Management of Discolored Tooth By Prof Dr. Asit Vats - Dentist in Sector 75, Noida



Before managing  a discoloured tooth  the cause of the discoloration (vital vs non-vital, extrinsic vs intrinsic) should be known clearly.
Best Dental Surgeon in Sec 75, Noida

Below is a clear, clinically oriented approach.

1. Determine the Cause
A. Extrinsic Staining
Caused by coffee/tea, tobacco, chlorhexidine, etc.
  • Appears on the surface, can be removed with prophylaxis.

B. Intrinsic Staining of a Vital Tooth
Causes:
  • Fluorosis
  • Tetracycline staining
  • Trauma (vital tooth may darken)
  • Age-related dentine thickening
  • Developmental defects (amelogenesis imperfecta).

C. Intrinsic Staining of a Non-Vital Tooth
  • Trauma causing pulp necrosis
  • Endodontically treated teeth
  • Haemorrhage inside pulp chamber

2. Management of staining/discolouration 
A. Extrinsic Staining
  1. Scaling and polishing- It can be done both manually or by ultrasonic 
  2. Air-polishing (prophy-jet)
  3. Oral hygiene improvement
  4. Dietary counselling – reducing the use of products such as pan masala , tea, coffee etc.

B. Intrinsic Discoloration (Vital Teeth)
1. Vital Bleaching
  • In-office bleaching (35–40% hydrogen peroxide)
  • At-home bleaching with custom trays (10–16% carbamide peroxide)
  • Suitable for mild–moderate intrinsic stains
  • Tetracycline staining may need prolonged treatment or veneers.

2. Microabrasion
  • For superficial enamel discoloration/white spots
  • Uses pumice + 6–18% hydrochloric acid slurry
  • Often combined with bleaching.

3. Composite Veneers / Porcelain Veneers
Used for severe fluorosis, tetracycline staining, or enamel defects

Dental veneers are thin, custom-made shells placed on the front surface of teeth to improve appearance. They are of two types.

a. Direct Veneers
  • Done chair side in one visit using composite resin.

b. Indirect Veneers
  • Fabricated in a laboratory (porcelain or indirect composite)
  • Require multiple visits.

4. Full-Coverage Crowns
  • Last resort for severely compromised aesthetics

C. Intrinsic Discoloration (Non-Vital Teeth)
1. Confirm Pulp Status
  • Radiographs
  • Pulp tests
  • Check for periapical pathology.

2. Endodontic Treatment (if necrotic)
  • If the tooth is non-vital and untreated, root canal treatment is required first.

3. Internal Bleaching (Walking Bleach Technique)
  • Place sodium perborate + water or carbamide peroxide in pulp chamber
  • Seal temporarily and repeat every 1–2 weeks
  • Indicated for darkened non-vital teeth with no root canal filling leakage.

4. Thermocatalytic Bleaching 
  • Heat + peroxide; not recommended due to external root resorption risk.

5. Veneer or Crown
  • Used if bleaching is unsuccessful
Summary Table
Cause                 First-line Treatment    Alternatives
Extrinsic stains   Scaling + polishing      Air-abrasion
Mild intrinsic (vital)  Vital bleaching       Microabrasion
Severe vital staining  Veneers                 Crowns
Non-vital discoloration RCT +bleaching Veneer/crown


Article Compiled By: 
Prof Dr. Asit Vats
BDS, MDS (Conservative Dentistry & Endodontics)

Dental Place

EF-47, First Floor, Spectrum Metro Phase 2, Sector - 75, Noida 201301.