The document discusses causes and treatment options for discolored teeth. It describes extrinsic staining caused by substances like coffee and tea that deposit on teeth. Intrinsic staining involves internal color changes and can be from local factors like pulp necrosis or systemic factors like tetracycline use. Bleaching options include internal bleaching using thermocatalytic or walking bleaching techniques after root canal treatment or external bleaching with mouth guard or chair side bleaching. Risks of bleaching include external resorption, damage to restorations, or chemical burns.

1. Bleaching of Discolored Teeth
Dr. Ashraf Refai
BDS MSc DD HMD
Al-Azhar University
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2. What options do we have?
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3. Causes of Discoloration
Extrinsic Intrinsic
Discoloration Discoloration
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4. Extrinsic Discoloration
Due to deposition of pigments or calculus
Causative factors
Coffee
Tea
Smoking
Doesn’t Need Bleaching – Needs Polishing
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5. Intrinsic Discoloration
Color changes of the internal tissues of the
teeth
• Discoloration after
Local tooth formation
• Discoloration during
Systemic tooth formation
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6. Intrinsic Discoloration
(Local Causes)
Patient related Dentist related
Pulp necrosis Endodontic related
• Remnants of pulp tissues left
• Root canal sealers
Intra-pulpal Hemorrhage • Intral canal medicaments
Calcific metamorphosis Restoration related
• Amalgam
• Pins & posts
Age
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7. Intrinsic Discoloration
(Systemic Causes)
• Tetracyline staining
Drug related • Endemic fluorosis (>4 PPM)
• Enamel hypoplasia
Developmental • Enamel hypocalcification
defects • Erythroblastosis Fetalis (RH factor)
Metabolic • Porphyria
diseases
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8. Necrotic Tooth
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9. Fluorosis

10. Tetracycline Staining

11. Hypocalcification

12. Bleaching Agents
Hydrogen
peroxide 35% • Nascent oxygen
(Superoxol)
• Sodium metaborate
Sodium perborate • Hydrogen peroxide
• Nascent oxygen
• Urea
Carbamide • carbon dioxide
peroxide 10% • hydrogen peroxide.
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13. Bleaching Techniques
Internal External
Bleaching Bleaching
Thermocatalytic Mouth Guard
technique bleaching
Walking Chairside
bleaching bleaching
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14. INTERNAL BLEACHING
THERMOCATALYTIC
TECHNIQUE
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15. Internal Bleaching (Thermocatalytic Bleaching)
• Done after root canal treatment
• Tooth is polished
• Temporary filling is removed
• Cavity is irrigated and dried
• Remove coronal gutta-percha
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16. Internal Bleaching (Thermocatalytic Bleaching)
• Place cement in the chamber
• Flush pulp chamber
• Apply vaseline to protect gum tissues
• Place the rubber dam
• Record the tooth shade
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17. Preparation for
Bleaching

18. Internal Bleaching (Thermocatalytic Bleaching)
• Place cotton pellet with bleaching agent
• Apply bleaching lamp or heat
• Check shade
• Process is repeated until appropriate
shade is reached
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19. Thermocatalytic Bleaching

20. Thermocatalytic Bleaching

21. INTERNAL BLEACHING
WALKING BLEACHING
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22. Internal Bleaching (Walking bleaching)
• Same procedure as for thermocatalytic
technique
• Mix sodium perborate with inert liquid or
anesthetic solution
• Place in the cavity and cover with
cement
• Repeat every 1-2 weeks till desired
shade is reached
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23. Adverse Effects of Bleaching
External Resorption
Damage to Restorations
Chemical Burn
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24. Adverse Effects of Bleaching
• Cervical resorption may occur
• 2 Theories:
– Diffusion through dentinal tubules
– Combination of heat with chemical may
cause cementum necrosis with
inflammation of the periodontal ligament
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25. External Resorption

26. Adverse Effects of Bleaching
External Resorption
Damage to Restorations
Chemical Burn
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27. External vs Internal Bleaching
• Use for vital teeth
• Used on the labial surface of the teeth
• Less effective than internal bleaching
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28. EXTERNAL BLEACHING
MOUTH GAURD BLEACHING
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29. Mouth Guard Bleaching
• Used for mild cases
• Active ingredient is 10%-15%
carbamide peroxide
• Decomposes in hydrogen peroxide
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30. Mouth Guard Bleaching
• 1st visit
– Polish the teeth
– Alginate impressions are taken
– A stone cast is poured
– Die relief is done
– Fabrication of the plastic mouthgaurd
(Vaccum formed)
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31. Mouth Guard Bleaching
• 2nd visit
– Take shade
– Fill mouth guard with bleaching gel
– Train the patient to use the system
– Used for 3-4 hours a day
– Explain possible side effects
– Treatment time up to a few weeks
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32. Different Bleaching Agents
Natural White
Karisma
Opalescence
White Brite
White & Brite Nite White
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33. EXTERNAL BLEACHING
CHAIR SIDE BLEACHING
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34. Chair Side Bleaching
• Photo activated or Laser activated
• Higher concentrations of peroxides
• Used for short periods of time
• Activated with light
• Zoom bleaching
• Side effects
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35. THANK YOU
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