Tetracycline staining and bleaching - is it effective?

Written by Heather Siler

Tetracycline staining is the most difficult intrinsic stain to treat with bleaching because it’s very tenacious and results vary. Following are some guidelines to achieve optimal results while providing realistic expectations:

  1. Tetracycline-stained teeth take longer to bleach than unaffected teeth, and the process can take 2 to 12 months to reach optimal results.
  2. Like “normal” teeth, tetracycline-stained teeth will lighten until they reach a plateau regardless of technique or product used. They will never become “white,” but they can lighten dramatically and look very nice when compared to the initial shade.
  3. The first few days of bleaching will usually produce noticeable whitening followed by no observable change for about one month. Therefore, patience is required.
  4. 10% carbamide peroxide worn in custom trays nightly is the method of choice for bleaching tetracycline-stained teeth. Carbamide peroxide remains active for 6 to 10 hours and delivers the bleach over a longer period than hydrogen peroxide. Using a strength over 10% doesn’t change the speed of whitening measurably, but it does increase sensitivity.
  5. As with unaffected teeth, existing restorations will not change color with bleaching. Therefore, the patient must be advised that new restorations may be necessary after the bleaching process to match the new shade of their teeth.
  6. Tetracycline staining takes an extended amount of bleaching over time to achieve the desired results, so sensitivity must be considered. A low concentration of carbamide peroxide (10%) and a proper fitting tray is imperative. Potassium nitrate 5% which is found in over-the-counter desensitizing toothpaste is very helpful in managing sensitivity. The patient can brush with the desensitizing paste and/or wear it in the bleaching trays for 15 minutes daily to treat and prevent sensitivity.
  7. The patient must be made aware of the reality of bleaching tetracycline-stained Treatment takes longer, there is an ongoing cost, and the results vary.
  8. Many practitioners and patients choose the “single arch treatment” approach treating one arch at a time. Most patients prefer to begin with the upper arch. This plan can be more cost effective for the patient, and it also serves as a great motivator when comparing the bleaching arch to the untreated arch. Furthermore,  sensitivity is reduced, wearing one tray versus two is easier on the TMJ, and it’s more comfortable for the patient.
  9. Bleaching is recommended before any other treatment such as veneer placement because the shadow of tetracycline-staining can show through veneers. Sometimes, after the bleaching is complete, the patient is satisfied with the results and decides against veneers.
  10. The bleaching process may have to be repeated over the years. It’s difficult to predict, but many patients do have to repeat the bleaching process after five It may or may not take as long with subsequent sessions.
  11. As with all bleaching, the cervical third of the tooth is the most difficult to whiten, and the blue-gray staining is more difficult to whiten than the yellow-brown

Bleaching tetracycline-stained teeth aren’t impossible, but it takes time, dedication, and patience to achieve the best results. The cost is far more than bleaching “normal” teeth, but it’s not ridiculously expensive. As long as the patient is realistic and compliant, it can be very beneficial and life-changing.