Tetracycline-Discolored Teeth: Options for Cosmetic Improvement

When the permanent teeth are forming in a young child's jaw (before they come through the gum tissue and can be seen), they can be positively affected by controlled systemic fluorides (made stronger and more resistant to dental decay). They can be adversely affected by high fevers, malnutrition, and prescription medications, most notably, the antibiotics in the tetracycline class. Tetracyclines are given to children who have shown a reaction to penicillin or who have a medical problem that can be treated best with the tetracyclines.

Depending on the age of the patient, the stage of development of the permanent teeth, and the type and dosage of the medication, the change in the tooth color (both dentin and enamel) can be slight, moderate, or quite disfiguring. The color of the teeth can change from the normal homogeneous yellow/white to light or dark gray, brown, yellow, or even purple/blue. Most often, the color is not uniform throughout the tooth. There may be horizontal bands or stripes of color that are visible. If you have ever seen a photograph of the planet Jupiter, with the brightly colored horizontal bands that mark the different wind zones, it would be similar to the tetracycline bands and colors seen on the permanent teeth.

Improving the Appearance of the Teeth

The color change due to tetracycline staining is not a superficial or surface problem. The dentin (the layer of tooth underlying enamel) is usually darker than the enamel and gives the tooth its color. Brushing harder or using a whitening toothpaste will not improve the color. Today the appearance of discolored teeth can be improved through tooth whitening, bonded porcelain or ceramic veneers, resin veneers, or full crowns.

What Is Right for You

What is right for you depends on the amount and type of discoloration, the speed with which you want them improved, and your finances. For mild to moderate discolorations, a whitening process can significantly improve the appearance of the teeth. A combination of in-office and at-home whitening works well. In the in-office “power” whitening process, a solution is applied to your teeth. The solution is activated by light energy and allowed to remain on each tooth to be whitened for several minutes. If we believe it is appropriate for you and you will need even more whitening, we may suggest that you continue the whitening process at home with a mouthguard whitening technique. In this technique, special mouthguard-like trays are custom fabricated to fit your teeth. You will be given a whitening solution to place in the trays and wear nightly until the desired color change occurs. The time required to achieve the desired effect depends on the degree of discoloration. Usually the at-home whitening procedure will need to be done nightly for 6 months at least to be effective. This is the least invasive and least costly method for improving the tooth color.

Custom porcelain veneers require preparation of the tooth and processing by a dental laboratory. Veneers are much quicker but more costly and maintenance requirements are more involved. Veneers can be expected to last 8 to 15 years, perhaps longer. Direct resin veneers are placed onto the teeth in one visit. They are less expensive than laboratory-processed veneers. Direct resin veneers can look almost as nice as laboratory-processed resin but are not as natural looking as porcelain. They will last about 5 years before needing replacement or touch up. If you are considering veneers, we may still recommend some degree of tooth whitening before they are made because the darker the teeth are, the harder it is to opaque or mask out the underlying color, which is the point of placing the veneers in the first place. The veneer that can transmit some underlying tooth color tends to look better than a fully opaque veneer. Alternatively, more tooth preparation can be made to permit an opaque layer to be covered by thicker esthetic porcelain. Each case is different, but an improved appearance is possible. In the case of the darkest discolorations, the only effective cosmetic solution may be full-coverage crowns.

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