Why Do Prepared Teeth Discolor?

December 23, 2022 Lee Ann Brady DMD

If the color of a prepared tooth darkens between the time you prepare it and the restoration is seated, the aesthetics of the final restoration can be impaired. This frustrating situation can be eliminated by knowing the causes of discoloration and what to do when planning treatment and prepping the tooth.

There are two processes that cause prepared teeth to discolor to a darker shade:
  1. Pulpal necrosis
  2. Chemical interaction between liquid vasoconstrictors and bacteria in the dentin tubules

Note that both processes can continue to further darken dentin weeks to months after you have seated the restoration. For more predictable aesthetic results, I learned some time ago to do the following.

Assess pulpal vitality first.

I am highly cautious when planning significant restorative treatment such as crown and bridge. Before prepping teeth, I review CBCT radiographs to make sure there are no pulpal health issues that need to be treated first. Like most dentists, I do not have CBCT imaging in my own practice, but I do have access to CBCT imaging via a collaborative relationship with a nearby specialist.

Use retraction paste instead of liquid vasoconstrictors for hemostasis.

Because the chemistry in liquid-viscosity vasoconstrictors can interact with bacteria in the dentin tubules to darken the dentin, I use retraction paste when I need hemostasis.

For me, these two seemingly simple steps are important ones when seeking optimal aesthetic results.

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About Author

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

One thought on “Why Do Prepared Teeth Discolor?

  1. I think it needs to be clarified that Viscosrat (Ferric Sulfate) can and often does discolor teeth. Ferric sulfate also reacts with epinephrine if used with Epi infused retraction cord) However, the classic Hemodent (aluminum chloride) does not.

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