My child is 15 and one of his front teeth is turning slightly gray from trauma that happened in a childhood fall. The endodontist recommends a root canal because the nerve is dying. My child does not have any discomfort in the tooth as of now. The endodontist is using the newest technology called Gentlewave for the root canal. It is supposed to be minimally invasive and better then a traditional root canal. He said that the slight greyness of the tooth will get better after the root canal. I am wondering if you know about this technology and if his tooth is likely to get better in color or get darker grey? If so, should I have him go to a cosmetic dentist to get the internal bleaching done or have it done at the endodontist and how soon after the root canal should he do that, if needed? There is also an option for us to keep watching the tooth and if discomfort starts, then go in and get a root canal done.
Mila from Dallas
(See Dr. Hall’s answer below.)
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Thank you for your excellent question.
I have a couple of different things to say about your situation.
First, I am wondering about this statement that the “nerve is dying” in this tooth. You didn’t say how old your son was when this trauma occurred, but I’m assuming that it was at least several years ago. Either the nerve died at that time or it recovered from the injury. I think your endodontist meant that the nerve is dead. I hope that’s what he or she means. If the tooth is turning gray, most likely the nerve is dead and has been dead for a long time. If it isn’t dead or infected, I wouldn’t do the root canal.
I am familiar with the GentleWave system for doing root canals. It’s a recent innovation, and has been praised in dental literature. It makes sense that it would do an excellent job, in some cases better than traditional endodontic treatment.
As far as the grayness going away from the root canal treatment alone, I am skeptical of that. With traditional root canal treatment, which is done with files, I’m confident the tooth wouldn’t get lighter. This GentleWave system uses sodium hypochlorite activated with sonic energy to dissolve the soft tissue inside the tooth, and it is conceivable that this could lighten the tooth very slightly. Sodium hypochlorite is the chemical that is in common laundry bleach, so it could have a very slight lightening effect on the tooth. But to bleach a front tooth that has had a root canal requires sealing a bleaching solution inside the tooth for days, where the GentleWave procedure is usually over in about ten minutes, not long enough to bleach the tooth any significant amount.
Most often, after a root canal treatment of a front tooth, the tooth turns considerably darker. This is because the dentist leaves root canal filling material and cement inside the pulp chamber, which is the inside part of the tooth that is visible above the gum. These materials should be totally cleaned out of that pulp chamber. If needed, the tooth can be then bleached internally by sealing bleaching solution inside the tooth. If that gives the tooth a color that matches the surrounding teeth, the tooth can then be restored with maybe a fiberglass post going down into the root and then the hole filled with composite. If it doesn’t, the color can be corrected with a porcelain veneer. A crown, in my opinion, is much too aggressive a treatment to merely correct the color of a tooth, especially on a front tooth. A crown would weaken the tooth and make it more susceptible to breaking off at some point.
As far as timing, the internal bleaching can be done as soon as the root canal treatment is completed. But it’s generally advisable to wait to place the post until you’re sure that there is no problem with the root canal treatment and the tooth is healing properly. And I would seek the services of an expert cosmetic dentist for the bleaching, and most definitely for the porcelain veneer to correct the color. That would be beyond the ability of the vast majority of family dentists.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.