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Tetracycline Tooth Staining: Its Cause, Prevention & Treatment
When I was a little boy, I remember seeing my brother in the bathroom trying to bleach his teeth. He tried many different formulations of bleaching agents to try to remove the staining on his teeth.
I asked him about it recently, and he told me he wasn't sure how it happened. We suspected that my mom unknowingly took some sort of antibiotic that stained his teeth when she was pregnant with him or that he had taken something as a kid. He couldn't remember.
Then, I called my mom. She said that she didn't take anything during her pregnancy and the discoloration came from a drug that was prescribed to him at a young age. Whatever the reason, nobody likes to have discolored teeth.
To the right is a close-up view of the same patient in the photo above. As you can see, the tetracycline has changed the color of his teeth.
Tetracycline Tooth Staining
Tetracycline can stain the teeth anywhere from a bright yellow shade to dark brown. Usually the staining starts out as a yellow color. Over time, as the tooth is exposed to light, a chemical reaction occurs and the yellow turns to a dark brown color. For this reason, many people with tetracycline tooth staining have brown teeth in front (the teeth that are exposed to the most light) and yellow teeth in the back (where not as much light reaches.) Under ultraviolet light, tetracycline staining can appear bright yellow.
However, it's not just tetracycline that stains the teeth - there are many other drugs as well.
Other Drugs That Cause Staining of Teeth
Many of tetracycline's homologues (similar drugs) are all associated with discoloration. Chlortetracycline, demethylchlortetracycline and oxytetracycline can all cause brown/gray/yellow staining of the teeth.
Ciprofloxacin is an antibiotic that can be given intravenously to infants for treatment of a Klebsiella infection. It can stain the teeth a green color, but the staining is usually more mild than tetracycline staining.
Minocycline hydrochloride is an antibiotic used to treat acne and rheumatoid arthritis. It is believed that minocycline binds to the tooth and then oxidizes it, producing a discoloration. Minocycline is able to stain teeth even after they are fully developed, unlike the tetracycline family of antibiotics and ciprofloxacin.
Prevention
Tetracycline can cross the placental barrier and incorporate into the developing tooth. It should be avoided (if possible) by mothers who are pregnant and also in kids until they are at least seven or eight years of age.
The book Oral Pathology: Clinical Pathologic Correlations by Regezi says the following about how tetracycline staining is caused:
Because tetracycline can cross the placenta, it may stain primary teeth if taken during pregnancy. If it is administered between birth and age 6 or 7 years, permanent teeth may be affected. Only a small minority of children given tetracycline for various bacterial diseases, however, exhibit clinical evidence of discoloration. Staining is directly proportional to the age at which the drug is administered and the dose and duration of drug usage.
Since there are many other antibiotics available that are as effective as tetracycline without the discolored teeth as a side-effect, tetracycline is usually not prescribed to children except in rare circumstances. Your doctor will be able to explain the reasoning if your child is ever prescribed tetracycline.
Treatment of Tetracycline Stained Teeth
It is very difficult to treat internal staining of teeth because it affects the dentin layer underneath the enamel.
For an overview of the layers of the teeth, check out this article on the anatomy of a tooth.
There are a variety of ways to treat tetracycline stained teeth depending on the severity of the staining. The most conservative is bleaching the tooth. If the tooth has undergone root canal treatment, it may be more effective to use an internal bleaching technique where the dentist puts a bleach inside the tooth to bleach it from the inside out. Internal bleaching is not possible with teeth that have not undergone root canal treatment because there is still living pulp inside the tooth where the bleach would be put.
If bleaching doesn't work, there are more invasive treatments. The dentist can shave off the outer layer of the tooth and put an aesthetically-pleasing tooth-colored filling on the front-facing surface of the tooth.
Another treatment option is putting veneers (a thin layer of tooth-colored porcelain) over the teeth.
The most drastic treatment would be to cut around the whole tooth and put an aesthetic crown over the tooth. This may end up being the most aesthetic option for severe tetracycline-stained teeth, but it is also the most expensive. I believe my dental school would charge somewhere around $500 for this procedure, which means it is probably near $1,000 if you get it done in private practice.
Conclusion
I hope this article helped you to better understand why antibiotics stain the teeth and what you can do to prevent it.
Are your teeth stained due to a medication such as tetracycline? Have you done anything about it? Don't hesitate to share your experience in the comments so others who have the same problem can see what worked for you.
If you have any questions or comments, go ahead and leave those in the comments section below as well. Thanks for reading!
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Hi, I'm Tom. I'm currently a 4th year dental student in the USA. I started this blog to help people take better care of their teeth. You can 
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Thank you for writing this. I have tried bleaching my teeth but it is still slightly stained. I talked with my dentist about veneers and I think I might go that route when I get the money saved up... It's tough in this bad economy though.
Thanks for your comment, Cathy. It's always good to know that people are getting something out of what I write.
I hope that the veneers work out good for you!
Cathy - I hope you get the veneers. After many years of embarassment, I gave in and paid for the veneers. I have not regretted it for a minute. Yes, I could have gone on a fabulous trip, bought an inexpensive car, or made a down payment on a house instead of getting veneers. You have no idea how much better you will feel with the veneers.
THANK YOU SO MUCH for this article. I had bad acne as a teenager and took several drugs for it. When I was in my late 20's or early 30's I noticed my teeth started turning darker, first yellow then a darker shade of brown (especially on my lower teeth - like in the photo on this website). My dentist told me it was because my mother took tetracycline when she was pregnant with me. I checked with her she informed me she DID NOT take anything like that while pregnant with me. For the longest time I have blamed it on the Accutane I took when it first came out as a "trial basis". I just assumed because they didn't know all the risks of it that it must have been what discolored my teeth. Now reading this article, I realize it was probably the minocycline I took. I recognized the name and remembered that was one of the medications I was on. I appreciate you stating "Minocycline is able to stain teeth even after they are fully developed....." None of the dentist’s I have seen has ever informed me of this.
I have tried bleaching and it did not work, so I will eventually end up getting the veneers.....when I can afford it.
Thanks again for the article!!
Thank you for your comment, Sue. When I read your comment, I wondered why it had taken so long for your teeth to get stained. I checked in my oral pathology book and found this on page 73:
"[Minocycline] staining is not universal; only 3% to 6% of long-term users become affected. In those affected, the period of time before discoloration becomes evident can range from just 1 month to several years."
It looks like that probably was the culprit.
Your dentists probably never informed you of this because they weren't quite sure. We don't go into too much detail about tetracycline in dental school. Luckily, I have this blog to motivate me to keep learning about different dental topics. For example, I probably wouldn't have known that minocycline could affect teeth several years after use. Thanks for your kind words, and good luck with your veneers in the future!
Thank you! I will recommend this website to anyone with dental questions. It was very helpful to me!
Best of luck to you!
Thank you, Sue. It's comments like these that give me encouragement to keep writing
Oh I'm so sorry. My internet automatically translated everything to danish, and that's why I wrote in danish too. But my question is stille the same.
Do you get yellow teeth no matter what when using Tetracycline? I'm 16 and currently getting some pills called Tetracyclin Actavis against acne, but if my teeth will become yellow because of that I don't think it's worth it.
Hi M - It's alright, I deleted the Danish comment for you.
Tetracycline incorporates itself into the teeth while they are forming. For this reason, doctors usually don't prescribe tetracycline-containing products to pregnant women or children under 8. Once you turn 8 years old, your teeth have finished developing and you shouldn't have any problems with yellow teeth.
Some acne medication, such as minocycline, has been shown to discolor teeth at any age.
I hope that helps. Thanks for your comment!
Thanks for posting this. I have teeth stained from taking tetracycline as a child. For years I had the four upper top ones bonded, but it was never a long term fix. Last year I had veneers put on my top teeth. I almost have them paid off and will eventually have the lowers done. My dentist specializes in cosmetic dentistry and the procedure is $1,500 per tooth in Houston. It really has changed my life and I encourage people, if they can afford it, to spend the money. A lot of dentists offer an interest-free credit program where you can pay monthly for a year as long as you make monthly payments and pay it off within the year. The interest-free credit was the final encouragement to get me to do it. I am so glad I did. It has given me more confidence and I have strangers who tell me how beautiful my teeth are.
Hi Julia - Thanks for sharing your story! I'm glad your dentist did a good job. Out of curiosity, how did you find a good dentist to do the veneers?
One thing to watch for is that many general dentists claim to "specialize" in cosmetic dentistry because cosmetic dentistry isn't one of the nine recognized dental specialties in the U.S. (It is illegal for a general dentist to claim to specialize in one of the nine recognized specialties.)
When looking for a cosmetic dentist, it is helpful to see if they are a member of the American Academy of Cosmetic Dentistry. Also, be sure to ask to see some "before" and "after" pictures of patients that the dentist has seen.
Also, some dentists have pre-selected patients who they've seen who wouldn't mind sharing their experience with someone who is considering having a cosmetic dental procedure done. If you're not sure about a certain cosmetic dentist, ask him or her if they have some past patients that you could speak with to see what they thought of treatment.
Thanks for your comment, Julia - I'm glad that the veneers are working out great for you!
Tom,
You make an excellent point and I'm really glad you mentioned that about finding a "cosmetic dentist." Houston is the fourth largest city in the U.S. and there are dozens of dentists who claim to be cosmetic specialists. I am very lucky because my dentist has worked at the dental school for 30 years. He almost always refers me to his former students. This time he referred me to a former student who was the partner of this dentist. He had discouraged me for several years for getting the veneers because of the cost and the difficulty in finding someone. She has done such a great job. I literally have strangers tell me what great teeth I have.
That's a great method to find a dentist, Julia. I've found that a lot of the dentists who teach at my dental school know the reputations of many of the dentists around our city. They can usually tell me which ones are known for doing high quality dental work.
With veneers, you really want to make sure you find the right dentist, since so many people will be looking at them. Thanks for sharing with us!
Hi, Tom, Thank you very much for sharing your expertise. I have tetracycline teeth. Do you know which one is better, veneer or crown? I mean if veneer can work. Thank you
don
Hi Don - Depending on the severity usually veneers can work. I think that a porcelain veneer would be the best option because the dentist only removes a thin layer on the front of the tooth, rather than cutting around the whole tooth as is done during preparation of a tooth for a crown.
Your best bet would be to find a good cosmetic dentist who has experience in treating tetracycline staining. Ask to see some before and after photos and make sure that they are the dentist's own work, and not simply stock photos. A good resource that you may want to look at is a new book called The Naked Tooth by Dr. Colleen Olitsky. She talks about veneers and tells you how to find a good cosmetic dentist. I found the book at my library - if yours has it, that can save you the cost of buying it.
I hope that helps, Don. Let me know if you have any other questions. Thanks for your comment!
Hi Julia, Thanks for sharing your experience! I'm glad your dentist did a good job. I have the same problem with my teeth. I live in Houston, TX. I need to find a good dentist to fix my tetracycline teeth. My dentist suggested me to do crown to cover the gray color and discouraged me to get the veneers because of the difficulty in covering compleltely the color. I would like to do veneer if it works very well. I wonder if you can give your cosmetic dentists name and phone I can consult and get my teeth fixed. It seems you have a very good general dentist. If you can give his phone number I want to switch my dentist. I appreciate it.
Don
Hi Tom, great work you have shared with us. I have a question about giving Amoxicillin to children especially around the age of 2yrs old for treatment; who have ear infections such as Otitis Media. NOw does amoxicillin cause any sort of teeth discoloration even if its given at the proper dosage for the child?
Thank you for your response....
Hi Tariq - I looked in my Pediatric Dentistry book and didn't find anything about Amoxicillin and tooth discoloration. After searching through the scientific literature, I did find some references. Here's a couple interesting articles:
- Association of Amoxicillin Use During Early Childhood With Developmental Tooth Enamel Defects
- Drug-Induced Disorders of Teeth
- Amoxycillin-Clavulanic Acid-Related Tooth Discoloration in Children
From what I gather, it doesn't appear to be as widespread as the tetracycline staining was many years ago, but it would seem that if it is taken in high enough dosages, amoxicillin could cause some tooth discoloration in certain people.
Thanks for your comment, now I know how to answer this if I get asked about this by a concerned parent in the future!
Hi Tom, this question does not have to do with teeth stains but it does involve the use of Tetracycline. I have been having issues with sensitivity in a couple of my back teeth for a couple of years. I suffer from a condition on the left side of my face that has resulted in the surgical removal of two benign neoplastic tumors on the parotid gland. One of the complications with the surgery is the possible damage that it may cause to the trunk of the facial nerve. I suspect that this damage may have affected my teeth in some way and this might have led to the development of pain in several healthy teeth. The pain occurs when I bite down on hard food and there is also an issue with hot and cold. I have been using Sensodine toothpaste for more than a year now and although it has helped with the hot and cold issue there still is a problem when I bite on hard food. I also wear a Nightguard since I grind my teeth. I have been consulting with my dentist about this issue and the latest thing he has suggested I do is to take Tetracycline to help with the sensitivity in those teeth. I tried doing my own research online but I have been unable to find any documentation on the use of Tetracycline to help with possible pain or sensitivity issues. I was wondering if you know anything about the use of this drug for this problem.
Thanks,
JM
Hi JM - I'm sorry to hear about your dental pain. I know that it can be stressful.
My best guess is that your dentist believes that there are bacteria getting in between the teeth and your gums. This could cause inflammation of the periodontal ligament. In my periodontics class, we talked about giving a long-term low-dosage of tetracycline to help fight the bacteria that cause periodontal disease.
Other than that, I have not heard of tetracycline being used to help with pain/sensitivity. I hope that helps, Juan. If you have any other questions, just leave another comment and I'll get back to you. Thanks for visiting, and I hope that the pain in your teeth starts to go away soon.
As far as I am concerned, Pfizer owes me (at least) a mouthful of dental implants! I was just a three year old child who was given Pfizer-made tetracycline which caused my dental staining. Pfizer was grossly negligent and should pay for my dental work.
Hi Rebel - I'm sorry to hear that! Was it before anybody knew that it could stain teeth? Thanks for your comment.
hi tom. i am still unsure if i should try bleaching my teeth that are discoloured due to use of tetracycline in infancy. my dentist says it may accuentate the problem?? it has become more noticable since removal of braces recently. please advise .........
Hi Colleen - I haven't heard of bleaching making tetracycline stained teeth any worse. I just did a quick search in a health database and came up empty handed. From what I know, bleaching is the best place to start when trying to get rid of the tetracycline staining on your teeth.
I found this study that discusses the effect of bleaching on tetracycline-stained teeth. All of the teeth became lighter. The only problem that occurred was slight sensitivity in the teeth, and that only happened in one person and it eventually went away.
I hope that helps. If you have any other questions, let me know. Thanks for your comment!
Hi Tom,
My acne started flaring again so I just went to see a dermatologist today and was prescribed Minocyclin for 6 weeks and Clyndoxyl gel. I did my research before I went to my appointment and found out about the tooth discoloration. When I asked my dermatologist, she said my teeth likely won't get stained because I will only be taking them for a short time and that you'll only be able to form discoloration if you're on the antibiotics for 4 months+...Is this true? Are the changes only evident for people on long-term use? I have perfect white teeth and I'd rather have acne than get stained, yellow teeth...
Thank you for your response.
Hi Vanessa - Your dermatologist is most likely correct in your case. Here's what I found out while reading Oral & Maxillofacial Pathology by Neville :
- Minocycline discoloration only occurs in certain people - only 3 to 6% of people who use minocycle for an extended period of time will get discoloration. If you don't fit into those 3-6%, then you shouldn't have anything to worry about in terms of tooth discoloration.
- In the affected 3-6% of the population, the amount of time it takes to discolor your teeth can range anywhere from 1 month to over three years.
- Some researchers believe that if you take Vitamin C supplements, then it will block the staining caused by minocycline.
I hope that helps, Vanessa. If you have any other questions, just leave another comment.
I was given tetracyclin as a newborn in 1966, to combat severe jaundice, and have grey/yellow teeth as a consequence. I suspect that my childhood dentist decided not to correct slight crookedness in the teeth on the grounds that they would still be grey anyway.
I have lived with this for over 40 years, and to be frank, it does not bother me.
I am aware that I have "British" teeth (I am a Brit), but it doesn't stop me smiling or make me self-conscious.
If anyone ever comments on it, I tell them that I was given childhood drugs that saved my life: I think stained teeth is a fair price to pay
Hi Matt - Thanks for sharing your experience. You have a good attitude regarding your teeth. If it's not broken, then there's no need to fix it.
Thanks for your comment!
Tom,
I'm a 57 year old woman in good health who was prescribed tetracycline after the age of 18 (permanent teeth obviously formed). I took the drug for over 30 years(always tetracycline never minocycline) because it seemed to control acne on my shoulders and chest. A few years ago I noticed a slight gray tinge at the base of my two lower middle teeth and along the top gumline of my four front upper teeth, which seems to be getting progressively worse.
I have used teeth whiteners and while they lighten my teeth they do not seem to lighten these gray areas, or if they do lighten them they don't lighten them up as much as the remainder portion of my tooth(s).
Have you ever heard of this discoloration, graying of the teeth, from tetracycline not occuring until late adulthood?
My dentist has not and seems quite puzzled by this. He is going to a conference in New York City soon and is going to present photos of my teeth as well as a history to get some input.
I'll let you know what he finds out, but in the interim was wondering if you had any insights?
Hi my teeth was turned yellow at the age of 2 from the docters giving me antibiotic im 24 now and my sons been given co-amoxiclav is this safe from the same problem and do u no if i can sue them as this has been a big trauma to my life
I took a lot of antibiotics an thus lost a lot of enamel. I now brush with baking soda, not tooth paste with its typical slimy glycerine, because if your teeth are OK then they will have a nice smell and appearance regardless. I take vitamins D3, K2, and A. It's been a year since I've been doing this and my teeth look better, though still not totally white. In some bright lights they look better than during a dim light. Anyway, I've had enough of dentists. Doctors and dentists can cause more problems than they solve. There are some alternative dentists that let you know of the dangers of bad bacteria on your teeth, so the the truth is out there. Even regular dentists are finding out just how bad root canals and veneers are. Just recently a dentists told me I needed a root canal for my back tooth. Indeed my cavity there smelled but I used the small bristle brush and tooth picks to clear it out. I drank and swished my mouth out with :goldenseal" and "echenicea." It still smelled for a while but after a month the tooth began to recover because the smell went away and there was no pain. Eat plenty of greens. Solve your problems naturally. It'll take time but you'll like how you solved your own problems.
Thanks for this article. My mother took tetracycline while pregnant with both me and my brother and we took it as children in the 70's. I believe my mom said it was in liquid form. His teeth are very bad as he took it more frequently. He needed to have all of them removed due to the staining. My teeth were brown at the tops in the front only. The rest were light yellow. After reading this I now know why. My fronts are currently bonded and I need to have veneers put on when I have the money. I wish the company would pay for this !
Hello
My name is Marisol. I'm 46 years old. I have had problems with my teeth because of tetracycline. All my teeth are gray-black color. I live in Indiana. Do you any Dentist here help me?