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Dentistry/Tooth Discolouration from childhood

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Question
Hello,

I have always been afraid of asking my family dentist regarding this situation because I have been with this practice since I have been born.

During a young age, my brother and I were play fighting and my two front tooth's were knocked out of my mouth too early. At that time, as my adult front tooth's were growing in there were cavities and other problems. My dentist had done a lot of cleaning and fixing till finally today, they're fine but a bit discolored (see below).

http://oi59.tinypic.com/10yhwgg.jpg

With regards to the above picture here, although the camera flash doesn't accurately depict what I will mean entirely, what can I do about the color imbalance? The yellow between tooth and gum I know is merely through better flossing and brushing, however do you see the imbalance of bright white and natural beige tooth color? I don't remember exactly what happened when I was younger but for years I have been embarrassingly battling this problem and I want to get rid of it. What are some suggestions as brushing clearly doesn't fix that imbalance of white discoloration.

Thanks.

Answer
Hi Bernard and thanks for your question.

The bright white areas on many of your teeth are due to fluorosis, a condition caused by the excess deposition of fluoride in the tooth structure during development. The overwhelming cause of this, is the ingestion of excessive amounts of toothpaste as a child and sadly, there is very little one can do to rectify the problem. You could consider external whitening procedure in order to lighten the natural tooth colour and in that way, reduce the color discrepancy between that and the brighter whiter areas. If it is a severe problem for you, you could discuss having porcelain veneers fitted with your dentist, but this does involve quite steep costs and these do not last forever. The good news, is that these whiter fluorotic lesion pose no risk for any future oral problems and in fact, due to the higher fluoride content, are probably the most resistant areas of your tooth against tooth decay.

With regards to the discoloration of your front teeth the problem really does not look that noticeable. I would suggest to you that your dentist test the vitality of these teeth to make sure that the nerve and blood supply is still viable. Teeth which have been knocked out and re-implanted do suffer the risk of losing their vitality due to severage of the nerve and blood vessels at the tip of the root. Sometimes, this is re-established naturally, but sometimes not and a non-vital or dead tooth would naturally discolor faster than your other teeth. If the teeth are still vital, then they can be individually bleached exteriorly or covered either with porcelain or composite veneers. If they are found to be non-vital or dead, then root canals should be done on them, that is if it hasn't been done already. In this case, these teeth could be bleached internally or considered for porcelain veneers as well.

Bu the way, your oral hygiene looks very good and isn't a contributor in anyway for your problem. The natural color and shade of teeth is greatly determine genetically and comes from the color of the underlying deeper dentine under the outer enamel. I hope this helps and wish you all the very best further, but discuss the problem openly with your dentist and get their professional opinion on the matter. Take care.

Kind regards
Dr Craig Peck

Dentistry

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Dr Craig W Peck ( B.Med.Sc., B.Ch.D., Clin. Botox, Cosmet. Derm.)

Expertise

I am a General Dental Practitioner, with special interests in Cosmetic Dentistry & facial aesthetics and Periodontology, placing a strong emphasis on the establishment and maintenance of a healthy periodontium (the support structure of the tooth) before cosmetic options are considered. I uphold all principles of prevention above interventional treatment and try as far as possible, to remain conservative in my approach. I believe in detailed, open and honest patient discussion, establishing what the patients expectations are and what the reality is of achieving this and involving the patient at every level of the treatment. I have strong principles on ethical treatment and appropriate patient management. I have chosen to treat and rehabilitate many nervous and phobic patients, who, for whatever reason, find it impossible to take part in the very important task of even a routine check-up. I will accept questions relating to general and cosmetic dentistry (in conjunction with the use of facial cosmetic procedures) and dental fears/phobias. I will be more than willing to answer any academic questions in dentistry, biology, physiology, psychology and health sciences in general. As most dentists will tell you, there is often not only one way of dealing with a dental issue - so very often, there is no precise right and wrong way of approaching the problem. All clinicians vary when it comes to treatments and what works best in their hands is often the treatment that is advised. Be understanding of this and bear in mind that nothing lasts forever! Patients are happy to accept only a one-years warrantee when buying a new car, but seem to expect that dental work is going to last them their lifetime.

Experience

I have worked for many years in the UK and RSA as a general dental practitioner - within the NHS, private practice and the government dental health services. I am certificated for the administration of Botox and Dermal Fillers for facial lines and wrinkles as I have attended further courses in minimally invasive facial cosmetic procedures. I started seeing an increasing number of patients who presented with severe to moderate dental fears, even with full-blown phobias, so I started with the slow and patient task of tackling this problem and have successfully rehabilitated many patients. The key is good, effective, concise and understandable communication, shifting control from the dentist to the patient in order to slowly, but confidently, regain their trust back in dentistry, thereby giving them the feeling of achievement and this self-empowerment which drives them to the next level of treatment.

Organizations
Academy of General Dentistry. American Dental Education Association. IAPAM (International Association for Physicians in Aesthetic Medicine). Professional Speakers, Writers and Managements Consultants in Dentistry. The British Dental Association. UK Aesthetics Group. ARC - Aesthetic Professionals. Botox. Aesthetics & Beauty. American Association for Dental Research. FDI - World Dental Federation. SOURCE1uk. World Dental Hygiene Forum. ProDentalCPD. Public Health Dentistry. Dentist Network. LinkedIn. Who's Who of South Africa.

Education/Credentials
B.Med.Sc. Degree (Medical Physiology and Medical Virology; Physiology Cum Laude; Stell 1994). B.Ch.D. Degree (Bachelor of Dental Surgery; Clinical Dentistry Cum Laude; Stell 1997). CPR and CPR-Advanced Courses (2000/2001; UK). Clinical Botox (UK, 2001). Cosmetic Dermatology (Botox and Dermal Fillers; RSA 2011).

Awards and Honors
Placed on the Dean's List at University for academic achievement (1994). Highest achievement in the subject Dental Materials. Medal from 3M and the Radiology Association of South Africa for highest achievement in the subject Dental Radiology and Imaging. Medal from The Periodontal Association of South Africa for highest achievement in the subject Periodontology. Highest achievement for Oral Medicine. Highest achievement in Oral Pathology. Received the DASA (Dental Ass. of South Africa) Gold Medal for highest achieving dental student across the 5 1/2 years of the Degree. Passed the subject, Clinical Dentistry with distinction in final year.

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