A Comprehensive Guide to Tetracycline Teeth

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If you don’t recognize the term “tetracycline teeth,” that’s okay. Most people don’t. But if we mentioned the term “gray teeth,” that would probably ring a bell for you.

The term tetracycline teeth is used to refer to teeth that are gray or brown in color (as opposed to the off-white that they should be). Teeth become gray or brown because of discoloration, which could be caused by to several internal and external factors. Not all grey or brown teeth are the result of tetracycline. However, for the purpose of this discussion, we’ll focus on tetracycline and its effects that cause teeth to become discolored.

Tetracycline Teeth
Teeth stained due to tetracycline antibiotic

More often than not, there are techniques that can be used to whiten tetracycline teeth, but sometimes, the condition of the teeth may be beyond whitening.

In this post, we’ll introduce you to the causes of why teeth become discolored and what you can do to whiten them if you have the condition. We’ll offer answers to questions like:

  • What are tetracycline teeth?
  • What is the cause behind them?
  • Does tetracycline cause tooth decay?
  • How do you remove tetracycline stains from teeth?

Let’s start by introducing you to the concept.

What is tetracycline?

Tetracycline is a strong antibiotic used to treat potentially life-threatening bacterial infections in children less than 8 years of age. The most common diseases this medicine treats include UTIs (urinary tract infections), respiratory tract infections, acne, gonorrhea, and rosacea.

The tetracycline group of medications was discovered in 1945 and first administered in 1948. It was considered to be one of the most effective ways to treat bacterial infections, and before the 1980s, this antibiotic was often prescribed to patients suffering from such diseases. This included pregnant women and young children. At that time, medicinal science hadn’t fully decoded the side-effects of this drug, which included permanent staining or discoloration of teeth in children whose teeth were not fully developed (that is, children who were less than 8 years of age).

Over time, as teeth staining was discovered in children taking this medicine, studies were conducted to conclude that tetracycline was causing the permanent staining of teeth. Later on, it was also found that the drug could cross placental barriers, meaning that if given to a pregnant woman, the effects of the drug were likely to cross over to the unborn child.

Since the discovery of this fact, several awareness programs were conducted across the world to reduce the use of tetracycline. Consequently, the present-day sees a significant decline in the occurrence of tetracycline staining. But even today, adults with tetracycline teeth can be spotted, so if you come across someone with such a condition, know that they must have been prescribed the antibiotic when they were less than 8 years old.

Categories of tetracycline-stained teeth

To this day, four categories of tetracycline staining have been observed:

  • Mild: This category materializes as minimal and uniformly distributed light yellow, light brown, or light grey stains restricted to the incisal part of the crown.
  • Moderate: This is a slightly deeper staining that varies in location and quantity. Discoloration can range from deep yellow to grey or brown, but usually, there’s no banding.
  • Severe: This is a more severe form of staining with dark brown, dark grey, or even blue and purple stains appearing on teeth, complete with banding.
  • Intractable: This is the highest form of tetracycline staining observed to date, which includes intense pigmentation of the teeth, including very dark stains and extremely pronounced bands.

While people may choose to live with mild or even moderate staining, living with severe and intractable cases of tetracycline teeth staining may be very challenging for self-esteem.

Factors that contribute to tetracycline tooth discoloration

Staining of the teeth due to tetracycline depends to a large extent on the following factors:

  • The medicine dose
  • The length of treatment
  • The stage of calcification of the child’s teeth

Though the staining can vary from yellow/gray to brown, most commonly, gray-colored teeth are found in children taking this medicine. The discoloration can affect an entire tooth, or the stains can appear in the form of horizontal bands (like stripes) that range from light to dark.

Tetracycline staining differs from minocycline staining. Minocycline is a variant of the antibiotic and thus is also prescribed as a treatment for bacterial infections. Though it also causes teeth staining and discoloration to some extent, the effects of both drugs differ in that tetracycline affected teeth give off a fluorescent yellow color under UV light.

Additionally, permanent teeth display a more diffused and less intense discoloration as compared to primary teeth.

angry boy tetracycline teeth
It usually only affects children

You may be wondering why the teeth staining affects only children. The reason is that it is directly related to the process of calcification of teeth. Calcification of teeth starts even before we are born, during pregnancy’s 2nd trimester, and lasts up to the age of 8. So if children whose teeth are still calcifying are exposed to tetracycline, the medicine attaches to the outside of the tooth, causing permanent staining. Also, the exact location where tooth discoloration occurs directly correlates to the stage of tooth development at the time of the exposure.

Does tetracycline stain teeth in adults?

Tetracycline causes permanent discoloration in children’s teeth because of the formation of insoluble calcium-tetracycline orthophosphate complexes in the dental enamel. These complexes darken on exposure to light, which leads to the grey or brown colored teeth. The discoloration is less prominent in adults because of the lack of free calcium in the dental enamel. While that’s true, minocycline has been reported to cause teeth discoloration in 3 to 6% of adults who are on a daily dose of more than 100mg for more than 1 month.

Therefore, although tetracycline staining is primarily observed in children, rarely, it may happen in adults as well, although it is fully reversible.

This fact has been demonstrated in this case. This 54-year-old woman suffered from brown-colored staining on her teeth after taking a 4-week tetracycline medication for blepharitis. However, regular visitations to her dentists and an extensive abrasive cleansing treatment resulted in the complete removal of the staining.

Does tetracycline cause tooth decay?

Though most dental experts point out that the worst that tetracycline can do is permanently stain teeth in children, some doctors believe tetracycline can sometimes bind to the calcium phosphate in young children’s teeth and result in its absorption by the dental tissues.

As a result of this absorption, the dental enamel of affected teeth can be damaged, and this can lead to pitting and susceptibility to the teeth and oral cavity.

Can tetracycline teeth be whitened?

Tetracycline stains are different from coffee, tea, and wine stains. Unlike the latter, which exist only on the teeth surface, tetracycline stains are within the teeth (intrinsic). Thus, whitening them can be a challenge for your orthodontist depending upon the level and stage of staining.

But that doesn’t mean it isn’t possible. Whitening for such teeth is quite possible, and usually, the procedure involves a combination of at-home whitening products and professional dental work such as veneers and crowns.  

In the video below Dr. Gordon talks about the effectiveness of bleaching on tetracycline stains.

The following table summarizes the kinds of teeth whitening options available for teeth stained with tetracycline.

Treatment Type Description Average Cost*
Teeth bleaching Overnight tray bleaching using a 10% carbamide peroxide bleaching agent Under $100 for over-the-counter, and up to $600 for professional bleaching
Cosmetic teeth bonding Covering of stained teeth by a tooth-colored filling material $300–4600 per tooth
Porcelain Veneers Sticking thin shells of tooth-colored material to the front surface of existing teeth $925–$2500
Crowns Removal or shaping of a significant part of the natural tooth $800–$1700 per crown

*All prices mentioned above are approximate values. Please consult your dentist for accurate pricing.

Conclusion

For someone who has tetracycline teeth, a simple task such as smiling could be embarrassing. Knowing why you have stained teeth could form an essential step in accepting the problem and looking for a solution.

If you have tetracycline teeth, it’s understandable that you seek treatment such as teeth whitening to regain the confidence to smile. Although the kind of treatment you choose depends on the condition of your teeth, your budget, and your preference, before opting for any of the procedures listed above, find out about their pros and cons and evaluate them carefully.

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Sources
ncbi.nlm.nih.gov: Tetracycline-Induced Discoloration of Deciduous Teeth. Consulted 4th March 2020. ebmconsult.com: The Mechanism for Tetracycline Associated Staining of the Teeth. Consulted 4th March 2020. nature.com: Reversible tetracycline staining of adult dentition in the treatment of chronic blepharitis. Consulted 4th March 2020. sciencedaily.com: Tetracycline Plus Teeth Equal Gray Smile. Consulted 4th March 2020. oralhealthgroup.com: Treatment of Tetracycline Discoloured Teeth with Full Ceramic Restorations. Consulted 4th March 2020. patientconnect365.com: Combating Tetracycline Stains. What Works?. Consulted 4th March 2020.
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