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Sunday, 23 July 2017

The Dark Side of a White Tooth

Dr. Vincent Wan


Have you seen someone smile and noticed they had a dark upper front tooth?  It doesn’t always mean they don’t brush their teeth so their upper front tooth is badly decayed.  Commonly, the dark coloured upper front tooth is due to a previous knock to the tooth which has caused it to die.

When a tooth is badly traumatised, the nerve inside the tooth cannot heal and it can break down.  When this happens the normally live, red, healthy internal tissue becomes dead, dark, necrotic tissue, which makes the tooth look dark when we look at it.

A nerve of a tooth can die due to a variety of traumatic events.  Because the upper front teeth a very easily accessed for cleaning and we can easily see how well we have done this, tooth decay and gum disease are less common reasons for the tooth to die.  Again due to it’s forward position in the mouth, the upper front teeth are commonly knocked or damaged by a physical force in some way or other.

Not everyone’s dead upper front tooth is dark in colour.  The standard treatment for a dead nerve is root canal treatment, which cleans away the internal dead tissue.  Sometimes, simply doing this will make the tooth look lighter in colour.  Other times, the tooth remains dark after root canal treatment as the inside of the tooth has been stained by the necrotic tissue breaking down or by bacteria that may have infected the dead tissue.  Doing internal tooth whitening after the root canal treatment can solve the colour issue in most instances.  A crown which covers the tooth for strength and prevents reinfection of the root canal treatment will usually hide any dark colour that remains.  Modern upper front tooth porcelain crowns are highly aesthetic and may not look much different to a normal healthy tooth.