Brown discoloration on front teeth.

I am in my early twenties, and I have always taken really good care of my teeth. Ever since my adult front teeth came in, they have been discolored and brown. I can’t remember who told me this, but I’ve always had the idea that this was because I was extremely ill when I was very young, and the discoloration was caused by the fever.

At the recommendation of my dentist, I’ve tried every whitening product on the shelf, but the situation just keeps getting worse. The areas around the spots are getting whiter, while the spots are getting darker. When I brought this to my dentist’s attention, he said he could try to grind away the material of my tooth until the discoloration is gone. I don’t claim to be a dentist, but this sounds like a terrible idea! He has no idea how much he might have to grind, and I have this horrible mental image of a mouth full of misshapen lumps where my teeth used to be.

Please help me figure out an alternative. Would professional teeth whitening help where the over-the-counter products have failed? I admit, I am pretty obsessed with getting this fixed. I hate my teeth. They create the wrong impression, and I feel like they are hurting my efforts to get a job. I just graduated from college (summa cum-laude) and my confidence is at an all-time low.

Please help.

Brianna from Charleston, SC

Dear Brianna,

You are wise to be uncomfortable with your dentist’s suggestion to grind away at your teeth. Not only will this probably still be ineffective at removing the spots, but he could do considerable irreversible damage to your teeth, too. I strongly suggest you seek the services of an accredited, experienced cosmetic dentist. You should not have to continue to be part of your dentist’s learning curve regarding stains and teeth whitening products.

If all those over-the-counter products did not work for you, it is extremely unlikely that a professional teeth whitening procedure will work. Both systems use the same whitening agents—the at-home systems just take more time. When your first attempts were not successful, your dentist should have been able to tell you that.

Depending on the kind and degree of severity of the spots, there is a chance that a procedure called “microabrasion” could help. If not, other treatment options open to you include dental bonding or porcelain veneers. Both procedures should absolutely only be done by an accredited, experienced cosmetic dentist.

Most general dentists are not at all qualified to do this kind of work, so it is very important that you locate the right dentist to help you.

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Bleaching natural teeth without damaging porcelain veneers

Are there any over-the-counter whitening products that are safe to use with porcelain veneers? I have six veneers that were placed several years ago. The veneers still look fantastic, but my other teeth have yellowed, and the difference is really noticeable.

Thanks for your advice,

Neil in Bethesda, MD

Dear Neil,

There are only a few teeth whiteningproducts that would be appropriate in this situation. Crest Whitestrips or other products that are similar are the only products I would consider both safe and effective. The active agent in the whitestrips is peroxide, which needs to be left on the teeth to penetrate and whiten them. The strips do a pretty good job, usually.

Whitening toothpastes, which are only on the teeth briefly, really don’t do anything at all. Some whitening products can actually make the problem worse over time. They contain acids that slightly etch the surface of your teeth, which allows the white pigment in the second step of the treatment to adhere to your teeth. Tests indicate that these products actually damage your teeth, and when the pigment wears away, the roughened enamel will pick up even more staining, making your teeth darker than they were before the treatment. If you are going to do this yourself, I would strongly suggest sticking with only the whitestrips type products.

There are, however, several reasons the whitestrips might not work for you. First, they are designed to work on the front six teeth, which are the teeth you have veneers on. You could try trimming them to fit, but you might wind up with strange gaps and uncovered areas. The whitestrips also take quite a while to really show dramatic results, as the peroxide solution that is legal to sell over the counter is so much weaker than  what is used in a dentist’s office. This could mean purchasing quite a few kits, and quite a lot of your time spent messing around with this.

It would almost certainly be worth it to get this procedure done in your dentist’s office. The bleach used in the office will not harm your veneers, and is simple enough that no special training is necessary, so your general dentist could take care of this.

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Replacement porcelain veneer doesn’t match.

Does the cement color affect the look of the veneer in certain shades? I had 10 A1 veneers put on 8 years ago with an A2 cement. Then I had a chip on the front tooth and the dentist put an A1 veneer with a clear cement and it doe! sn’t match in darker shades. The one tooth is lighter.
What should I do?
- Jim in Michigan

James,
Yes, the cement color affects the porcelain veneer.

But your problem isn’t that simple. If you ask two different laboratory technicians to produce an A-1 porcelain veneer, unless they collaborate with each other, they are going to look slightly different. Every tooth has multiple colors. And if all the dentist told the technician was “A-1″, that isn’t sufficient. You need a dentist with enough training in color to create a complete color map, and then to know how to try in the porcelain veneer and check the color before it is bonded. Matching a single front tooth is very demanding, especially with a thin porcelain veneer.

Find an expert cosmetic dentist. There’s a website, mynewsmile.com, that recommends cosmetic dentists who can do beautiful smile makeovers. Check out their list of recommended cosmetic dentists. They will know how to take care of this for you.

Dr. Hall

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