Internal teeth whitening causes treatment and how to use it correctly

"Have you noticed a change in the color of your teeth after a root canal treatment or injury? Internal tooth whitening is the perfect solution to restore the brilliance of your smile while maintaining your oral health. If you suffer from internal discoloration caused by factors like root canal treatment or injuries, internal whitening helps effectively and safely remove these stains. we will explore the causes of internal tooth discoloration, the different types of internal whitening, as well as how to use it for ideal and long-lasting results. Keep reading to discover how internal whitening can improve the appearance of your smile and boost your self-confidence."

What is Internal Tooth Whitening?

Internal tooth whitening is a cosmetic procedure aimed at lightening the color of a tooth that has lost its vitality due to a root canal treatment (endodontic treatment). This treatment is used for non-vital or treated teeth that need lightening from the inside.

How is Internal Whitening Done?

Internal whitening is performed by placing a whitening agent inside the empty pulp chamber of the tooth. This agent helps to lighten the tooth color from the inside out, effectively removing deep stains within the dentin layer that traditional methods cannot reach.

Does Internal Whitening Remove the Enamel Layer?

Yes, the internal whitening process may slightly remove the enamel layer. However, this is done with great care to maintain the tooth's health.

Can Internal Whitening Be Done on Broken or Damaged Teeth?

Yes, internal whitening is also effective for broken or damaged teeth. When a tooth is injured or cracked, its color may change due to blood retention or internal tissue damage, and internal whitening can help restore its natural color.

Is Internal Whitening Permanent?

The results of internal whitening can last for a long time, but the color may change over time due to consumption of certain foods and drinks like coffee or smoking. Proper oral care is important to maintain the color.

Can Internal Whitening Be Done on All Teeth?

Internal whitening is primarily used for teeth that have undergone root canal treatment or those with deep stains. If a tooth has severe decay or has lost a significant portion of its structure, it may be better to consider fillings or crowns instead of whitening.

Can Internal Whitening Be Used with Old Fillings?

The whitening materials do not affect the fillings inside the tooth. However, whitening may cause old fillings to change color, requiring the replacement of the filling after the internal whitening treatment.

Is Internal Whitening Suitable for Patients with Sensitive Teeth?

If you have sensitive teeth, it’s best to consult with your dentist before undergoing internal whitening. In some cases, the dentist may recommend using a less potent whitening agent or other techniques to reduce sensitivity.

How Many Sessions Will I Need?

Typically, good results can be achieved after one or two sessions. However, if the results are not satisfactory, additional sessions may be required. The number of sessions depends on the degree of discoloration and the condition of the tooth.

Can I Eat or Drink After Internal Whitening?

After internal whitening, it's advisable to avoid foods and drinks that can stain your teeth, such as coffee, tea, or red wine, for a few days. It's also important to maintain good oral hygiene to avoid re-staining.

Is Internal Whitening Painful?

Usually, internal whitening is painless. However, some people may experience temporary sensitivity after the treatment, especially when consuming hot or cold foods or drinks. Your dentist may recommend using desensitizing toothpaste to alleviate the sensitivity.

Do I Need Special Care After Internal Whitening?

Yes, after internal whitening, you should care for your teeth properly. It's recommended to avoid pigmented foods and drinks, use a soft toothbrush, and select an appropriate toothpaste. Regular visits to your dentist are also important to monitor the results.

When Will I See Results from Internal Whitening?

Results from internal tooth whitening typically appear shortly after the treatment, but the time it takes to see the results may vary depending on the condition of the tooth. Here’s what you can expect:

After the First Session:
- Expected Time: You will likely notice improvement in color within 24 to 48 hours after the whitening agent is applied inside the tooth.
- Immediate Effect: Once the dentist removes the whitening material after a certain period (usually one or two days), you may see a noticeable difference in color.
- Initial Results: The color may become brighter with reduced yellowing or darkening.
If Additional Sessions Are Needed:
- Expected Time: In some cases, several sessions may be needed to achieve the desired result.
- Gradual Results: Between each session, the color of the tooth may improve gradually. More noticeable results may appear after the second or third session.
- Timeline: Each whitening session may require one to two weeks between sessions, as the internal whitening needs time to interact with the tissues inside the tooth.

3. Final Results:

Expected Time: Final results of internal whitening may take several weeks to fully appear, especially in cases where the teeth have severe discoloration.

Color Retention: If the whitening is done properly, the new color may remain stable for a long time (from months to years). However, maintaining good oral care is essential to preserve the results, such as avoiding certain foods and drinks that could cause new staining.

4. Gradual Improvement:

In some cases, whitening may not show full results after the first session, especially if the discoloration is severe or deep. However, with each session, the color will gradually improve.

After the tooth is sealed with a permanent restoration, the whitening results may appear even better, as the new color is integrated with the overall appearance of the tooth.

Causes of Tooth Discoloration from the Inside:

Root Canal Treatment (Endodontic Filling):
When a tooth undergoes treatment by removing the nerve and damaged tissue inside the pulp, the color of the tooth may gradually darken. This happens due to the cessation of blood flow within the tooth, leading to the deterioration of internal tissues and their absorption of substances that change the color.
Injuries and Cracks:
Trauma or accidents that result in the cracking or damage of a tooth can cause internal bleeding or tissue damage, leading to a change in the tooth’s color to darker shades such as gray or blue. This is known as discoloration due to trauma.
Medication Effects:
Some medications, such as tetracycline (an antibiotic), can lead to internal staining of teeth, especially when taken during tooth development stages, such as in children or during pregnancy.

Medications like chlorhexidine and iron can also cause internal discoloration of teeth.
Dietary Effects and Bad Habits:
Consuming foods and drinks with strong pigments, such as coffee, tea, berries, or soda, can lead to internal staining of the teeth as the pigments penetrate the tooth through small pores or cavities.
Smoking:
Cigarettes contain nicotine and tar, both of which can seep into the internal layers of the teeth over time, causing discoloration from the inside, especially if the teeth are weak or have cavities.
Aging:
As we age, the outer enamel layer of teeth wears down, making the inner dentin layer, which is more yellow, more visible, leading to a gradual change in the tooth’s color from the inside.
Deep Decay:
If decay progresses to deeper layers of the tooth, it may cause internal discoloration due to bacterial accumulation or materials resulting from decay, leading to the appearance of darker colors.
Genetics:
Some people may have a genetic predisposition to internal tooth discoloration due to weak enamel or tooth structure, leading to the accumulation of pigments inside the teeth.
Pulp Tissue Inflammation:
Inflammation of the pulp tissue (the inner tissue of the tooth) due to infection or injury may cause the tooth to change to darker shades.
Exposure to Chemicals or Toxins:
Certain chemicals or toxins affecting the body may lead to internal discoloration of the teeth.

Table: Difference Between Internal and External Tooth Whitening

Feature	Internal Whitening	External Whitening
Whitening Method	Done by placing a whitening agent inside the tooth after cleaning it internally.	Done by applying a whitening agent directly on the tooth surface.
Objectives	Used for whitening teeth stained from the inside or teeth that have undergone treatments (e.g., root canal).	Used for whitening teeth stained on the outside due to food, smoking, or coffee.
Procedure	Requires opening the tooth to access the pulp and inject the whitening agent.	The whitening agent is directly applied to the teeth using gel or paste.
Time	Takes longer as it involves an internal procedure for the tooth.	Takes less time and is typically performed in short sessions.
Results	Provides better results for non-vital or heavily discolored teeth from the inside.	Gives effective results but may require repeated sessions sometimes.
Side Effects	May cause increased tooth sensitivity if not done properly.	May cause gum irritation or tooth sensitivity for some people.
Cost	Generally more expensive due to the complexity and medical procedures involved.	Less expensive and is considered more common.
Longevity	Results may last longer if the teeth are properly cared for.	Results are temporary and may require repeated sessions to maintain the white color.

Types of Internal Tooth Discoloration:

Gray or Blue Discoloration:
- Main Cause: Injuries or trauma.
- Description: This type of discoloration occurs after a direct trauma to the tooth, such as accidents or injuries, causing internal bleeding or tissue damage, leading to a color change to dark shades like gray or blue.
- Cause: Blood inside the tissues causes a color change due to hemoglobin leakage.
Brown or Dark Yellow Discoloration:
- Main Cause: Root canal treatment or deep decay.
- Description: After root canal therapy or endodontic filling, the tooth may turn brown or dark yellow due to the death of internal tissues and the absence of blood flow inside.
- Cause: The interaction of dead tissues inside the tooth with chemicals or substances from tissue decay.
Gray or Black Discoloration:
- Main Cause: Injuries or deep tooth decay.
- Description: A tooth may show a gray or black color due to deep tooth decay that reaches the pulp or as a result of a direct injury.
- Cause: Bacterial accumulation or dead tissues inside the tooth.
Yellow or Orange Discoloration:
- Main Cause: Medication effects or aging.
- Description: Certain medications like tetracycline can cause internal staining, especially in children or during pregnancy. Aging can also cause the appearance of yellow due to enamel wear.
- Cause: Accumulation of minerals or interaction of medications with internal tooth tissues or enamel loss.
Green or Dark Blue Discoloration:
- Main Cause: Infection or poisoning.
- Description: This type is rare and occurs due to severe infection or poisoning leading to internal discoloration of the teeth.
- Cause: The interaction of toxic substances or bacteria inside the tooth.
Pink or Red Discoloration:
- Main Cause: Severe infection or bleeding.
- Description: In rare cases, a tooth may turn pink or red due to inflammation or internal bleeding, especially after injury or infection.
- Cause: Internal bleeding due to injury to the pulp tissue or infection.
Pale White Discoloration:
- Main Cause: Internal cavities or mineral accumulation.
- Description: This discoloration occurs when the teeth have small cavities or when calcium accumulates in the tooth’s internal layers. The color may be less obvious but appears more clearly under light.
- Cause: Mineral accumulation like calcium that alters the color balance inside the tooth.
Dark Brown or Black After Root Canal Treatment:
- Main Cause: Interaction of dead tissues with dental fillings.
- Description: After root canal treatment or old fillings, the tooth may turn darker due to the interaction of dead tissues with chemicals in the fillings.
- Cause: The interaction of dead tissues with fillings or chemicals inside the tooth.
Intense White Discoloration (Internal Whitening):
- Main Cause: Internal whitening treatment after therapy.
- Description: In some cases, after internal whitening of discolored teeth, the tooth may appear intensely white due to the use of whitening chemicals. This whitening may not be permanent and may require repeated sessions.
- Cause: Whitening chemicals used in internal treatment lead to whitening of the inner tooth color.

Steps for Internal Tooth Whitening:

Initial Examination and Diagnosis:
- Goal: Ensure the tooth is suitable for internal whitening.
- Steps:
  - The dentist examines the affected tooth to determine the cause of discoloration.
  - X-rays are used to check the health of the pulp and ensure there is no decay or infection.
  - Determine whether the tooth has previously undergone root canal treatment.
Local Anesthesia:
- Goal: Ensure patient comfort during the whitening procedure.
- Steps:
  - Local anesthesia is applied around the affected tooth to reduce pain or discomfort.
  - The dentist may also need to anesthetize the surrounding gums or tissues.
Accessing the Pulp:
- Goal: Access the internal part of the tooth (pulp) where whitening will occur.
- Steps:
  - The dentist makes a small incision in the tooth to reach the pulp (inner part).
  - The pulp is cleaned of any remnants or dead tissue.
  - If the tooth has had a previous root canal, the old filling material may need to be removed.

4. Application of Whitening Agent Inside the Tooth:

Objective: To use powerful whitening agents to lighten the dark color inside the tooth.

Steps:

The cavity inside the tooth is filled with a whitening agent, usually a mixture of hydrogen peroxide or carbamide peroxide.
In some cases, the whitening agent may be applied over several sessions if the discoloration is severe.

5. Temporary Sealing of the Tooth:

Objective: To seal the tooth after applying the whitening agent to allow it to take full effect.

Steps:

After applying the whitening agent, the dentist seals the tooth using a temporary filling to prevent leakage.
The agent is left inside the tooth for one or two days to give it enough time to interact with the internal tissues and lighten the color.

6. Removal of Whitening Agent and Evaluation of Results:

Objective: To check the effectiveness of the whitening.

Steps:

After the set time, the dentist removes the temporary filling and the whitening agent from inside the tooth.
The results are evaluated to ensure the color has improved sufficiently.
If the desired level of whitening is not achieved, the dentist may decide to perform additional sessions.

7. Permanent Sealing of the Tooth:

Objective: To restore the health of the tooth and prevent leakage or contamination.

Steps:

After confirming the results, the dentist permanently seals the tooth with a filling that matches the tooth color.
The dentist may also reinforce the tooth with a special material if it’s fragile after the procedure.

8. Post-Whitening Care:

Objective: To maintain the results and prevent other issues.

Steps:

The patient is advised to avoid foods and drinks that can cause staining, such as coffee, tea, and cola, for a week after the procedure.
Maintain good oral hygiene using a soft toothbrush and whitening toothpaste.
The patient may need to visit the dentist regularly to monitor the tooth and ensure the whitening results are being maintained.

Potential Risks of Internal Tooth Whitening and Preventive Measures:

1. Increased Tooth Sensitivity:

Risk: Some individuals may experience increased sensitivity after internal whitening, especially if the tooth has thin enamel or has undergone root canal treatment.
Cause: The whitening agent, like hydrogen peroxide, can irritate the nerves inside the tooth, leading to sensitivity to hot or cold foods and drinks.
Preventive Measure: The dentist may recommend using toothpaste for sensitive teeth or applying a protective gel to shield the teeth during whitening.

2. Damage to Internal Tooth Tissues:

Risk: If the whitening agent is applied improperly or for too long, it can damage the internal tissues of the tooth.
Cause: Chemicals may interact adversely with the dead tissue inside the tooth, leading to further damage.
Preventive Measure: The dentist should monitor the procedure carefully and determine the optimal time for removing the whitening agent.

3. Uneven Whitening:

Risk: Internal whitening may not always result in uniform color across the entire tooth.
Cause: Some areas of the tooth may remain darker, particularly in cases of severe discoloration or deep decay.
Preventive Measure: The dentist may recommend additional sessions or use different techniques to ensure uniform color.

4. Increased Tooth Weakness:

Risk: A tooth that has undergone root canal treatment is typically weaker than a healthy tooth, and internal whitening could increase its fragility.
Cause: The chemical reaction with internal tissues may make the tooth more prone to breakage if not properly reinforced.
Preventive Measure: The dentist may suggest placing a crown or reinforcing the tooth with a special material after whitening to maintain its strength.

5. Gum Irritation or Inflammation:

Risk: The gums surrounding the tooth may become irritated if the whitening agent comes into contact with the gums.
Cause: The bleaching agents may irritate the delicate gum tissue, leading to inflammation or temporary irritation.
Preventive Measure: The dentist should use protective materials for the gums during the whitening procedure to prevent direct contact with the whitening agent.

6. Reaction with Old Fillings:

Risk: If the tooth has old fillings, the whitening agent could change the color of the fillings or cause them to react with the whitening substance.
Cause: The internal whitening may alter the color of the old fillings or cause them to deteriorate.
Preventive Measure: The dentist should evaluate the condition of any fillings and consider replacing them before proceeding with internal whitening.

7. Some Teeth May Not Respond to Whitening:

Risk: Some teeth may not respond well to internal whitening, resulting in little or no noticeable improvement in color.
Cause: The response to whitening varies depending on the type of staining and the condition of the tooth's internal tissues.
Preventive Measure: The dentist may suggest alternative methods such as external whitening or crowns if internal whitening does not achieve the desired results.

8. Recurrent Staining After Whitening:

Risk: After internal whitening, the tooth may experience new staining if exposed to factors like smoking or consumption of staining foods and drinks.
Preventive Measure: Maintaining good oral hygiene and limiting exposure to staining agents will help extend the whitening results.

Different Treatment Options for Internal Tooth Whitening:

1. Traditional Internal Whitening (Whitening Agent Inside the Tooth):

Method: A strong whitening agent is applied inside the tooth after opening it and accessing the pulp. The whitening agent is left inside for a specific period (usually one to two days) to allow it to react with the internal tissues and lighten the color.
Advantages:
- Does not require the removal or reduction of tooth structure.
- Effective for teeth that have undergone root canal treatment or sustained an injury.
Disadvantages:
- Takes longer compared to some other methods.

2. Internal Whitening Using Light or Laser:

Method: A whitening agent is applied inside the tooth, and the agent is activated using light or a laser to accelerate the whitening process.
Advantages:
- Faster results compared to traditional whitening.
- More effective in removing stubborn stains.
Disadvantages:
- May lead to greater tooth sensitivity.
- Not suitable for all cases.

3. Internal Whitening Using Intensive Chemical Agents (e.g., Carbamide Peroxide Gel):

Method: A whitening gel containing carbamide peroxide is applied inside the tooth after it is opened. Additional materials like heat or light may be used to enhance the chemical reaction.
Advantages:
- Can provide long-lasting results.
- Suitable for teeth with severe internal discoloration.
Disadvantages:
- More expensive compared to other methods.

4. Using Hypochlorite or Hydrogen Peroxide (Powerful Chemicals):

Method: The tooth is opened, and hydrogen peroxide or hypochlorite is applied inside the cavity. These substances break down accumulations and stains inside the tooth.
Advantages:
- Extremely effective in removing stains that cannot be treated with other methods.
- Faster results compared to some other treatments.
Disadvantages:
- The chemicals can be strong and may lead to increased tooth sensitivity.

5. Using Internal Stabilizing Materials (After Whitening Treatment):

Method: In some cases, stabilizing materials are placed inside the tooth after whitening to maintain the white color for a longer period. This stabilization may involve a permanent filling that matches the tooth’s new color.
Advantages:
- Helps to maintain the white color for an extended period.
- Provides a long-term solution for teeth that need continuous whitening.

6. Treatment Using Artificial Teeth (Crown or Composite Filling):

Method: If the tooth is severely discolored or damaged, a crown or composite filling may be recommended instead of internal whitening.
Advantages:
- Ideal when whitening is ineffective or the tooth is too damaged.
- Guarantees long-lasting aesthetic results.
Disadvantages:
- May be more expensive compared to internal whitening.

7. Home Internal Whitening (Whitening Agent and Stabilization in the Clinic):

Method: The patient may be given a special whitening agent for home use that is applied inside the tooth. This option complements the in-clinic treatment.
Advantages:
- Allows the patient to continue whitening in the comfort of their home.
- Can be more affordable in some cases.
Disadvantages:
- Requires medical follow-up to ensure optimal results.

General Benefits of Internal Whitening:

Effective at addressing internal stains that cannot be treated with external whitening.
Does not require removal of the tooth structure as some treatments like crowns or fillings do.
Results can last for a long time if good oral care is maintained after the treatment.

Recommendations:

It is important to consult with a dentist before starting any internal whitening treatment to determine the most suitable option for your tooth’s condition.
Patients should follow the dentist’s guidelines for post-treatment care to avoid re-staining or increased sensitivity.