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Tetracycline Plus Teeth Equal Gray Smile

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sushantpatel_doc's picture
Joined: 30 Nov 2009

New cost-effective and non-invasive treatment plan significantly lightens stubborn stains.

Many adults over age 35 cover their mouth to avoid smiling in public in order to hide their teeth darkened by tetracycline stains. Typically, invasive as well as costly treatment options, such as veneers, crowns and bonding, served as the only treatment options to help these individuals hide such stains and boost their self-esteem.

However, Kim L. Capehart, DDS, MBA, AGD member and clinician, will explain how a new tooth whitening procedure he used on a patient helped significantly lighten these tough-to-remove stains and saved his patient more than $10,000 in dental restorative fees. He'll share this information during his discussion titled "Treating Tetracycline Staining in the Adult Dentition" to be presented at the Academy of General Dentistry's (AGD) 54th Annual Meeting & Exposition in Denver, August 2-6, 2006. For patients, this means that AGD members that attend this course will offer them the latest in dental health technology, knowledge and treatment.

Tetracycline is a powerful antibiotic that kills a wide array of bacteria. Many women, prior to 1980, may have take this antibiotic during their pregnancy. When teeth are forming in utero, the drug becomes calcified in the dental and enamel of the child's teeth and creates a permanent dark and deep gray or brown stain over the entire tooth. Other stains appear in a pattern of horizontal stripes of varying intensity. Also, during the same time period (before 1980) many children may have been given the drug and had the same stains. Often dentists can tell if a child had a high fever, just by looking at the stain pattern on their patient's teeth. In the 1950s, tetracycline stains reached widespread levels because so many doctors prescribed this drug.

Since the stain is embedded deep into the tooth, different restorative materials have to be used to completely cover up the effects of tetracycline. These materials, such as veneers and crowns, have to be placed across all the teeth that show when smiling (typically 8 upper and 8 lower teeth). To place veneers or crowns on all teeth can cost in range from $1,000 to $2,000 per tooth. "The cost deters many people from seeking treatment," says Dr. Capehart.

However, Dr. Capehart developed a special treatment plan for a patient who was embarrassed by his tetracycline-stained smile, but who could not afford such costly treatment. He developed a personalized treatment plan for the patient, which allowed him to significantly alter the shade of his patient's teeth, without the costly procedures.

Dr. Capehart's new tooth whitening treatment protocol involves placing the patient on a prescription dose of fluoride toothpaste for two weeks in order to minimize tooth sensitivity from the whitening solutions. Then, the patient comes in for a one-hour tooth whitening session, where the enamel is painted with the whitening solution and "cured" under a UV light. Then, for every night for three weeks, the patient uses customized trays that deliver the whitening solution to the teeth. During this time period, the patient maintained a meticulous home oral hygiene care and took potassium nitrate, which also decreases sensitivity after bleaching. Then, after the three week time period, the patient uses the trays for another three weeks.

"The results significantly boosted my patient's self-esteem and he was thoroughly pleased with the results," says Dr. Capehart. He now comes back every six months for a regular cleaning and then uses the whitening trays once a year to maintain their new color. "Although tetracycline is no longer widely prescribed today, parents need to be aware that other drugs can stain their children's teeth, such as chlortetracycline, oxytetracycline, tetracycline and minocycline."

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drmithila's picture
Joined: 14 May 2011
Tetracycline Plus Teeth Equal Gray Smile

Coffee can be complicated and tobacco tenacious, but the toughest tooth stain dentists grapple with is the dark blue-gray caused by tetracycline.

How dark can it be? So dark that doctors now avoid prescribing this antibiotic to children lest they spend a lifetime afraid to smile. So dark that none of the professional tooth-color reference scales go this far toward blackness.

Yet dentists are gaining ground in the effort to whiten such teeth. So reported the November-December 2006 issue of Operative Dentistry: "Tetracycline-stained teeth can be effectively lightened with the extended use of tooth whiteners."

Not just any whitener, though. As the article points out, carbamide peroxide has emerged as the most promising compound tested for this purpose. While previous studies had drawn the same conclusion, the international team of investigators, from Indiana University in the United States and Wuhan University in China, went further.

First, they created a new color reference by adding three successively darker tabs to the Vitalescence Esthetic Restorative Masters Shade Guide. Having a guide that measured the darker shades was important so the team could more accurately indicate how much lighter the teeth became.

Second, the researchers tested three different concentrations of carbamide peroxide gel -- 10 percent, 15 percent or 20 percent -- to see which was most effective and whether one was more irritating than the other.

The investigators randomly divided 44 subjects into six different groups. Each group was assigned to use one of the three concentrations on the left side and another concentration on the right side. The researchers constructed a custom maxillary arch tray for each patient and instructed them to soak their teeth overnight for six months.

The investigators met with their subjects with decreasing frequency over five years to measure their tooth color. They also asked patients to rate their gingival sensitivity to the carbamide peroxide and prescribed a desensitizing gel to any with more than moderate sensitivity. None withdrew from the study because of sensitivity.

And indeed, their teeth got whiter, with 55 percent of the whitening effect occurring in the first month. After nine months, the teeth gained a mean 15.64 chroma meter values. But after two years, the teeth began to darken again; at four-and-a-half years, the teeth had lost 35 percent of the brightness they'd had at their peak, nine months into the study-- leading investigators to recommend that dentists have their patients with tetracycline stains consider a second bleaching after five years.

As expected, the stronger the concentration of carbamide peroxide, the faster the bleaching. But the difference was only modest, and patients using the different concentrations got virtually the same whitening effect by the end of the five years. Worse, the strongest gel caused significantly more irritation. Two overall caveats from the study: teeth didn't whiten uniformly, and the cervical area was the hardest to lighten.

At the end of three months, 88 percent of the subjects were "pleased" with the results. At the end of five years, only 41 percent felt this way, but 91 percent said they would recommend the bleaching to a friend with similarly stained teeth.

The bottom line, say the researchers? Tetracycline stains can be removed very successfully with this bleaching technique. Although the researchers didn't recommend one concentration over another, patients experiencing sensitivity should switch to a lower concentration.

The investigators also recommended more than six months of bleaching for patients with cervical tetracycline stains. "The categories that were most likely to produce an excellent result were those where tetracycline staining was homogenous, concentrated in the incisal two-thirds of the tooth or where banding was evident," they wrote.


BA Matis et al., "Extended bleaching of tetracycline-stained teeth: a 5-year study."
Operative Dentistry, 31(6):643-51 Nov-Dec 2006


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