Dealing With Difficult Tooth Stains

As we all know, there are some patients whose teeth are more challenging to whiten than the average whitening case. Fluorosis, tetracycline stains, or decalcification—while seemingly difficult to address—can actually be improved and frequently corrected with the proper treatment.

Fluorosis

What Causes Fluorosis?
Fluorosis is an enamel defect that occurs when a patient receives excess fluoride during tooth development. The result can take the form of mild spots ranging in color from white to yellow or brown.

What Are the Treatment Options for Fluorosis?
Fluorosis can be conservatively treated with take-home tooth whitening products. If the patient is not satisfied with the whitening results, a minimally invasive microabrasion treatment (pictured right) may be needed to further correct the staining. The treatment time and success rate will vary from patient to patient, depending on the severity of the staining. Above, the patient's fluorosis stains were treated with Opalustre and 21 days of home bleaching with Opalescence.

Tetracycline Staining

 What Causes Tetracycline Staining?
Tetracycline is a broad-spectrum antibiotic used to treat infections, and is commonly prescribed to treat acne. This drug calcifies in the dentin if there is exposure during dental development, which spans from fetal development to the age of eight. This calcification manifests as brown or gray banding, sporadic stains, or overall tooth shade.

What Are the Treatment Options for Tetracycline Stains?
Whitening time frames will vary from case to case for tetracycline stains. Where normal whitening can take anywhere from 2–6 weeks, tetracycline stains can take 2–6 months¹ to lighten with consistent, overnight, custom tray whitening. It is important to give your patient a realistic expectation and to make sure they are willing to comply with the extended time frame needed to whiten their stains. The case presented here shows significant progress in 2 weeks.

Decalcification

What Causes Decalcification?
Plaque buildup can cause decalcification, which creates white spots on the tooth. This enamel defect is common in orthodontic patients once their brackets are removed.

What Are the Treatment Options for Decalcification?
White spots from decalcification can be frustrating for many patients. We suggest tooth whitening as a first course of action, since it can help blend the white spots with the rest of the tooth. The decalcified enamel whitens more quickly than the rest of the tooth, so the spots will often become more pronounced in the first few days of treatment. At this point, many patients will cease their whitening treatment, for fear that the spots will become worse. It is important to educate patients about this possibility so you can encourage their continued compliance. After a couple more days of whitening, the rest of the tooth will usually match or blend with the decalcification. If the patient isn't satisfied, an inexpensive chemical and mechanical microabrasive treatment may further correct the appearance of the teeth.

1 - Rosenstiel SF, Gegauff AG, Johnston WM. Efficacy & safety evaluations of a home bleaching procedure. Columbus OH: College of Dentistry, Ohio State University. (Lit #34)
2 - Haywood VB. Bleaching tetracycline-stained teeth. Esthetic Dentistry Update. 1996 February; 7(1).