Rescuing a "Dead Tooth" with Internal Whitening
Necrotic teeth can turn a dull, dark color. But these teeth can be whitened from the inside-out. Here's how it works.
Patients often ask me about crowns and veneers to improve the appearance of a discolored tooth. Commonly referred to as “dead teeth”, they have usually darkened over time due to an accident or other type of trauma.
I’d like to highlight a conservative and effective approach to restoring teeth in this condition without a crown or veneer!
What causes a dead tooth?
The innermost layer of a tooth is called the pulp, and contains the blood supply and nerve tissue. When this layer is damaged, due to a deep cavity or a traumatic accident, the tissue inside the pulp can die, resulting in what we call pulpal necrosis.
In addition to causing a cosmetic issue due to dark discoloration, this condition can be dangerous because it leads to an infection in the root of the tooth, which can increase in size and severity over time, often resulting in a very painful and potentially life-threatening abscess.
How can I fix a dead tooth?
First, the necrotic tissue must be removed to allow the infection to heal. This requires a procedure called a root canal, in which the pulp is cleaned away and the area is disinfected. This prevents further infection, but is not always enough to restore the natural color or shape and function of the tooth.
The back teeth, or molars and premolars, usually require a crown in order to protect them from fracturing over time after a root canal. But with front teeth, this is not always necessary. In today’s case, this tooth was treated with internal whitening.
What is Internal Whitening?
Necrotic teeth often have staining deep within them that cannot be improved by the usual, external application of whitening material. Rather than drilling away healthy tooth structure and covering the tooth with a crown, these teeth can often be restored to their natural color, or very close to it, with internal whitening.
In this procedure, a small opening is made in the back of the tooth. This is usually already done in order to perform the root canal. A whitening medication is placed inside the tooth and covered with a temporary filling. After two weeks, this step is repeated, sometimes twice, before a permanent filling is placed to close the opening.
Occasionally, the tooth may darken again over time, in which case the process may need to be repeated, or a crown or veneer can be considered.
This tooth was treated with a root canal and about 4 weeks of internal whitening. My patient was thrilled that he did not need a crown or veneer after all!