The Cosmetic Dentistry Blog

Dr. Hall, I’m writing about my 9 year old daughter. She has severe fluorosis stains on her teeth. Her bottom central and lateral incisors are extremely yellow (those are the only permanent bottom teeth she has so far). Her top central and lateral incisors are very blotchy, and one of them is jagged on the side. She currently has braces correcting the problems resulting from years of sucking her fingers. Her teeth have bothered her for some time. The only reason we put braces on now, instead of waiting for the 12 yr molars, is to give her more self-confidence with her smile. It also gives us a little more time to figure out how to correct the fluorosis.
Thanks, Carly from Arizona

Carly,
You say your daughter has severe fluorosis. When fluorosis is severe, you need to cover the stained teeth with porcelain veneers – cover all of the teeth that are part of her smile.

Fluorosis is caused by consuming too much fluoride while the teeth are forming. Much natural drinking water has some fluoride in it. There is some natural water that doesn’t have enough fluoride, which makes teeth more susceptible to decay. Communities where this occurs generally add fluoride to the drinking water to bring it to the optimal level of about one part per million. But some communities naturally have water that has too much fluoride, and then some of it needs to be removed. If it isn’t, drinking that water for extended periods while the teeth are forming can cause fluorosis. Or, where people are drinking their own untreated well water, this can occur. Fluorosis can also be caused by mistakenly consuming fluoride supplements when it isn’t needed or by swallowing too much fluoridated toothpaste.

Mild fluorosis causes spotting of the teeth, and the spots can be white or brown, depending on the severity. Often direct bonding can be used in these cases, which just covers the affected spots.

If the fluorosis spotting is extensive, then the teeth need to be covered more extensively, and porcelain veneers would be the treatment of choice.

If there is just a general yellowish color, but that color is even – not mottled – then I would try teeth bleaching first. If that is the case, you’re probably not dealing with fluorosis but some other cause of the staining.

Just be sure you go to a highly experienced and capable cosmetic dentist. This is beyond the ability of your family dentist. Beyond the technical ability and beyond his or her artistic understanding.

You’ll want to wait until the braces come off. And the dentist will need to know how to time the work. I don’t know how long the braces will be on, but when they come off it may be possible that her very front teeth still haven’t fully erupted. In that case, it may be best to do some direct bonding temporarily, or something else. There will be a lot of different ways to tackle the problem, and a lot will depend on her attitude toward the problem. Dentists who aren’t artistically sensitive just aren’t equipped to handle these self-image issues very well, but experienced cosmetic dentists are quite used to them.

There is no minimum age for porcelain veneers, as long as the dentist knows what he or she is doing, and properly factors in the degree of present and future tooth eruption and other factors. Children can also have teeth bleaching.

- Dr. Hall

Click here to find a cosmetic dentist, screened for training and artistic ability.

I had crowns put on my upper 8 front teeth and lower 6 front teeth. I had tetracycline stains. He kept trying to re-do the crowns, but they never looked right.

The first set of crowns looked really bad—thick yellow and badly contoured. The second set looked much better. The bottoms were still somewhat yellow but we were going to put them on and try to use a liner on the bottom to block out the yellow. He tried different colored liners and they made the crowns look blue or gray. So he made another more opaque set of crowns. They look like the porcelein a sink is made out of. I let him put them on because I figured if he tried again I don’t know if they would look better or worse but the front upper 4 look particularly bad. The lab tried to make them look more “natural” and blended some translucent color and it looks like gray streaks and spots. I didn’t notice to what extent until I got home and looked at them more closely.
- Kim from California

Kim,
I don’t know what to tell you, except that I hope other people learn from what happened to you. Tetracycline stains are very difficult to treat, and most dentists don’t have a clue about how to go about it. It appears that your dentist had never done tetracycline stains before. Very few have. And the whole thing just bombed.

You don’t need crowns for tetracycline stains – only porcelain veneers. Crowns require grinding the whole tooth down. Porcelain veneers just need the front of the tooth shaved a little. And it’s tricky to block out the intense dark color of the stain and still get the tooth to look natural. Dentists either don’t block it out enough, and the teeth look gray, or they block it out too much and they look like a toilet bowl. And it sounds like your dentist’s laboratory was also taking it’s first attempt at dealing with tetracycline stains.

You may be able to get your money back. You can try. My advice is not to be confrontational. First thing I would do, however, is find a qualified cosmetic dentist from our list of excellent cosmetic dentists in the Los Angeles area, and see what they think. Then I would go for getting all your money back and starting over. You can have a beautiful smile, but you need a genuine cosmetic dentist to do it.
- Dr. Hall

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Dr. Hall,
I have severe tetracycline stains and have had porcelain veneers for 18 years. They have always been gray, but better than what I had. My teeth are almost black underneath. My dentist brought in the lab specialist that makes the veneers and both have decided to do the crowns. Do you think this is a wise choice?
- Ann from Louisiana

Dear Ann,
Very bad choice, doing the crowns. You don’t need crowns. You need this done by an expert cosmetic dentist. Tetracycline stains are very difficult, and your family dentist simply doesn’t know how to do this. Don’t let them grind your teeth down to stubs.

They recommend crowns because your dentist isn’t a genuine cosmetic dentist, and your laboratory technician isn’t one who specializes in cosmetic dentistry. You don’t need crowns, and even with the crowns, I’m afraid that you will end up ones that look opaque and fake. Only one or percent, maybe two, of dentists can do this beautifully for you.

Your teeth can be beautiful – they can sparkle and be white, natural, and fabulous looking. All it takes is a little effort to find a REAL cosmetic dentist. See the photos of tetracycline-stained teeth on our web site and you will see what the beautiful possibilities are.

And check our list of Louisiana cosmetic dentists. I have carefully screened every dentist listed on that page to make sure they can give you beautiful results. If you aren’t that close to one, believe me when I say it would be worth a drive of several hours, if it needs to be that, to have a beautiful smile instead of one that looks sort of mediocre. Don’t you think so?

Please, for your own sake, do this right. This is way over the head of the vast majority of dentists, which is why you’ve suffered with gray teeth for the past eighteen years.
- Dr. Hall

Dr. Hall,
I’ve been on tetracycline for about 2 years. The dermotologist gave me this for acne. I went to my dentist for a clean recently and they say I have stains on the back sides of my front teeth. They are brown lines. Its from the medicine right? How can I get rid of this problem before it get worse?
- Mindy in Pennsylvania

Dear Mindy,
It’s possible that the staining you’re getting on the backs of your front teeth is from the tetracycline you’re taking, but I doubt it.

Tetracycline stains your teeth by getting absorbed into the enamel and dentin while your teeth are forming, so you need to be under the age of 13 for it really to have an effect. Though there is one study that showed that minocycline, a particular variety of tetracycline, can cause stains in teeth after they’re already formed.

If it’s true tetracycline stain, it’s absorbed into your teeth and needs to be bleached out or covered over with dental bonding or porcelain veneers.

The best at-home stain prevention you can do is to use Supersmile toothpaste. I’d try that and see if it helps keep the stain off.

- Dr. Hall

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