Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

January 24, 2019

My dentist wants to do crowns for my tetracycline stains

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Dr Hall,

I have severe tetracycline staining on all my teeth. As I’m getting older, it’s starting to bother me more and I really would like to improve my smile. I’m 48 and have very healthy teeth. I’ve only had 2 cavities so far. I’d like to explore porcelain veneers, but every dentist I go to wants to give me a full mouth of crowns. What can I do?

Your help is much appreciated!
– Gregory from Seattle

Severe tetracycline staining is definitely one of the most challenging aesthetic problems a dentist will face. It is caused by taking the antibiotic tetracycline before the age of 12 which is when the permanent teeth are forming. A gray-brown color becomes embedded deeply in the teeth and, when the staining is severe as it is in your case, that color is very dark.

There are a couple of problems with trying to cover this stain with porcelain veneers. One is that to make the porcelain look lifelike it needs to be somewhat translucent. A translucent porcelain veneer, however, will allow the dark underlying color to show through. Click the link for an example of a case that was brought to my attention. Or, the dentist and/or the laboratory technician, in an attempt to prevent that, will use too much opaquer, leaving the veneers looking chalky and fake. Another is that dentists who aren’t experienced in treating tetracycline stains will cover the fronts of the teeth only, leaving dark shadows showing through on the edges.

This is why you truly need an expert cosmetic dentist for this. With dentists who aren’t passionate about cosmetic dentistry, their weakest skill is often color manipulation. So I wouldn’t go to any dentist to treat your tetracycline stains unless they can show you before-and-after photographs of a successful tetracycline case that they have treated. Or, if the dentist is AACD accredited, you can be pretty confident that they have the skills needed to do this right and give you a beautiful smile. If you have any doubts about the dentist, insist that you get a clear view of the case with a try-in before the veneers are bonded. Make sure that you see with your own eyes that he or she has successfully given you a beautiful smile that you are proud to display before they are permanently affixed to your teeth. Don’t accept any excuses like, “Oh, once they are bonded on they will look better.” I also have confidence in all the dentists I list on this site.

There are properties of some porcelains where they scatter light in a way that creates a perception of translucency while they are blocking out underlying color. These opalescent porcelains are used by some of the more sophisticated dental laboratories teaming up with expert cosmetic dentists. But don’t expect 98% of dentists to know about this.

The way that your everyday family dentist may get around all these difficulties is to grind your front teeth down to stubs and put crowns on them. You clearly don’t want that, and I would never want to do that to a patient when there is a much more conservative solution. And, in some cases, even the crowns won’t fully block out the very dark underlying color.

Good luck,
Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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