Classification of severe tooth discolorations and treatment options

Abstract

In this literature study, a classification of severe discolorations and a summary over the options for different dental treatments have been described. Various causes of these severe discolorations are presented and how the mechanisms behind tooth discolorations affect the outcome of a treatment or treatment options. Finally, the aesthetic outcome of a possible bleaching treatment of the different classified discolorations is discussed. In the management of patients with stained teeth it is very important to know and understand the mechanisms behind tooth discolorations as well as the clinical features of different types of tooth staining, in order to make a correct diagnosis. The teeth are an integrated part of facial aesthetics and are involved in a complex social, cultural and psychological interaction. For people with severe discolorations, bleaching can be an important and valuable treatment. Brown and yellow staining are easier to change compared to grey and blue stains which are mostly resistant to bleaching. Discolorations located in the gingival area have a poor prognosis. However, recent research has shown that for example tetracycline-stained teeth that often have a grey-blue staining may demand longer bleaching treatments, from one to 12 months, but it is almost impossible to predict the result of such a treatment. Clinical research has shown that it is best to try bleaching first, as a patient may be pleased with the outcome of this treatment and thus the need for veneers or replacement with full crowns will be eliminated. There are no guidelines telling the dental practitioner when it is correct to carry out bleaching or operative treatment. Therefore, in cases with aesthetic problems, it is important to understand the self-perceived opinion of the patient in the treatment planning.