internal tooth whitening

Tooth discoloration is a common dental concern for people seeking a brighter smile. While external or surface stains can be treated with traditional teeth whitening methods, internal tooth discoloration requires a specialized approach known as internal tooth whitening. This technique targets the deep, intrinsic stains within the tooth, offering a solution for discoloration that cannot be remedied with conventional bleaching methods. In this comprehensive guide, we will explore the causes of internal tooth discoloration, the internal whitening procedure, its benefits, risks, and aftercare recommendations.

 

Understanding Tooth Discoloration

Tooth discoloration can broadly be classified into two categories: extrinsic and intrinsic stains.

Extrinsic Stains

These are surface stains that occur on the outer layer of the teeth (enamel). They are often caused by the consumption of staining substances like coffee, tea, red wine, tobacco, and certain foods. Extrinsic stains are easier to treat with conventional teeth whitening methods such as over-the-counter whitening strips, toothpaste, or professional bleaching treatments.

Intrinsic Stains

Intrinsic discoloration, on the other hand, occurs within the tooth’s inner structure, known as the dentin. This type of stain is more challenging to address because it is not just a surface-level issue. Intrinsic stains can be caused by a variety of factors, including trauma, certain medications, aging, and even previous dental treatments like root canals. Since the discoloration lies deep within the tooth, standard whitening procedures are often ineffective in treating intrinsic stains, making internal whitening a more viable option.

 

Causes of Internal Tooth Discoloration

Several factors can contribute to intrinsic tooth discoloration, necessitating internal tooth whitening. The most common causes include:

  • Trauma or Injury
  • Root Canal Treatment
  • Medications
  • Fluorosis
  • Aging

 

Trauma or Injury

Physical trauma to a tooth can cause damage to the pulp, leading to a condition called pulp necrosis. When the pulp (the innermost part of the tooth containing nerves and blood vessels) becomes damaged or dies, it can cause the tooth to darken. This can result in a gray, brown, or black appearance of the tooth.

Root Canal Treatment

While root canals are essential for treating infected or damaged teeth, they can sometimes result in discoloration over time. This is because the removal of the tooth’s pulp can leave the tooth vulnerable to changes in color as it is no longer receiving nourishment from the body.

Medications

Certain antibiotics, such as tetracycline, can cause intrinsic stains when taken during childhood, while the teeth are still developing. These stains are often deep and present a challenge for surface-level treatments.

Fluorosis

Excessive exposure to fluoride during the development of teeth can lead to a condition called fluorosis, which causes white spots or brownish discoloration on the teeth. In severe cases, the stains can penetrate deeper into the tooth.

Aging

As we age, the enamel on our teeth naturally thins, revealing the underlying dentin. Dentin is more yellow than enamel, and its exposure can cause the teeth to appear discolored over time.

 

What is Internal Tooth Whitening?

Internal tooth whitening, also known as “intracoronal bleaching” or “non-vital bleaching,” is a cosmetic dental procedure specifically designed to address intrinsic stains. Unlike external whitening techniques that focus on the outer enamel, internal whitening involves placing a bleaching agent directly inside the tooth to lighten the internal structure.

This treatment is most commonly performed on non-vital teeth, which are teeth that have undergone a root canal and no longer contain living tissue. In some cases, it may also be used on teeth that have not had root canal therapy but have experienced discoloration due to trauma or other intrinsic factors.

 

Internal Tooth Whitening Procedure

The internal whitening process involves a few key steps, all of which require the expertise of a dental professional. Here’s a breakdown of the procedure:

  1. Examination and Diagnosis
  2. Accessing the Tooth’s Interior
  3. Placement of the Bleaching Agent
  4. Temporary Filling
  5. Evaluation and Reapplication

 

Examination and Diagnosis

Before proceeding with internal whitening, the dentist will conduct a thorough examination of the discolored tooth to determine the underlying cause of the stain. This may include taking X-rays to assess the health of the tooth’s root and ensure that there is no active infection or other issues that would contraindicate whitening.

Accessing the Tooth’s Interior

Once the dentist confirms that the tooth is suitable for internal whitening, they will need to access the tooth’s internal chamber. For teeth that have undergone a root canal, this involves reopening the access point that was created during the root canal procedure. If the tooth has not had a root canal, the dentist may need to perform one before proceeding with whitening, as internal bleaching is typically performed on non-vital teeth.

Placement of the Bleaching Agent

After accessing the tooth’s interior, the dentist will carefully clean the chamber to remove any debris or old filling material. A bleaching agent, usually a solution of sodium perborate or hydrogen peroxide, is then placed inside the pulp chamber.

The bleaching agent works by breaking down the pigmented molecules that have caused the tooth to discolor. It is typically left inside the tooth for several days to allow the whitening process to take effect.

Temporary Filling

To protect the tooth and keep the bleaching agent in place, the dentist will seal the tooth with a temporary filling. The patient is then sent home and instructed to return after a few days for follow-up treatment.

Evaluation and Reapplication

When the patient returns to the dental office, the dentist will evaluate the results of the internal whitening. If the tooth has lightened to the desired shade, the temporary filling will be removed, and a permanent filling will be placed to seal the tooth. In some cases, the dentist may need to reapply the bleaching agent for additional sessions if the tooth has not reached the desired level of whiteness.

 

Advantages of Internal Tooth Whitening

Internal tooth whitening offers several benefits for individuals dealing with intrinsic tooth discoloration:

  • Effective for Deep Stains
  • Conserves Tooth Structure
  • Non-invasive Solution for Root Canal Teeth
  • Customizable Results
  • Minimizes the Need for Restorative Dentistry

 

Effective for Deep Stains

Internal whitening can reach stains that are embedded deep within the tooth’s structure, which are resistant to external whitening methods.

Conserves Tooth Structure

Unlike procedures such as veneers or crowns, internal whitening does not require significant removal of the tooth’s enamel or dentin. This makes it a more conservative cosmetic option.

Non-invasive Solution for Root Canal Teeth

Teeth that have undergone root canals often become discolored over time. Internal whitening can restore the appearance of these teeth without the need for more invasive treatments like crowns.

Customizable Results

The dentist can control the level of whitening by adjusting the number of applications or duration of the treatment, allowing for customized results that meet the patient’s aesthetic preferences.

Minimizes the Need for Restorative Dentistry

In many cases, internal tooth whitening can eliminate the need for more invasive restorative treatments like crowns or veneers, saving patients time, money, and the need for more extensive procedures.

 

Risks and Considerations of Internal Whitening

While internal tooth whitening is generally considered safe and effective, there are some risks and considerations to be aware of:

  • Tooth Sensitivity
  • Fragility of Non-Vital Teeth
  • Risk of Re-discoloration
  • Not Suitable for All Types of Discoloration
  • Multiple Sessions May Be Required

 

Tooth Sensitivity

As with any bleaching procedure, internal whitening can cause temporary tooth sensitivity. However, this is typically less common than with external bleaching methods because the whitening agent is placed inside the tooth rather than on the surface.

Fragility of Non-Vital Teeth

Non-vital teeth that have undergone root canal treatment may be more brittle than vital teeth. While internal whitening is generally safe for these teeth, there is a slight risk of further weakening the tooth structure. In some cases, the dentist may recommend a crown to protect the tooth after whitening.

Risk of Re-discoloration

Internal whitening can provide long-lasting results, but there is always a possibility that the tooth may darken again over time, particularly if the underlying cause of the discoloration, such as trauma or medication, persists. However, touch-up treatments can be performed if necessary.

Not Suitable for All Types of Discoloration

Internal whitening is most effective for treating teeth that have been discolored due to trauma or root canal treatment. It may not be as effective for teeth that have been stained by certain medications, such as tetracycline, or by other factors like fluorosis.

Multiple Sessions May Be Required

Depending on the severity of the discoloration, multiple sessions of internal whitening may be necessary to achieve the desired results. This can extend the overall treatment time.

 

Aftercare and Maintenance

To prolong the results of internal tooth whitening and maintain a bright, healthy smile, patients should follow proper aftercare and maintenance practices:

  1. Maintain Good Oral Hygiene: Brushing twice a day with a fluoride toothpaste and flossing daily can help prevent the buildup of stains and maintain the results of whitening.
  2. Avoid Staining Foods and Beverages: After whitening, it’s important to limit the consumption of foods and drinks that can stain teeth, such as coffee, tea, red wine, and dark-colored sauces.
  3. Regular Dental Checkups: Regular visits to the dentist for cleanings and examinations can help monitor the health of whitened teeth and address any issues before they become more severe.
  4. Consider Touch-Up Treatments: Over time, some patients may notice slight discoloration returning. If this occurs, a touch-up internal whitening treatment may be recommended to maintain the desired shade.

 

Who Is a Good Candidate for Internal Tooth Whitening?

Internal tooth whitening is a specialized treatment designed for individuals with specific dental concerns. It is essential to determine whether someone is an ideal candidate before proceeding with the procedure. Here are the key factors that define suitability for internal whitening:

  • Root Canal Treated Teeth
  • Teeth Affected by Trauma
  • Isolated Discoloration
  • Healthy Gums and Oral Health
  • Patients Seeking Non-Invasive Cosmetic Solutions

 

Root Canal Treated Teeth

The most common candidates for internal whitening are patients with teeth that have undergone a root canal. Root canal therapy removes the tooth’s pulp, leaving the tooth susceptible to discoloration over time. Internal whitening can restore the tooth’s appearance without the need for extensive restorations like crowns.

Teeth Affected by Trauma

If a tooth has experienced trauma—such as a blow to the face—it may darken due to pulp necrosis (death of the tooth’s nerve and blood supply). Internal whitening can address this issue by targeting the darkened dentin beneath the enamel.

Isolated Discoloration

Internal whitening is usually recommended when the discoloration is limited to one or a few teeth. Patients with general staining across all teeth may benefit more from external whitening methods, as internal whitening is focused on specific problem areas.

Healthy Gums and Oral Health

Before undergoing internal whitening, patients should have healthy gums and a mouth free of active infections or serious decay. The dentist will perform a thorough examination to ensure that the tooth is structurally sound and ready for treatment.

Patients Seeking Non-Invasive Cosmetic Solutions

Internal tooth whitening offers a less invasive alternative to restorative options like crowns or veneers. Patients who prefer a conservative approach to tooth enhancement, without altering the tooth’s natural structure, often find internal whitening to be the ideal solution.

 

Alternatives to Internal Whitening

While internal tooth whitening can be highly effective for treating intrinsic stains, it may not be suitable for everyone. In such cases, there are alternative cosmetic dental treatments that can help improve the appearance of discolored teeth:

  • Dental Crowns
  • Ceramic Veneers
  • External Teeth Whitening
  • Composite Bonding

 

Dental Crowns

A crown is a tooth-shaped cap that fits over the entire tooth, effectively covering any discoloration. Dental crowns are often used when the tooth is severely discolored or damaged. While crowns provide long-lasting results, they require more invasive preparation, as a portion of the tooth’s natural structure must be removed to accommodate the crown.

Ceramic Veneers

Veneers are thin shells made of porcelain or composite resin that are bonded to the front surface of the teeth. Ceramic veneers can provide a natural-looking and long-lasting solution for teeth that are severely discolored, misshapen, or otherwise cosmetically flawed. Like crowns, veneers involve some removal of the tooth’s enamel.

External Teeth Whitening

For patients with extrinsic stains (surface-level discoloration), external whitening treatments such as professional bleaching trays or in-office laser treatments may be more appropriate. These treatments work well for stains caused by food, drinks, smoking, or poor oral hygiene.

Composite Bonding

In cases of minor discoloration, composite bonding can be used to improve the tooth’s appearance. The dentist applies a tooth-colored resin material to the surface of the tooth, which can be sculpted and polished to blend in seamlessly with the surrounding teeth.

 

Managing Expectations: Results and Longevity of Internal Whitening

As with any cosmetic dental procedure, it is essential for patients to have realistic expectations about the results and longevity of internal tooth whitening. While internal whitening can dramatically improve the appearance of discolored teeth, the following points should be kept in mind:

  • Results May Vary
  • Longevity of Results
  • Multiple Treatments May Be Required
  • Touch-Ups and Maintenance

 

Results May Vary

The outcome of internal whitening depends on the cause and severity of the discoloration. In most cases, patients see a significant improvement in the color of the treated tooth, but the final result may vary depending on how deeply stained the tooth was initially.

Longevity of Results

Internal whitening can offer long-lasting results, especially when proper aftercare is maintained. However, depending on the underlying cause of the discoloration, the tooth may gradually darken again over time. For example, a tooth that was discolored due to trauma may become darker again if further damage occurs, while a root canal-treated tooth may remain stable for many years.

Multiple Treatments May Be Required

In some cases, patients may need multiple internal whitening sessions to achieve their desired results. This is particularly true for teeth with severe or longstanding discoloration. The dentist will monitor the tooth’s progress and recommend follow-up treatments as needed.

Touch-Ups and Maintenance

Just like external whitening treatments, internal whitening may require occasional touch-ups to maintain the brightness of the tooth over time. The frequency of touch-ups depends on the patient’s lifestyle, oral hygiene habits, and the nature of the initial discoloration.

 

Achieving a Brighter, Healthier Smile

Internal tooth whitening is a transformative cosmetic dental procedure designed to address stubborn intrinsic discoloration that external whitening methods cannot reach. By treating the root cause of the discoloration deep within the tooth, this procedure offers a safe, minimally invasive, and highly effective solution for patients seeking to restore the natural beauty of their smiles.

Although it is typically reserved for non-vital teeth or teeth affected by trauma, internal whitening provides a customized approach that preserves tooth structure while delivering noticeable results. As with any cosmetic procedure, it is crucial for patients to consult with a qualified dental professional to determine the best course of action for their unique situation.

Whether you are dealing with the aftermath of a root canal, a traumatic injury, or long-standing intrinsic stains, internal tooth whitening can be a powerful tool in your quest for a radiant smile. With proper care and maintenance, the results of internal whitening can last for many years, allowing you to enjoy the confidence and aesthetic benefits of a brighter, whiter smile.