kwakster928

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it is well known that tetracycline causes staining of teeth. can these stains be removed by bleeching? just curious.
 
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The tetracycline has caused intrinsic staining meaning the color comes from the inside of the tooth. Bleaching the exterior may or may not be able to correct it.

It's usually a case by case issue.
 

cusp of carabelli

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kwakster928 said:
it is well known that tetracycline causes staining of teeth. can these stains be removed by bleeching? just curious.
the depth of staining is likely related to the stage at which the tooth is in when the tetracycilne was administered. For the very deep stains....unless you want to do elective endo on all your teeth so that you can do internal bleaching, most of these cases are usually treated with veneers or something like that. External bleaching of these teeth usually have very little effect...
 
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kwakster928

kwakster928

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cusp of carabelli said:
the depth of staining is likely related to the stage at which the tooth is in when the tetracycilne was administered. For the very deep stains....unless you want to do elective endo on all your teeth so that you can do internal bleaching, most of these cases are usually treated with veneers or something like that. External bleaching of these teeth usually have very little effect...
that's what i figured. thank you all for your experties.
 

dc-10

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egpndoc said:
what about internal bleaching?
Is it true that internal bleaching doesn't work very well? I mean the tooth gets lighter while the sodium perborate is in there, but 2 months after you take it out, the tooth is back to its original color? That's just what one dentist told me. Anyone heard anything like this?
 

aphistis

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The problems with internal bleaching are that it requires RCT beforehand, and it's not reliably effective. It works for some patients, but not for everyone--and the endo itself can lead to further discoloration.
 

bitecys

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The endo residents at Iowa have been doing a lot of research into this area recently. We have a small enclave of patients from SE Asia where tetracycline is given quite regularly to developing kids...pretty much because it's a damn good antibiotic. The patients then have a lot of staining.

Their argument is that endo may actually be the more conservative approach than all others. Here is why:

Veneers: life span is about 5 years, gingival recession, reduction of virgin tooth structure that isn't permanant.

Crowns: This is a good option if there's already a lot of restorative on the teeth.

Endo: yeah, it's a lot of elective endo, but the results they're getting with walking bleach (internal bleaching) is really quite amazing. They're doing 1st bi to first bi on top and canine to canine on bottom. Since it's endo on virgin teeth, the prognosis for treatment is very high 90's%. No enamel is removed, no new crown margins are there, and if the endo is performed correctly, you'll have a very good coronal seal as well.

I'm not sure what i'd want done if I had tetracycline or minocycline stains, but I certainly can see the idea of doing the endo over some of the other options.
 

egpndoc

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aphistis said:
The problems with internal bleaching are that it requires RCT beforehand, and it's not reliably effective. It works for some patients, but not for everyone--and the endo itself can lead to further discoloration.
Who is occam and what about his razor, I dont get it. Sorry, Im a bit slow
 

cusp of carabelli

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bitecys said:
The endo residents at Iowa have been doing a lot of research into this area recently. We have a small enclave of patients from SE Asia where tetracycline is given quite regularly to developing kids...pretty much because it's a damn good antibiotic. The patients then have a lot of staining.

Their argument is that endo may actually be the more conservative approach than all others. Here is why:

Veneers: life span is about 5 years, gingival recession, reduction of virgin tooth structure that isn't permanant.

Crowns: This is a good option if there's already a lot of restorative on the teeth.

Endo: yeah, it's a lot of elective endo, but the results they're getting with walking bleach (internal bleaching) is really quite amazing. They're doing 1st bi to first bi on top and canine to canine on bottom. Since it's endo on virgin teeth, the prognosis for treatment is very high 90's%. No enamel is removed, no new crown margins are there, and if the endo is performed correctly, you'll have a very good coronal seal as well.

I'm not sure what i'd want done if I had tetracycline or minocycline stains, but I certainly can see the idea of doing the endo over some of the other options.
you also introduce the possiblity of infection from the endo process itself...possible overfills leading to future pathology during the RCT, ankylosed teeth that will be a pain to take out in the future if necessary and also the fact that you are killing about 1/2 the teeth in your dentition. I would rather have the minimal reduction for the veneers or even use the veneers where you don't have to prep the enamel at all than to risk this doing that much elective endo and the consequences of these procedures...i hardly think that that much elective endo would be a more conservative approach than a less than .5 mm reduction in enamel...

and when you say no enamel is removed...that is completely false b/c you need to create the endo access in the first place...which in itself is taking away much more tooth structure than veneers and also weakening the overall tooth as well....
 

bitecys

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my bad about the enamel comment, yes endo does remove some tooth structure...not saying it isn't perfect, however, .5mm x 11mm x 8 mm (counting for surface area of veneer) is still more tooth reduction than say even a large 5mm x 5mm access with 1.0-1.5mm of enamel.

Yes, there is a risk, however you still will have a patient that on average will need to replace their veneers every 5-7 years and possibly chase that darn gingival recession that is likely to occur with each new prep vs. if the endo is done correctly, and is successful like the 90+% of the time it is, long term costs, trips to dentist, could be less with the internal bleaching.

Oh, and last time I checked RCT tx teeth ankylose very rarely...the PDL is still going to be there and doesn't require a viable pulp to function.