A single darkened tooth can significantly affect a smile, leading to questions about specialized whitening. A “dead tooth” is a non-vital tooth, meaning the inner dental pulp has died, typically following trauma or a root canal. Standard external whitening methods are ineffective for this internal discoloration. The solution requires a targeted, professional dental procedure to address the stain from the inside out.
Understanding Tooth Discoloration
The color change in a non-vital tooth is caused by intrinsic staining deep within the tooth structure. This discoloration often presents as a gray, brown, or black hue, making the affected tooth stand out against healthy teeth.
The cause is the breakdown of blood products within the dentin, the layer beneath the enamel. When the dental pulp dies, usually due to trauma or infection, blood vessels rupture, releasing hemoglobin. The iron in the hemoglobin breaks down into iron sulfides, which permeate the surrounding dentinal tubules, creating the dark stain. Discoloration may also result from certain materials used during a root canal procedure, such as sealers, which contribute to internal darkening.
The Internal Bleaching Procedure
The specialized treatment for a non-vital tooth is internal or non-vital bleaching, often called the “walking bleach” technique. This technique targets intrinsic staining where traditional external whitening cannot reach. The process begins with the dentist creating a small access opening, usually on the back surface of the tooth, leading into the pulp chamber.
Residual filling material, such as gutta-percha, is removed from the coronal portion of the pulp chamber. A protective barrier, often glass-ionomer cement, is then placed over the root canal filling to seal the root canal space. This barrier prevents the bleaching agent from seeping into the root, mitigating the risk of external root resorption.
The dentist then inserts the bleaching agent, typically a combination of sodium perborate and water or a low-concentration hydrogen peroxide gel, directly into the cleaned pulp chamber. The access hole is sealed with a temporary filling, allowing the bleaching agent to work from the inside of the tooth over several days, hence the term “walking bleach.”
The patient typically returns after a few days, and if the desired shade has not been achieved, the dentist will replace the old bleaching material with a fresh application and reseal the tooth. Once the tooth has reached the desired color match, the bleaching material is removed, and the access cavity is permanently restored with a tooth-colored composite filling.
Cost Variables
The cost of internal bleaching is variable, but it is generally considered a conservative and cost-effective option for addressing a single discolored tooth. The typical price range for internal bleaching usually falls between $250 and $800 per tooth. This range reflects the complexity of the procedure compared to standard external whitening, as it involves accessing the tooth’s interior.
Several factors influence where the final price lands within this range. Geographic location is a major determinant, as dental service costs are often significantly higher in major metropolitan areas compared to rural or smaller urban settings. The specific expertise of the dental professional also plays a role, since a specialist in endodontics or cosmetic dentistry may charge more than a general dentist.
The number of required appointments directly affects the final bill, since most cases require two to four separate visits to achieve the optimal shade. Additionally, if the tooth has not yet received a root canal, that procedure must be completed first, adding a substantial separate cost to the overall treatment plan. The procedure is generally considered cosmetic, meaning that dental insurance rarely provides coverage, and patients should expect to pay the full amount out-of-pocket.
Other Options for Permanent Restoration
While internal bleaching is often successful, it may not be suitable for teeth with severe discoloration or significant structural damage. In these instances, more permanent restorative options are available to mask the darkness and restore the tooth’s appearance. Dental veneers and crowns are the two primary alternatives, offering a long-term solution with predictable color matching.
Dental Veneers
A dental veneer is a thin, custom-made shell of porcelain or composite material that is bonded to the front surface of the tooth. This is a more conservative approach that requires less reduction of the existing tooth structure. Porcelain veneers typically cost between $925 and $2,500 per tooth.
Dental Crowns
A dental crown is a cap that completely covers the entire visible portion of the tooth. Crowns provide superior structural protection for teeth that are weakened or have large fillings, but they require more extensive tooth preparation. The cost for a dental crown is generally higher, ranging from $1,000 to $3,500 per tooth, depending on the material used. Unlike internal bleaching and veneers, a crown may be partially covered by dental insurance if it is deemed necessary for structural health and function.