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Tooth discoloration and whitening

  • Procedure

Teeth stain on the surface (coffee, tobacco) or from within (drugs, fluoride, trauma). Cleaning removes surface stains; bleaching treats deeper ones.

Updated

What it is

Extrinsic stains sit on the enamel surface and are removed by professional cleaning. Intrinsic discoloration lies inside the enamel or dentine: from tetracycline taken while teeth form, fluorosis, developmental defects, ageing, or a tooth that darkened after trauma or pulp death. Whitening with peroxide gels lightens the tooth by breaking down stain molecules; a dead tooth can be bleached from inside the root canal.

Indications and contraindications

  • Extrinsic: tea, coffee, red wine, tobacco, chlorhexidine and some bacteria.
  • Intrinsic: tetracycline (grey-brown bands), fluorosis (white to brown mottling), pulp necrosis or trauma (single dark tooth), amelogenesis or dentinogenesis imperfecta, ageing (yellower).
  • Contraindications to bleaching: untreated caries or leaking fillings, pregnancy and breastfeeding, and unrealistic expectations.
  • Fillings, crowns and veneers do not bleach and may need replacing to match.
  • A single dark tooth needs a vitality test and a radiograph before any whitening.

How it is done

  1. Find the cause and type of stain, and check the teeth and gums for caries, cracks and recession.
  2. Remove extrinsic stain with professional cleaning and polishing first.
  3. Vital teeth: dentist-supervised bleaching in the office or with custom trays at home.
  4. Non-vital root-filled tooth: seal the root filling, then bleach inside the crown (internal bleaching).
  5. Superficial white or brown spots: microabrasion or resin infiltration.
  6. Severe or resistant stains: veneers or crowns.

Complications and pitfalls

  • Sensitivity and gum irritation are the common side effects of bleaching and usually settle once it stops.
  • Stricter rule applied: in the EU, whitening products stronger than those sold over the counter may be used only by or under a dentist, and not in people under 18.
  • Internal bleaching without a good seal over the root filling is linked to external cervical root resorption.

Next step / Initial management

  • Single darkened tooth after trauma: refer to the dentist for vitality testing and radiographs.
  • Advise against unsupervised high-strength products bought online and against bleaching under 18 years.
  • Grey-brown banding of permanent teeth in a child: ask about tetracycline exposure and refer to the dentist.

Test yourself

Think of the answer, then tap the question to see it.

What does a single dark front tooth after a blow suggest?

Pulp bleeding or necrosis; it needs vitality testing and a radiograph before any whitening.

What are two contraindications to vital tooth bleaching?

Any two of: untreated caries or leaking fillings, pregnancy or breastfeeding, age under 18 under EU rules, unrealistic expectations.

Which complication is linked to internal bleaching of a root-filled tooth?

External cervical root resorption, especially if the root filling is not sealed.

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Connections

In Pharmacology2

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Educational content; it does not replace assessment by a dentist or doctor and is not a clinical instruction. For facial or neck swelling with difficulty swallowing or breathing, a knocked-out tooth or bleeding that will not stop, go to an emergency department at once.

Sources: Internal Tooth Whitening (StatPearls Publishing (NCBI Bookshelf), 2024); Efficacy of Dental Bleaching with Whitening Dentifrices: A Systematic Review (International Journal of Dentistry (PMC open access), 2018); Council Directive 2011/84/EU (cosmetics: hydrogen peroxide in tooth whitening products) (European Union, EUR-Lex, 2011); Dental Fluorosis (StatPearls Publishing (NCBI Bookshelf), 2023).

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