap on it. Or a plastic bonding or a porcelain veneer. For deeply stained teeth, you may want to opt for any of these decorative coverings that your dentist can apply. With bonding, you can color just a portion or all of a tooth as well as reshape it or fill in gaps. Porcelain veneers, which cover the whole tooth, look more natural but are more expensive. Caps, the most expensive alternative, cover all surfaces of the tooth—front, back, sides and top.