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Stained Teeth, Tetracycline Teeth

Cosmetic Dental Procedures for Tetracycline-stained Teeth

Some teeth contain heavy internal stains that are either hereditary or caused by certain medications that were administered during tooth development. The most common stains of this kind are the ones caused by Tetracycline antibiotics. They often display a typical pattern of generally brownish-gray teeth with even darker horizontal lines. Tetracycline stains are permanent due to the ability of tetracycline and its derivatives to chelate calcium ions (reference 1). The patterns and the hues of the discolorations vary depending on the time and length of administration and the particular tetracycline derivative. Even adults with completely developed teeth can develop adult-onset tooth discoloration following long-term ingestion of tetracycline and minocycline (reference 2).

Long-term vital bleaching of tetracycline-stained teeth over months may lead to acceptable color changes, but may involve long-term post-treatment dental sensitivity (reference 3). In addition, dental bleaching has been shown to reduce the surface hardness of enamel (reference 4). While some studies have reported that dental bleaching is relatively safe and its side effects are only transient (reference 5), other studies have concluded that tooth-whitening products should be used with caution and for limited periods of time (reference 6). It has been demonstrated that bleaching agents have toxic effects on dental pulp cells (reference 7).

In many cases, tetracycline-stained teeth are not just discolored but also display surface defects, cavities, and wear. This may be contributed to the inferior enamel quality due to a disturbance of normal amelogenesis during tetracycline administration (reference 8). Various studies have demonstrated the deleterious effects of tetracycline on amelogenesis and enamel. (references 9 to 11)


Tetracycline-stained Teeth without Porcelain Veneers
tetracycline-stained teeth after porcelain veneers
This Vietnamese patient had very dark teeth. She wanted naturally lighter teeth which could not have been achieved with a bleaching regimen. She received porcelain veneers.


Aged teeth before cosmetic dentistry
Aged teeth after cosmetic dentistry
This patient had heavily worn and discolored teeth with large unsightly fillings. He requested to have his smile rejuvenated. Teeth were rebuilt to intact incisal edges and proper anatomical features. Proportions, forms, and balance were reestablished.

Examples of Tetracycline-stained teeth:


Stained teeth before placement of porcelain laminates
Stained teeth after placement of porcelain laminates
This patient came from Singapore for the treatment of her Tetracycline-stained teeth. She had already received some dental bonding in her country; obviously with only limited success. She received 10 upper veneers as seen on the picture on the right. One year later she decided to also cover her lower 10 front teeth with porcelain.


stained and misaligned teeth before smile rejuvenation
stained and misaligned teeth after smile rejuvenation
This patient had old and discolored direct composite restorations to replace missing tooth structure. They lost surface luster and their prior tooth color. The patient did not like the misalignment of her teeth, the spacing (diastemas) between the lateral incisors and the canines, and asymmetries at the gum line. Her concerns were addressed by performing a gum lift to create a symmetric gum line and porcelain veneers. The benefit of this cosmetic dental treatment approach is to address all concerns stated, dental misalignment, spacing, disproportionate tooth sizes, and dental discolorations. Meticulously bonded adhering to state-of-the art protocol and proper design to holistically integrate the new porcelain restorations into oral function, the patient will enjoy her new smile for many years to come.

References:

  1. Sanchez AR. Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity. Int J Dermatol 2004; 43(10): 709-715.
  2. McKenna BE. Minocycline-induced staining of the adult permanent dentition: a review of the literature and report of a case. Dent Update 1999; 26(4): 160-162.
  3. Tsubura S. Clinical evaluation of three months' nightguard vital bleaching on tetracycline-stained teeth using Polanight 10% carbamide gel: 2-year follow-up study. Odontology. 2010; 98(2): 134-138.
  4. Eifallah HM. A review of the effect of vital teeth bleaching on the mechanical properties of tooth enamel. N Z Dent J. 2013; 109(3): 87-96.
  5. Auschill TM. Randomized clinical trial of the efficacy, tolerability, and long-term color stability of two bleaching techniques: 18-month follow-up. Quintessence Int. 2012; 43(8): 683-694.
  6. Lucier RN. Soft-tissue alterations following exposure to tooth-whitening agents. J Periodontol. 2013; 84(4): 513-519.
  7. Lima AF. Toxic effects of daily applications of 10% carbamide peroxide on odontoblast-like MDPC-23 cells. Acta Odontol Scand. 2013; 71(5): 1319-1325
  8. Ranggard L.Tetracycline as a marker in hard tissue research: effects on enamel formation in rat maxillary incisors. Scand J Dent Res. 1989; 97(5): 381-386.
  9. Westergaard J. Dose and age dependent variations in effect of tetracycline on enamel formation in rat. Scand J Dent Res. 1975; 83(1): 209-232.
  10. McIntosh HA. Tetracycline-induced tooth changes. Part 4: discoloration and hypoplasia induced by tetracycline analogues. Med J Aust. 1970; I: 114.
  11. Hilton HB. Tetracyclines in bones and teeth. Br Med J 1962; 2(5316): 1403.