Tetracycline Stains on Teeth

Question:

What would you recommend for tetracycline stained teeth that are healthy and straight?

—Johnna in Virginia

Dear Johnna,

Porcelain Veneers Are the Treatment of Choice for Tetracycline Stain

Bleaching really doesn't work very well for tetracycline stains. They just don't respond well to bleaching or tooth whitening. They are too dark and too deep for bleaching.

Porcelain veneers are the treatment of choice for tetracycline stains. But you really need an expert cosmetic dentist—these stains are different from any other in that they are very deep in the tooth, and to cover them up requires a mastery of color, translucency, and opacity. These principles simply aren't taught in dental schools, and in my experience, most dentists have difficulty with challenging color issues like this.

How Tetracycline Teeth Stains Are Unique

This stain is dark, and the surprise for dentists that haven't treated this much is that the deeper they go into the tooth, the darker the stain gets. If they use ordinary materials, the dark gray or brown will shine through the bonding or the porcelain and the patient will end up with a gray tooth, not a white tooth. An expert cosmetic dentist knows how to block out these stains and still give you a natural translucency in the tooth.

Other Frequent Mistakes for Non-Expert Cosmetic Dentists Treating Tetracycline Stains on Teeth

Besides erring in not covering up these dark stains enough, non-expert cosmetic dentists will often leave dark triangles between the teeth that show through, or the porcelain veneers will have a dark halo near the base. Or sometimes, the dentist will concentrate on opaquing out the dark color and the teeth will end up pasty-looking and opaque.

Another mistake is that they can treat them too aggressively, grinding the teeth down using crowns, which aren't really necessary. Well-done porcelain veneers, which require just shaving the fronts of the teeth, should give a beautiful result if they are done properly, as you can see in the pictures below. All three cases were treated with porcelain veneers.

Most expert cosmetic dentists will have stories they can tell you of re-doing the porcelain veneers of patients who had tetracycline stains treated by a non-expert. I had several of these cases while I was practicing, and have had e-mails from many disappointed patients, and all of the mistakes listed above have been mentioned in these e-mails.

And please don't make the mistake that many visitors to this site have made, which is to read about these techniques and then think you can just tell your regular dentist about them and magically he or she will become an expert cosmetic dentist. I have many e-mails to illustrate that this doesn't work. The information on this page is all available to dentists who really care about creating beautiful smiles, and if your dentist hasn't been interested enough in creating beautiful smiles to attend the courses where these things are taught, my strong advice is not to trust him or her with this difficult procedure.

What Causes Tetracycline Stain on Teeth

Tetracycline is an antibiotic. It's a fairly powerful antibiotic that kills a broad spectrum of bacteria, and it can be life-saving. However, when it is taken while teeth are forming, it deposits in the dentin and enamel of the teeth and creates a permanent gray or brown stain. It can be a uniform discoloration of the entire tooth or can occur in the form of horizontal bands of stain of varying intensity. They can range from mild to very dark.

—Dr. Hall

Here are three sets of pictures showing the beautiful results you can achieve when tetracycline stains are treated by an expert cosmetic dentist. This first case was performed by Dr. Thomas Dudney of Alabaster, Alabama. For more information, please see our page of Alabama cosmetic dentists. Along with the beautiful work, notice how much more relaxed and confident her smile is in the "after" picture:

Dr. Dustin Nelson, Pasadena, California cosmetic dentist, did the case below, creating a beautiful smile for Cinta. Her teeth were crowded together at various inclinations and moderately stained from tetracycline. Remember, however, that the gray color gets more intense the deeper you go into the tooth, so even milder cases are difficult to treat. Dr. Nelson treated twenty teeth and created for her this beautiful smile that she can show off without embarrassment:

Here is another case of a patient with deep tetracycline teeth stains, treated with porcelain veneers by an expert Texas cosmetic dentist, Dr. Craig Carlson of San Antonio: