Procedures performed in-office

Achieving outcomes of naturally beautiful teeth


Sometimes teeth have either brown or white stains which are not amenable to bleaching alone. These stains are usually caused by a decalcification process of some sort (white stains) or by a defect created during tooth formation, such as fluorosis (too much fluoride intake during tooth development). Fluorosis can create severe brown stains which are within the enamel layer of a tooth. Many times these types of stains lighten significantly with bleaching, but are not eliminated without further treatment. There are four treatments to remove these stains. Microabrasion, bonding, porcelain laminates and crowns. The last three options are described in their sections on this website.

Microabrasion is a technique developed by Dr. Theodore Croll in Doylestown, PA. It utilizes a mixture of hydrochloric acid and pumice (an abrasive) which is rubbed onto the surface of the tooth repetitively until the outer layers of the enamel containing the stains are abraded away. If the stains are in the outer layers of enamel they can be successfully removed, leaving a smooth, glassy enamel surface as the finished result. This surface has been demonstrated to be more caries resistant than the original surface.

The teeth must be first isolated with a rubber dam to protect the gums from coming into contact with the acid. The pumice-acid slurry is then applied to the tooth or teeth and rubbed either manually or with a very slow speed rubber cup. After a few layers of enamel are removed, the slurry is rinsed with water and the result is evaluated. This process is repeated until the stain is gone or the process must be stopped for other reasons (enamel getting too thin or tooth getting sensitive). After the process is complete, the teeth are usually bathed in a fluoride gel in order to reduce post-operative sensitivity and the rubber dam is removed. The entire process takes less than an hour and is permanent. This is a wonderful technique to remove these types of stains, whether used alone or in combination with bleaching or bonding, it gives dramatic results.

As you will see in the following cases, I have treated cases as extreme as severe fluorosis and as simple as a small white line after braces have been removed.

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