Tetracycline was introduced in 1948 as a broad spectrum antibiotic alternative to Penicillin. Unknown at the time of its introduction, tetracycline’s were found to bind to calcium ions and incorporate into developing teeth and bones. Since, permanent teeth begin developing very early in life and continue into the teenage years, if children were given tetracycline during this developmental period the result was permanent staining. The stain tends to be a dark brown or grayish color and can cover the entire surface of the tooth.
Unfortunately, whitening does little to improve the discoloration caused by tetracycline staining. Often times the best cosmetic results are achieved by covering the teeth with either a porcelain veneer or crown.
The challenge for the dentist in restoring these teeth is trying to achieve a balance between a beautiful cosmetic result while preserving the otherwise healthy, natural tooth structure. Full coverage porcelain crowns will certainly block out the dark discoloration caused by the tetracycline staining and can give a fabulous cosmetic result. However, full coverage crowns (or caps) mean that the entire tooth has to be prepared and a significant amount of tooth structure irreversibly removed. Often times, especially in younger patients, this is a very aggressive option. Porcelain veneers are an exceptionally thin, minimally invasive way of cosmetically improving the teeth. Porcelain veneers require minimal tooth removal. A thin porcelain facing is applied over the tooth improving the shape, color and size. The challenge for the cosmetic dentist in this case is blocking out the dark, stained natural tooth with a thin piece of porcelain and not allowing that dark shade to show through the material without looking opaque and lifeless.
In the example below, the patient had severe tetracycline staining as a young child. She decided to have porcelain veneers done to correct the cosmetics. The original veneers were very opaque and lifeless. Over time, gingival (gum) recession occurred with staining around the veneer margins. The patient was no longer happy with the esthetics of her smile. The old veneers were removed revealing a very dark internal tooth shade. Notice how little tooth structure is removed in preparing for the veneers, the majority of the healthy, natural tooth remains untouched. When the final veneers are placed the patient’s smile is fabulous. The veneers manage to block out the dark staining and remain natural looking. This patient was able to achieve the natural, youthful appearance desired without significant reduction to her otherwise healthy teeth.
Cosmetic dentistry can be a wonderful and life changing choice. However, it’s important to keep in mind the sacrifices you are making to achieve that esthetic option. If it’s possible to maintain healthy tooth structure while achieving the desired results, every effort should be made to do so. It’s not often easy but with experience, expertise and careful planning it’s possible. All our offices strive for conservative, cosmetic and compassionate care, we welcome the opportunity to improve your smile.
All photos published to this blog are actual patients of Saratoga Springs Dentists. This case was completed by Dr. Gregory P. Dodd.