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Bleaching: the initial treatment consideration for tetracycline-stained teeth

British Dental Journal volume 230, pages 807–812 (2021)Cite this article

Abstract

Tray tooth bleaching involves the use of carbamide peroxide in a custom-fitted tray to bleach teeth. One of the most difficult stains to bleach is tetracycline. This paper will present several different patient situations of tetracycline-stained teeth being bleached and will discuss the benefits and limitations of bleaching tetracycline-stained teeth. By providing the patient with realistic potential outcomes of bleaching, as well as the preservation of tooth structure and cost-benefit ratio of bleaching compared to veneers or crowns, the chance for a successful acceptance of the outcome is better, even if the outcome is less than ideal. Bleaching before prosthodontic treatment can also provide a better outcome for subsequent veneers or crowns if that is possible, but sensitivity may preclude bleaching.

Key points

  • Vital tooth bleaching should be considered as the initial treatment for tetracycline-stained teeth.

  • Vital tooth bleaching can have a dramatic effect on whitening tetracycline-stained teeth as a conservative sole therapy.

  • Bleaching can be performed prior to adjuvant prosthodontics in complex tetracycline-staining cases, requiring less reduction of tooth structure and producing more profound results.

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References

  1. Okuda W H. Correction of Extremely Dark Anterior Teeth. 2019. Available at https://www.dentistrytoday.com/articles/10587 (accessed May 2021).

  2. Leonard Jr R H, Haywood V B, Caplan D J, Tart N D. Nightguard vital bleaching of tetracycline-stained teeth: 90 months post treatment. J Esthet Restor Dent 2003; 15: 142-153.

  3. Mccaslin A J, Haywood V B, Potter B J, Dickinson G L, Russell C M. Assessing dentin colour changes from nightguard vital bleaching. J Am Dent Assoc 1999; 130: 1485-1490.

  4. Haywood V B, Sword R J. Tooth bleaching questions answered. Br Dent J 2017; 223: 369.

  5. Leonard Jr R H, Haywood V B, Eagle J C et al. Nightguard vital bleaching of tetracycline-stained teeth: 54 months post treatment. J Esthet Dent 1999; 11: 265-277.

  6. Haywood V B. Tooth whitening: indications and outcomes of nightguard vital bleaching. Batavia: Quintessence Publishing, 2007.

  7. Haywood V B, Caughman W F, Frazier K B, Myers M L. Tray delivery of potassium nitrate-fluoride to reduce bleaching sensitivity. Quintessence Int 2001; 32: 105-109.

  8. Haywood V B. Extended bleaching of tetracycline-stained teeth: a case report. Contemp Esthet Restor Pract 1997; 1: 14-21.

  9. Haywood V B, Leonard R H, Dickinson G L. Efficacy of six months of nightguard vital bleaching of tetracycline-stained teeth. J Esthet Restor Dent 1997; 9: 13-19.

  10. Haywood V B. Nightguard Vital Bleaching-Indications and Limitations. US Dent 2006; 18: 2-8.

  11. Haywood V B. Treating sensitivity during tooth whitening. Compend Contin Educ Dent 2005; 26: 11-20.

  12. Haywood V B, Cordero R, Wright K et al. Brushing with a potassium nitrate dentifrice to reduce bleaching sensitivity. J Clin Dent 2005; 16: 17-22.

  13. Kwon S R, Dawson D V, Wertz P W. Time course of potassium nitrate penetration into the pulp cavity and the effect of penetration levels on tooth whitening efficacy. J Esthet Restor Dent 2016; 28 Suppl 1: S14-S22.

  14. Haywood V B, Parker M H. Nightguard vital bleaching beneath existing porcelain veneers: A case report. Quintessence Int 1999; 30: 743-747.

  15. Cohen S, Parkins F M. Bleaching tetracycline-stained vital teeth. Oral Surg Oral Med Oral Pathol 1970; 29: 465-471.

  16. Arens D E, Rich J J, Healey H J. A practical method of bleaching tetracycline-stained teeth. Oral Surg Oral Med Oral Pathol 1972; 34: 812-817.

  17. Matis B A, Wang Y, Jiang T, Eckert G J. Extended at-home bleaching of tetracycline-stained teeth with different concentrations of carbamide peroxide. Quintessence Int 2002; 33: 645-655.

  18. Kelleher M. Dental bleaching (QuintEssentials of Dental Practice Book 38). London: Quintessence Publishing Company Limited, 2019.

  19. Haywood V B. Nightguard vital bleaching. Quintessence Int 1989; 20: 173-176.

  20. Haywood V B. History, safety, and effectiveness of current bleaching techniques and applications of the nightguard vital bleaching technique. Quintessence Int 1992; 23: 471-488.

  21. Matis B A, Cochran M A, Eckert G, Carlson T J. The efficacy and safety of a 10% carbamide peroxide bleaching gel. Quintessence Int 1998; 29: 555-563.

  22. Ritter A V, Leonard Jr R H, Georges A J S, Caplan D J, Haywood V B. Safety and stability of nightguard vital bleaching: 9 to 12 years post-treatment. J Esthet Restor Dent 2002; 14: 275-285.

  23. Witkop C J, Wolf R O. Hypoplasia and intrinsic staining of enamel following tetracycline therapy. JAMA 1963; 185: 1008-1011.

  24. Sánchez A R, Rogers 3rd R S, Sheridan P J. Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity. Int J Dermatol 2004; 43: 709-715.

  25. Grossman E R, Walchek A, Freedman H, Flanagan C. Tetracyclines and permanent teeth: the relation between dose and tooth colour. Pediatrics 1971; 47: 567-570.

  26. Goulden V, Glass D, Cunliffe W. Safety of long-term high-dose minocycline in the treatment of acne. Br J Dermatol 1996; 134: 693-695.

  27. Chen J-h, Shi C-x, Wang M, Zhao S-j, Wang H. Clinical evaluation of 546 tetracycline-stained teeth treated with porcelain laminate veneers. J Dent 2005; 33: 3-8.

  28. Petricevic N, Puhar I. Porcelain Veneers and Zircon-Porcelain Crowns for the Esthetic Treatment of Severely Discoloured Anterior Teeth. JSM Oro Facial Surg 2017; 2: 1-10.

  29. McLaren E A. Porcelain veneer preparations: to prep or not to prep. Inside Dent 2006; 2: 76-79.

  30. Sailer I, Makarov N A, Thoma D S, Zwahlen M, Pjetursson B E. All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: Single crowns (SCs). Dent Mater 2015; 31: 603-623.

  31. Fradeani M, Roedemagni M, Corrado M. Porcelain laminate veneers: 6-to 12-year clinical evaluation-a retrospective study. Int J Periodontics Restorative Dent 2005; 25: 9-17.

  32. Haywood J D, Delash J. Determining Appropriate Fees for Tooth Bleaching. Inside Dent 2019; 15: 34-42.

  33. American Dental Association. Survey of Dental Fees 2018 - CPS-55492. 2018. Available online at https://ebusiness.ada.org/productcatalog/55492/Center-for-Professional-Success/Survey-of-Dental-Fees-2018/CPS-PR063 (accessed May 2021).

  34. Napitu A, Batchelor C. Cosmetic Dentists Costs: Explore Different Ways to Improve Your Smile. 2021. Available at https://www.dentaly.org/en/cosmetic-dentistry/ (accessed May 2021).

  35. Edelhoff D, Sorensen J A. Tooth structure removal associated with various preparation designs for anterior teeth. J Prosthet Dent 2002; 87: 503-509.

  36. Leonard Jr R H, Haywood V B, Phillips C. Risk factors for developing tooth sensitivity and gingival irritation associated with nightguard vital bleaching. Quintessence Int 1997; 28: 527-534.

  37. Cooper J S, Bokmeyer T J, Bowles W H. Penetration of the pulp chamber by carbamide peroxide bleaching agents. J Endod 1992; 18: 315-317.

  38. Browning W D, Haywood V B, Hughes N, Cordero R. Research Update-Prebrushing with a Potassium Nitrate Dentifrice to Reduce Tooth Sensitivity During Bleaching Evaluated in a Practice-Based Setting. Compendium 2010; 31: 220.

  39. Curtis J W, Dickinson G L, Downey M C et al. Assessing the effects of 10 percent carbamide peroxide on oral soft tissues. J Am Dent Assoc 1996; 127: 1218-1223.

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Authors and Affiliations

  1. Assistant Professor, Department of Restorative Sciences, The Dental College of Georgia, Augusta University, Augusta, GA, 30912, USA

    Ryan F. Bloomquist

  2. Associate Professor, Department of Restorative Sciences, The Dental College of Georgia, Augusta University, Augusta, GA, 30912, USA

    Rhoda J. Sword & Jimmy Londono

  3. Professor, Department of Restorative Sciences, The Dental College of Georgia, Augusta University, Augusta, GA, 30912, USA

    Van B. Haywood

Authors
  1. Ryan F. Bloomquist
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  2. Rhoda J. Sword
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  3. Jimmy Londono
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  4. Van B. Haywood
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Correspondence to Ryan F. Bloomquist.

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Bloomquist, R., Sword, R., Londono, J. et al. Bleaching: the initial treatment consideration for tetracycline-stained teeth. Br Dent J 230, 807–812 (2021). https://doi.org/10.1038/s41415-021-3121-x

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