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can stain tooth surfaces, and some foods and beverages (including blueberries, coffee, and red wine) also can cause stains. The death of the pulp of a tooth can turn the tooth gray. Some drugs, taken either in large doses or at specific times during childhood, can cause defective, discolored tooth enamel to form. Severe cases of some childhood infections, such as whooping cough and measles, can produce patches of discoloration on the teeth. Abnormally high levels of natural fluoride in drinking water, which occur in some areas, can lead to fluorosis, which causes white or brown marks on the teeth. Fluorosis does not occur, however, in areas where a controlled amount of fluoride is added to the water supply as a public health measure to reduce the incidence of tooth decay.

Treatment

To treat discoloration on the surface of a tooth, your dentist or dental hygienist will clean the tooth with a rotary polisher and polishing paste. Deeper discoloration can be treated by applying a bleaching gel directly to the teeth. Bleaching is safe and effective for healthy teeth and can be done at home or at the dentist’s office. Healthy teeth with minor discoloration can be treated by bonding tooth-colored plastic material to the discolored area of the tooth. If a tooth is not in good condition overall but does not need a crown, a veneer made of porcelain laminate or acrylic resin can be bonded to the entire front surface of the tooth.

Veneers

One possible treatment for a discolored tooth is to cover it with a veneer, a material such as porcelain laminate or acrylic resin that closely resembles the color of the teeth. The porcelain laminate is made in a lab and then glued onto the front surface of the tooth. The acrylic resin is applied to the tooth in thin layers.

Poorly Aligned Teeth

Ideally, the alignment (occlusion) of the teeth is a horseshoe-shaped arch that is exactly the right size for the jaws. In normal occlusion—the relationship between the upper and lower teeth when the mouth is closed—the upper teeth slightly overlap the lower teeth, and the cusps (points) of the molars mesh with the spaces between the opposing upper or lower teeth.

However, few people have perfectly aligned teeth. Because a person inherits genetic characteristics from each of his or her parents, sometimes the two sets of characteristics do not match, resulting in misalignment of the teeth (malocclusion). For example, if your teeth are too big for your jaws, your teeth can develop only by sloping backward or forward, by turning, by rotating, or by overlapping adjacent teeth. If your teeth are too small for your jaws, there will be some spaces between your teeth. If your lower jaw is smaller than your upper jaw, the teeth in your upper jaw may protrude, causing a type of malocclusion called an overbite. If your lower jaw protrudes slightly, your permanent upper front teeth may bite just behind the lower teeth, causing a type of malocclusion called an underbite. In some people, the position of the back teeth may prevent the front teeth from meeting properly, causing a type of malocclusion called an open bite.

Heredity is not the only cause of malocclusion. Crowding is sometimes the result of loss of primary teeth (baby teeth) through decay. For example, when primary molars are lost prematurely, the permanent molars move forward in the jaw to fill the gaps. Then, when the permanent premolars and canines appear, usually between ages 10 and 12, they are crowded or blocked out of the natural arch of the teeth. In some people, some permanent teeth may not appear at all.

In mild cases of crowding, a person has an increased risk of tooth decay and gum disease because it is more difficult to keep crowded teeth clean. In some people, severe crowding can lead to dental disease or difficulty chewing. Malocclusion can make some people self-conscious about their appearance. For them, orthodontic treatment not only can improve a faulty bite, but it can also improve their appearance and sense of well-being.

Treatment

If you are an adult with minor occlusion