Treating patients with tetracycline stains
Stained dentition is always going to present challenges when it comes to restorative dentistry. However, whilst many stains can be effectively managed, some aesthetic defects can be very difficult to overcome, such as staining caused by tetracycline.
But what is tetracycline staining and why does it occur?
A stubborn stain
Tetracycline staining is an aesthetic defect caused by the use of the antibiotic, tetracycline. This staining occurs on permanent teeth as they are forming under the gumline. If an individual takes the antibiotic when their adult teeth are still forming, the drug is able to calcify into the tooth structure, often deep in the enamel. This means that these stains are usually classified as intrinsic.[i]
Appearance wise these defects are difficult to miss. When a developing tooth that has been affected by tetracycline first erupts, the stains are usually bright yellow in colour. Over time, the calcified drug inside the tooth is oxidised, shifting the colour of stains from yellow to dark brown or grey. These stains can appear as either block areas of colour or in streaks throughout the whole of the tooth. They can also affect every tooth in the mouth or just some teeth depending on when the drug was taken and which teeth were still developing at that time.
Even unborn children can be prone to the effects of the antibiotic. If a pregnant woman takes the drug, when her child develops teeth in early childhood they can erupt from the gum already stained.[ii] The drug also works its way into breast milk, so new mothers who are breastfeeding are recommended to avoid it.
When do people take tetracycline?
Tetracycline is taken to treat a number of bacterial infections. It has no effect on viral infections such as colds and flu, and is therefore usually prescribed to combat bacterial infections of the skin, intestines, urinary tract and genitals, as well as STDs such as chlamydia, gonorrhoea and syphilis. The drug is also sometimes used when other antibiotics are not suitable, for instance if a person is allergic to penicillin.[iii]
Although some of these conditions are only likely to effect adults, infections can strike at any age and this means that young children with emerging teeth may still be at risk. Thankfully, with information and understanding surrounding the drug much developed, it’s highly unlikely that young children or expectant mothers would be prescribed this antibiotic. Most medical professionals are now widely aware of the effect the drug has on the dentition and will prescribe an alternative. However, there is evidence that tetracycline can cause slight staining in use at any age. Luckily, this staining is not intrinsic and therefore can be removed with polishing from a dental hygienist or dental therapist.[iv]
Unfortunately, this information was not readily available when tetracyclines were first discovered in 1945, so many adults even today may have tetracycline stains caused by taking the drug as a young child, or because their mother took it during pregnancy.
More than just aesthetics
At a glance tetracycline staining appears to be a serious condition. However, despite the very obvious discolouration of teeth, in most cases the dentition remains healthy and functional.
Regardless, a major impact of staining is the harm it does to the self-esteem of those affected. People with bad staining are unlikely to want to smile and may even develop certain mental disorders such as anxiety and depression. One study that assessed the psychological impact of having stained anterior dentition found that the majority of participants felt that having stained teeth prevented them from joining discussions, smiling and interacting with others.[v]
Anxiety and depression caused by discoloured teeth can also come full circle. Both of these conditions are thought to result in less frequent visits to the dentist, as well as unhealthier eating habits and lax oral health routines.[vi]
What can dentists do?
Although tetracycline stains can be bleached to improve them, this process can often take years and still result in an unsightly outcome.[vii] Therefore, options for treating patients with tetracycline staining are limited, especially as most restoratives are unable to mask these stains effectively.
Filtek Universal Restorative from 3M Oral Care is different. The new, Pink Opaquer shade has been specially designed to mask metallic defects and stained dentition during restoration, helping you to achieve optimal aesthetics.[viii] By applying a 1mm layer of the pink opaquer followed by a composite layer from the simplified Filtek Universal Restorative shade choice, you can match your patient’s teeth and beautiful opacity can be achieved.
[ii] 1-800 Dentist. Tetracycline stains. Link:  [Last accessed July 19].
[v] Ibiyemi, O., Taiwo, O. Psychological Aspect of Anterior Tooth Discolouration Among Adolescents in Igbo-Ora, SouthWestern Nigeria. Ann Ib Postgrad Med. 2011 Dec; 9(2): 94–99.
[vi] Oral Health Foundation. Mental Illness and Oral Health. Link: https://www.dentalhealth.org/mental-illness-and-oral-health [Last accessed July 19].
[vii] Matis, B., Wang, Y., Eckert, G., Cochran, M., Jiang, T. Extended Bleaching of
Tetracycline-Stained Teeth: A 5-Year Study. Operative Dentistry. 2006; 31(6): 643-651.
[viii] 3M Oral Care Internal Data. Masking with Pink Opaquer. Claim 7393.