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Bleaching Tetracycline-Stained Teeth

The term Tetracycline-stained teeth comes from teeth discoloration due to the use of tetracycline as a drug. The stain is influenced by the dosage used, the length of treatment and stage of tooth mineralization. The discoloration is permanent and can vary from yellow or gray to brown. The bleaching of tetracycline-stained teeth and normal teeth are similar in procedure with the exception of the product used and the duration of treatment. The ideal bleaching method suggested by the dentist should be affordable, safe, and practical for the patient. The most extensively used procedure for Tetracycline-Stained Teeth is overnight bleaching with a 10% carbamide peroxide bleaching agent.

tetracycline stained teeth

How Teeth Respond to Bleaching

Teeth bleaching seems to have a different effect on each patient. It is determined by the condition of the stained teeth as well as the patient’s overall dental health. Some patients’ teeth respond very well that they only require a few dental visits for bleaching, while others may take a longer time to respond to the desired action of the bleaching agent. Tetracycline stains are generally difficult to remove, requiring more visits and a timeframe of 2 to 12 months for teeth bleaching.

The action of the bleaching agent is a continuous process. Teeth respond slowly until they attain the maximum bleaching level. Beyond this, the bleaching agent is no longer effective, and further increases in concentration were futile. For a natural appearance, the optimal teeth color after bleaching should match the sclera of the eye. Bleaching for tetracycline-stained teeth will take up to 15 months to achieve the best results using 10% carbamide peroxide in an overnight bleaching technique.

The significance of the Bleaching Examination

Pre-examination is crucial in dentistry as well as prior to bleaching. Before bleaching, a clinical examination was conducted to assess the type of patient’s teeth staining, intensity, and oral health status. The assessment of the smile line is usually subjected before the bleaching due to a change in enamel thickness near the gum line in the gingival third. The enamel in this vicinity is thin, and the dentine is more evident. In tetracycline staining, the molecules are tightly bonded with dentine, so bleaching can be difficult near the gingival end.

A gummy smile also affects the final outcomes of teeth whitening. The smile with exposed gums is more visible in lighter shades than the yellow hue of teeth. In that case, the optimal procedure is the passive eruption of teeth to minimize the gingival display before the bleaching. Bleaching can also be hampered by prior restoration. The restorative material does not bleach like natural teeth, and the shade difference may jeopardize treatment outcomes.

Bleaching stained teeth are often affected by a compromised periodontal condition or an exposed root surface. Because the bleaching agent had no influence on the root surface, the exposed root areas remain darker than the tooth. It may cause the patient dissatisfaction with the treatment process. Teeth should also be inspected for existing decay or sensitive areas.

Sensitivity during Bleaching

The most common reported complaint following bleaching is sensitivity. The primary reason is the bleaching agent’s quick and repaid penetrating ability in the teeth. Lowering the bleaching agent concentration with a proper-fitting tray or applying 5 percent potassium nitrate before or after bleaching will alleviate tooth sensitivity. For tetracycline-stained teeth bleaching, a 2-week prophylactic use of a desensitizing agent can minimize sensitivity, or the patient can continue with the bleaching without any difficulty.


X-rays examination before dental bleaching or teeth whitening may assist in determining the primary cause of teeth staining. Because many dental problems mimic teeth staining, it is important to rule out the other cause of staining.

Bleaching Materials

The choice of the bleaching agent is made by considering the patient dental status or teeth staining severity. The most common and effective bleaching agents used in vital staining are carbamide peroxide and hydrogen peroxide. The 10-% carbamide peroxide is superior for tetracycline-stained teeth bleaching due to its anticaries activity or increasing the patient compliance in the overnight bleaching technique. The hydrogen peroxide can be used in the daytime or office bleaching technique.

Tray Fabrication

Bleaching requires a well-fitted and custom-designed tray. The tray with gingival cover can be used for low concentration bleaching agents, but for higher concentrations, gingival contact should be avoided. A Perfect fitted, non-scalloped, no-reservoir tray for 10% carbamide peroxide bleaching is recommended for tetracycline bleaching.

Composite Bonding

Dental bleaching restricts the binding ability of the composite due to the production of free oxygen molecules. So, there should be a delay of 2 weeks between bleaching and composite bonded restoration.

Charges for Extended Bleaching Treatments

The cost of bleaching is based on the length of treatment. The tetracycline stain demands a longer time, approximately 9-12 months, so the dentist should explain the entire process to the patient, or it is preferable to begin bleaching with an initial investment for one arch. The bleaching should initiate with the maxillary arch and progress to the lower arch. It will also alleviate the pressure on patients and improve patient compliance.

Single Arch Treatment

Single arch treatment is an effective strategy in dental bleaching. The bleaching should initiate from the upper maxillary arch. It will minimize the influence on occlusion, ultimately reduce sensitivity, and improve patient compliance and comfort.

Patient Compliance

Patient compliance for a longer procedure that lasts 6 to 9 months is difficult, but it is critical for treatment success. A clearer explanation of the treatment and its consequences aids in achieving compliance.

Bleaching Vs. Veneers

Veneers are an alternative option for discolored teeth. Veneers form a thin covering around the teeth and boost the patient’s appearance. The veneers are better suited for the darker stained tetracycline teeth in the gingival third of teeth. Similarly, the teeth with incisal staining have a better prognosis with bleaching. The dentist should inform the patient about the pros and cons of both procedures.  Treatment planning for severely tetracycline-stained teeth usually involves placement of veneers or crowns to cover the darkened teeth. It is usually the severity of the stain that may discourage any attempt to whiten the teeth using bleaching agents.

Let’s get started. Request An Appointment for Teeth Bleaching

Tetracycline staining is a difficult challenge that really had no good solution, but with our system, significant improvements can be achieved with proper treatment and maintenance.  Dr. Rahaf Suede, DDS at Great Lakes Smiles Dental is trusted by many patients in Plymouth and surrounding areas for comprehensive dental care. She is recognized for her high quality dental treatment and patient satisfaction. Contact her now for an appointment Call (734) 459-9360

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