A Discussion with Debra McIntosh, D.M.D.

Can tetracycline teeth stains be whitened?

Tetracycline stains are very difficult to remove; however with today’s advancements in dental technology it is now possible to whiten teeth with this condition. Years ago, Tetracycline was prescribed by doctors as an effective antibiotic for treating many illnesses years ago. At that time the effects on teeth enamel were unknown. Today many adults who received tetracycline have stained teeth that have a grey tone.

There are varying degrees of tooth discoloration, but researchers have discovered that tetracycline staining becomes darker as the tooth is penetrated below the surface. Therefore it is unlikely that severe stains can be removed with over the counter products. It requires a treatment plan that may involve a combination of Zoom! in-office whitening system, take home whitening kits and routine use of a whitening gel.

The whitening treatments all use hydrogen peroxide to bleach teeth. Zoom! uses a light to activate the hydrogen peroxide. Patients with tetracycline stained teeth should expect that it will take longer for them to respond to bleaching treatments verses a patient with normal discoloration who can achieve brighter teeth on average up to 8 shades whiter within 2 hours after Zoom treatments.

It is important to note that no two patients will respond to bleaching the same way. If bleaching is not effective there are other cosmetic procedures available, such as porcelain veneers that cover the whol tooth. I recommend asking your dentist to customize a plan that is right for you.

Are there dental techniques to improve a "gummy" smile?

Yes there are various restorative and cosmetic procedures to improve the aesthetics of a patient’s gum line. Patients with a "gummy" smile appear to have short teeth but their teeth may actually be the proper length, they are just covered with too much gum tissue.

Crown lengthening is an option that allows us to reshape the gum tissue using a soft tissue laser that helps us to expose more of the natural tooth. Crown lengthening may be the only procedure needed or it may be one part of a treatment plan based on the condition of the teeth. For example, when a restoration is required such as crowns or veneers but the teeth are decayed, broken below the gum line or if there is insufficient tooth structure for a restoration, we use crown lengthening first to adjust the bone level to expose more of the teeth.

Before a treatment plan is established your dentist will take x-rays to assess the bone level and then use different probes to see if there is enamel underneath the gums to determine if you are a candidate for these non-invasive procedures. However, in some cases patients are recommended for a surgical procedure by a periodontist.

What options are available to straighten teeth?

Today patients with misaligned or crooked teeth have more options than ever to improve their smiles. If a patient's primary goal is to straighten teeth then they should see an orthodontist. There are retainers used to straighten teeth for minor movement. When the patient’s condition requires more extensive movement to straighten teeth, Invisalign, the invisible braces, are now available.

Patients that wore braces during childhood often prefer cosmetic procedures to correct their teeth. The Golden Proportion procedure uses veneers and allows us to make the centrals, laterals and cusps a certain size lining everything up in the middle. This advancement is exciting because it enables us to improve a patient's smile in one appointment.

There are other cases when a patient desires to not only straighten his or her teeth, but wish to remove the gaps between teeth or the patient may feel their teeth are too small or too large for their mouth. These patients can benefit from a combination of cosmetic and restorative procedures.

It is important to stress that each patient is different. Therefore, their conditions must be approached with a customized plan that ensures that the end result will look natural.

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