Tooth whitening made simple in combination with TrioClear™

The success of tooth whitening depends largely on the type of staining present. Intrinsic staining is discolouration that is incorporated into a tooth, either while the tooth is developing, or after it has erupted – this stain cannot be removed by prophylaxis.

Some of the main causes of intrinsic staining are excessive fluoride intake over the period that the tooth develops. The resulting fluorosis manifests itself as either white and chalky enamel, or brown staining. Either way, bleaching can be used in most cases to reduce the contrast of the mottled enamel and improve the appearance.

Another major cause of intrinsic staining is use of the antibiotics, tetracycline and minocycline. These impart a blue-grey banding on the teeth. Severity of staining will differ depending on the type and duration of use. In both cases the staining is similar, however, minocyucline can stain teeth both during development and after eruption. Prolonged whitening is usually required in these cases, but more often thant not, it must be used in combination with bonding or veneers to get a satisfactory result.

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The most common cause of intrinsic staining is trauma which manifests itself in a two-fold process. Firstly, inflammation of the pulp causes hemorrhage into the dentinal tubules to give the tooth a pinkish tinge. The haemoglobin then breaks down to iron sulfide to give a dark black colour. This type of staining responds well to prolonged whitening. Likewise, if a tooth becomes necrotic secondary to trauma, a similar process occurs. However, treatment in this case must include root canal treatment to remove the necrotic material.

Other common causes of intrinsic staining are hereditary. Imperfections in the formation of either enamel or dentin can cause discouloured teeth. both amelogenisis and dentinogenesis imperfecta, along with enamel hypoplasia are examples of hereditary causes of intrinsic staining. Diseases like porphyria can also cause discoloured teeth due to excess porphyrins in the blood during mineralization of the teeth. Affected teeth are usually pinkish brown.

Age also causes intrinsic discolouration of teeth. This is due to changes in the physical compostition of the tooth. Over time, layers of enamel are lost, exposing the darker underlying dentine. Sclerosis and secondary dentine can often take on a darker hue, which also contributes to age related discolaration.