What Is It?
Your teeth can become discolored by stains on the surface or by changes inside the tooth. There are three main types of tooth discoloration:

• Extrinsic — This occurs when the outer layer of the tooth (the enamel) is stained. Coffee, wine, cola or other drinks or foods can stain teeth. Smoking also causes extrinsic stains.

• Intrinsic — This is when the inner structure of the tooth (the dentin) darkens or gets a yellow tint. You can get this type of discoloration if:
  • You had too much exposure to fluoride during early childhood.
  • Your mother used tetracycline antibiotics during the second half of pregnancy.
  • You used tetracycline antibiotics when you were 8 years old or younger.
  • You had trauma that affected a tooth when you were a young child. A fall, for example, may damage the developing permanent tooth.
  • You had trauma in a permanent tooth, and internal bleeding discolored the tooth.
  • You were born with a rare condition called dentinogenesis imperfecta. This causes gray, amber or purple discolorations.

• Age-related — This is a combination of extrinsic and intrinsic factors. Dentin naturally yellows over time. The enamel that covers the teeth gets thinner with age, which allows the dentin to show through. Foods and smoking also can stain teeth as people get older. Finally, chips or other injuries can discolor a tooth, especially when the pulp has been damaged.

Symptoms
Symptoms include stains on the enamel. They can range from white streaks to yellow tints or brown spots and pits. If the enamel has worn away, and dentin is showing through, you may notice a yellow tint.

Diagnosis
No special tests are needed. A dentist or other dental professional can diagnose tooth discoloration by looking at the teeth.

Expected Duration
Some tooth discoloration can be removed with professional cleaning. An example would be the stains caused by coffee. Many stains are permanent, however. Teeth sometimes can be whitened with a bleaching gel. In some cases, if the discoloration is severe, a crown or veneer may be required to cover it.

Prevention
Brushing your teeth after every meal will help to prevent some stains. Dentists recommend that you rinse your mouth with water after having wine, coffee or other drinks or foods that can stain your teeth. Regular cleanings by a dental hygienist also will help to remove surface stains.

Intrinsic stains that are caused by damage to a nerve or blood vessel in a tooth sometimes can be prevented. You may need to have root canal treatment to remove the inner part of the tooth (the pulp) before it has a chance to decay and darken. However, teeth that have root canal treatment may darken anyway.

To prevent intrinsic stains in children, avoid too much early exposure to fluorides. Once the enamel is formed, fluoride will not discolor teeth.

Treatment
Many extrinsic stains caused by food and drink can be removed by regular professional cleanings and home care. Good home care includes brushing, flossing and rinsing after meals.

Discoloration often can be removed by applying a bleaching agent to the tooth enamel. One technique is called “power bleaching.” With this method, the dentist applies a light-activated bleaching gel. It causes the teeth to get significantly whiter in about 30 to 45 minutes. Several follow-up treatments may be needed, or take-home bleaching trays may be provided.

It’s also possible to remove discoloration at home. You will use a bleaching gel and a mouth guard given to you by your dentist. The bleaching gels designed for use at home aren’t as strong as those applied by your dentist. This means that the process takes longer — usually two to four weeks.

You also can buy whitening products over the counter. They contain a weaker bleach than the products you can get from your dentist. The whitening agent is applied as a gel placed in a mouthpiece or as a strip that sticks to your teeth. Over-the-counter mouthpieces fit less securely than the kind you get from your dentist, but they will lighten your teeth over time.

Whitening toothpastes may remove minor stains. They do not actually change the overall color of your teeth.

If your tooth has darkened after a root canal, bleaching the enamel won’t help. Your dentist can apply a bleaching material to the inside of the tooth, or you may consider a crown or veneer.

Bleaching will not lighten some stains, such as tetracycline stains. In this case, your dentist may recommend covering the discolored areas. This also may be useful when the tooth is chipped or badly damaged.

A tooth can be covered with a color-matched composite bonding material. Another option is to get veneers. These are thin ceramic shells that cover the outer surfaces of the teeth.

When To Call a Professional
Tooth discoloration is mainly a cosmetic problem. Visit a dentist if you’re unhappy with how your teeth look. Any change in a child’s normal tooth color should be evaluated by a dentist.

Prognosis
The prognosis is very good for extrinsic stains. Intrinsic stains may be more difficult or take longer to remove.

Teeth are remarkably strong, but they can chip, crack (fracture) or break. This can happen in several ways:

• Biting down on something hard
• Being hit in the face or mouth
• Falling
• Having cavities that weaken the tooth
• Having large, old amalgam fillings that don’t support the remaining enamel of the tooth

When a tooth chips or breaks, it may not hurt. However, your tongue usually feels the sharp area quite quickly. Minor tooth fractures usually don’t cause pain, but if a large piece of the tooth breaks off, it can hurt. The nerve inside the tooth may be damaged. Extreme discomfort also can happen when nerve endings in the dentin are exposed to air, or to hot or cold foods or drinks.

Pain from a broken or cracked tooth may be constant or may come and go. Many people feel pain when they chew because chewing puts pressure on the tooth.

What You Can Do

Cracked (Fractured) Teeth
There is no way to treat a cracked tooth at home. You need to see your dentist. Sometimes the tooth looks fine, but it hurts only when you eat or when the temperature in your mouth changes (because you drank something hot or cold, for example). If your tooth hurts all the time, it may have a damaged nerve or blood vessels. This is a serious warning sign. You will know if you have a cracked tooth if it does not hurt to bite on the tooth, but pain occurs when you release the bite.

Broken Teeth
If you have a broken tooth, see your dentist as soon as possible. Your dentist can figure out if the break was caused by a cavity, and if the tooth’s nerve is in danger. A damaged nerve usually will require root canal treatment.

Until you get to the dentist’s office:

• Rinse your mouth well with warm water.
• Apply pressure with a piece of gauze on any bleeding areas for about 10 minutes or until the bleeding stops. If this doesn’t work, use a tea bag with pressure on the area to stop the bleeding.
• Apply a cold pack to the cheek or lips over the broken tooth. This will help reduce swelling and relieve pain.
• If you can’t get to your dentist right away, cover the part of the tooth that is in your mouth with temporary dental cement. You can find this at a drugstore.
• Take an over-the-counter pain reliever.

What Your Dentist Will Do

There are several types of tooth fractures and breaks, each of which requires different treatments. These include:

• Minor cracks —Also called “craze lines,” these are surface cracks that affect only the outer white surface of the tooth, called the enamel. Minor cracks rarely need treatment. However, your dentist may lightly polish the area to smooth out any rough spots.
• Cracked tooth — This type of fracture involves the whole tooth, from the chewing surface all the way down to the nerve. The pieces remain in place, but the crack gradually spreads. Cracks can sometimes be repaired with filling material. The tooth often will need a crown to prevent the crack from getting worse. If the pulp (nerve and other live tissues) is damaged, you may need a root canal as well.
• Chips — Minor chips don’t always need treatment. Your dentist may suggest repairing the damage with filling material to prevent it from getting worse or to make the tooth look and feel better. If the chip is very small, the dentist may polish and smooth out the chipped area.
• Broken cusp — These breaks affect the pointed chewing surfaces (the cusps) of the teeth. They usually do not affect the pulp and are unlikely to cause much pain. Your dentist may repair the damage to restore the tooth’s shape. Frequently, however, an onlay or crown will be required.
• Serious breaks — These breaks go deep enough to expose the nerve. They almost always cause the tooth to hurt and be sensitive. Usually, the broken part of the tooth will bleed. You will need root canal treatment to remove the exposed nerve and probably a crown to restore the tooth to normal function so you can eat and chew properly.
• Split tooth — This means that the tooth has split vertically into two separate parts. Some teeth, such as your back teeth (molars), have more than one root. It may be possible to keep one of the roots, which will then be covered with a crown. First, you will need root canal treatment. Second, the dentist will remove any roots that cannot be kept. Third, you will need a crown to cover the root and replace the tooth. In some cases, when a root cannot be saved, the tooth will have to be removed.
• Vertical breaks or split root —These cracks start in the root of the tooth and extend upward toward the chewing surface. These breaks are often painful because the area around the root may be inflamed or infected. In most cases, the tooth will have to be removed.
• Decay-induced break — In this case, the tooth has broken or crumbled because a cavity weakened it from the inside out. Your dentist will evaluate the cavity and recommend the best way to restore the tooth. In some cases, if the decay is extensive and goes down to the bone,the tooth may have to be removed.

What is gum disease?

Gum disease, or periodontal disease is a chronic inflammation and infection of the gums and surrounding tissue. It is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life. Periodontal diseases include gingivitis and periodontitis.

What causes gum disease?

Bacterial plaque – a sticky, colorless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. If plaque isn’t removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets that fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper, and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Are there other factors?

Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body’s ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body’s immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control. Pregnant women experience elevated levels of hormones that cause the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as “pregnancy gingivitis.”

What are the warning signs of gum disease?

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, pus between the gum and tooth, persistent bad breath, a change in the way teeth fit together when the patient bites and a change in the fit of dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That’s why patients are advised to get frequent dental exams.

What does periodontal treatment involve?

In the early stages of gum disease, most treatment involves a special cleaning called scaling and root planning, which removes plaque and tartar around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums – sometimes with the assistance of a laser – and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

How do you prevent gum disease?

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs.

What is the role of the general dentist?

The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, the patient will be referred to a periodontist. The dentist and periodontist will work together to formulate a treatment plan for the patient.

How can I maintain treatment at home?

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of periodontal therapy. Patients should visit the dentist every three to four months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, they should brush at least twice a day, floss daily and brush their tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, but don’t reach any further into the pocket than manual brushes. Proxy brushes (small, narrow brushes) and other interdental cleaners are the best way to clean between the recesses in the teeth and should be used once a day. Wooden toothpicks and rubber tips should only be used if recommended by your dentist.

What Causes a Toothache?

While decay often is cited as the primary cause of a toothache, it’s important for you to have a complete oral examination to determine the cause. Other dental causes of a toothache include: infection, gum disease, grinding teeth (bruxism), tooth trauma and an abnormal bite. Tooth eruption may be the cause of tooth or jaw pain in babies and school-age children.

TMJ, sinus or ear infections and tension in the facial muscles can cause discomfort that resembles a toothache, but often these health problems are accompanied by a headache. Pain around the teeth and the jaws can be symptoms of heart disease such as angina. If your dentist suspects a medical illness could be the cause of your toothache, he or she may refer you to a physician.

Why does my toothache?

You may have a dental cavity or advanced gum disease. The first sign of decay may be the pain you feel when you eat something sweet, very cold or very hot. If the pulp – the inside of the tooth that has tissue and nerves – has become irritated, this can cause pain in your tooth.

What are the symptoms of a toothache?

Because the symptoms of a toothache may resemble other medical conditions or dental problems, it can be difficult to diagnose the cause without a complete evaluation by your dentist. If you notice pus near the source of the pain, your tooth may have become abscessed, causing the surrounding bone to become infected. Or the pus could indicate gum disease, which usually is characterized by inflammation of the soft tissue and abnormal loss of bone surrounding the teeth.

Contact your dentist immediately if you have any of the following symptoms:

• Fever
• Difficulty breathing or swallowing
• Swelling around the tooth area
• Pain when you bite
• A foul-tasting discharge

How do I alleviate the pain if I cannot see my dentist right away?

Anyone with a toothache should see a dentist at once for diagnosis and treatment because, if left untreated, your condition can worsen. However, if you are unable to schedule an emergency appointment, a self-care treatment can temporarily alleviate pain and inflammation from a toothache:

• Rinse with warm salt water.
• Gently floss teeth to dislodge any food particles trapped between teeth.
• Take an over-the-counter pain reliever such as aspirin, ibuprofen or acetaminophen to relieve pain. If your child has a toothache, use acetaminophen.
• Never put aspirin or any other painkiller against the gums near the aching tooth, as it may burn the gum tissue.
• Apply an over-the-counter antiseptic containing benzocaine directly to the irritated tooth and gum to temporarily relieve pain. Direct application of oil of cloves (eugenol) may also help to numb the gums. The oil may be rubbed directly on the sore area or soak a small piece of cotton and apply it to the sore tooth.
• If there has been some trauma to the tooth, a cold compress may be applied on the outside cheek to relieve pain or swelling. If your tooth has been knocked out, forced out of position, loosened or fractured, visit the dentist’s office or a hospital emergency room immediately.

How can my dentist help?

Your dentist will conduct a complete oral examination to determine the location and cause of the toothache, looking for signs of swelling, redness and obvious tooth damage. He or she may also take X-rays looking for evidence of tooth decay between teeth, a cracked or impacted tooth or a disorder of the underlying bone – problems that the dentist may not be able to find through a routine exam.

Your dentist also may prescribe pain medication or antibiotics to speed the healing of your toothache. If, by the time you see your dentist, your tooth has become infected, then treatment could require removal of the tooth or a root canal procedure, which involves removing the damaged nerve tissue from the middle of a tooth.

Is there a way to prevent a toothache?

The key to preventing toothaches is establishing a regular oral hygiene routine and sticking to it. For example, failure to brush and floss regularly after meals can significantly increase your risk of developing cavities. After you eat, bacteria in your mouth feed on sugar and starch and produce acid that can “eat” a hole (or cavity) in your tooth’s enamel. If the cavity is not filled, it can cause considerable pain and potentially destroy the dentin, pulp and the tooth’s nerve.

Here are a few tips to help reduce your risk for developing a toothache:

• Brush at least twice a day, preferably after every meal and snack.
• Floss once a day to prevent gum disease.
• Visit your dentist twice a year for oral examinations and a professional cleaning.