Arun Kumar, MDS, Vijay Kumar, BDS, Janardhan Singh, PhD, Anita Hooda, MDS, and Samir Dutta, MDS
- Although tooth discoloration has not been identified as a public health problem, there is a trend toward the use of agents for whitening or lustering teeth.
- Drugs, mouth rinses, physical agents, or common environmental chemicals can adversely affect human teeth during their embryonic
- development and after their eruption into the oral cavity. (1)
- Drug-induced tooth discoloration is a common cause of decline in use or withdrawal of such drugs.
- Changes in color of teeth may be physiological/pathological or exogenous/endogenous in nature. (2) With increasing age, the enamel becomes thinner because of erosion, and dentin becomes thicker because of deposition of the secondary dentin. Therefore, teeth of elderly persons are usually more yellow or grayish yellow than those of younger persons. (2)
Tooth discoloration is of 2 types:
- Extrinsic discoloration is present on the outer surface of teeth and is caused by tea, coffee, tobacco smoking/ chewing, and betel morsel (piper betel; paan) chewing. (3)
- Intrinsic discoloration, stains are deposited within the enamel of dentin during the development of tooth (e.g., tetracycline stains).
Purpose of the Review
The review describes drugs that have potential to induce changes in color of teeth.
- Mouth rinses: Extrinsic staining of teeth is a well-known local side effect of the use of cationic antiseptic mouth rinses, particularly chlorhexidine. (4 – 7)
- Iron Salts/Other Metals: Extrinsic discoloration of teeth following large consumption of tannin-containing beverages is a well-known observation. (8 – 11)
- Antimicrobials: Netherlands Pharmacovigilance Foundation reported 25 cases of yellow to brown discoloration of tooth following oral use of liquid drugs; 84% involved antibiotics of which 14 were amoxicillin. (12 – 14)
- Linezolide: Extrinsic discoloration of lower anterior teeth was reported after linezolide therapy for 28 days in a 11-year-old immunocompromised girl with cellulitis. (15, 16)
- Ciprofloxacin: In 13 infants (premature babies) treated with 10 to 40 mg/kg/d ciprofloxacin in 2 divided doses (slow intravenous infusion), some developed greenish discoloration of teeth, which could not be removed by mechanical means.(17)
- Glibenclamide: Tooth discoloration is a novel side effect of sulfonylurea therapy in patients with permanent neonatal diabetes. (18)
- Tetracycline: Clinical evidence began to appear in the early 1960s showing that tetracycline antibiotic could cause tooth discoloration. (19 – 33)
- Fluorides: Although fluoride therapy makes the tooth more resistant to dental caries, after chronic use fluorides have adverse effects on tooth. Tooth discoloration may occur when total daily intake of fluoride ion from sources such as drinking water, fluoride dentifrices, gel, foam, solution, mouthwashes, or varnishes is high during enamel formation and maturation. (34)
- Discoloration is almost impossible to eliminate if caused by silver nitrate or strongly colored iodine solutions in the root canal.
- It is very important for practitioners to prescribe, to pregnant women and to children, drugs that are free from any adverse effect on teeth.
- Billings RJ, Berkowitz RJ, Watson G. Teeth. Pediatrics. 2004;113(4 suppl):1120-1127.
- Suresh Chandra B, Gopi Krishna V, eds. Grossman’s Endodontic Practice. 12th ed. New Delhi, India: Lippincott Williams & Wilkins; 2010:342-360.
- Chopra RN, Chopra IC, Handa KL, Kapur LD. Indigenous Drugs of India. Calcutta, India: UN Dhur & Sons 1958; p 371-77.
- Addy M, Roerts WR. Comparison of the bisguanide antiseptics alexidine and chlorhexidine. J Clin Periodontol. 1981;8:220-230.
- Addy M, Mahdavi SA, Loyn T. Dietary staining in vitro by mouth rinses as a comparative measure of antiseptic activity and predictor of staining in vivo. J Dent. 1995;23:95-99.
- Autio-Gold J. The role of chlorhexidine in caries prevention. Oper Dent. 2008;33:710-716.
- Addy M, Moran JM. The formation of stain on acrylic surfaces by the interaction of cationic antiseptic mouth rinses and tea. J Biomed Mater Res. 1984;18:631-641.
- Nordbo H, Eriksen HM, Rolla G, Allramadal A, Solheim H. Iron staining of the acquired enamel pellicle after exposure to tannic acid or chlorhexidine: preliminary report. Scand J Dent Res. 1982;90:117-123.
- Addy M, Moran JM, Griffiths AA, Wills-Wood A. Extrinsic tooth discoloration by metals and chlorhexidine. I. Surface protein denaturation or dietary precipitation? Br Dent J. 1985;159:281-285.
- Stack MV, Burkitt AJ, Nickless G. Lead in children’s teeth. Nature. 1975;225:169.
- Brudevold F, Aasenden R, Srinivasan BN, Bakhos Y. Lead in enamel and saliva, dental caries and the use of enamel biopsies for measuring past exposure to lead. J Dent Res. 1977;56:1165-1171.
- Mey-Boom RH, Verduijn MM, Sleemvoorden MG, Dekens-Komter JA, Van-Puijen Brock EP. Reversible tooth discolouration during oral use of antibiotics [in Dutch]. Med Tijdschr Geneeskd. 1996;140:207-209.
- Dewit ME,Stricker BH, Porsius AJ. Discolouration of teeth by drugs [in Dutch]. Med Tijdschr Tandheelkd. 1996;103:3-5.
- Garcia-López M, Martinez-Blanco M, Martinez-Mir I, Palop V. Amoxicillin-clavulanic acid related tooth discoloration. Pediatrics. 2001;108:819-820.
- Matson KL, Miller SE. Tooth discoloration after treatment with linezolid. Pharmacotherapy. 2003;23:682-685.
- Ma JS. Teeth and tongue discoloration during linezolid therapy. Pediatr Infect Dis J. 2009;28:345-346.
- Lumbiganon P, Pengsaa K, Sook-Pramee T. Ciprofloxacin in neonates and its possible adverse effect on the teeth. Pediatr Infect Dis J. 1991;10:619-620.
- Kumaraguru T, Flanagam SE, Greeley SA, et al. Tooth discoloration in patients with neonatal diabetes after transfer on to glibenclamide. Diabetes Care. 2009;32:1428-1430.
- Olsen CA, Riley HD. Complications of tetracycline therapy. J Pediatr. 1996;68:783-791.
- Guggenheimer J. Tetracyclines and the human dentition. Compend Contin Educ Dent. 1984;5:245-254.
- Sheets CG, Paguette JM. Tooth whitening modulates for pulpless and discoloured tooth. In: Cohen S, Burns RC, eds. Pathways of the Pulp. 8th ed. St. Louis, MO: Mosby; 2002:749-764.
- Jordan RE, Boskman L. Conservative vital bleaching treatment of discoloured dentition. Compend Contin Educ Dent. 1984;5:803-805.
- Driscoll MA, Rothe MJ, Abrahamian L, Grant-Kels JM. Long term antibiotics for acne: is laboratory monitoring necessary? J Am Acad Dermatol. 1993;28:595-602.
- Wallman IS, Hilton HB. Teeth pigmentation by tetracycline. Lancet. 1962;1:827-829.
- Kim ST, Abbott PV, McGinley P. The effects of Ledermix paste on discoloration of immature teeth. Int Endod J. 2000;33:233-237.
- Cheek CC, Heymann HO. Dental and oral discolorations associated with minocycline & other tetracycline analogs. J Esthet Dent. 1999;11:43-48.
- Good ML, Hussey DL. Minocycline: stain devil. Br J Dermatol.2003;149:237-239.
- Rosen T, Hoffman TJ. Minocycline-induced discoloration of the permanent teeth. J Am Acad Dermatol. 1989;21(3 pt 1):569.
- Mozaffer T, Gordon PH, Irvine CA. Minocycline-induced skin and dental pigmentation. Neurology. 2006;67: 2185-2186.
- Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod. 2010;36:1086-1091.
- Lochary ME, Lockhart PB, Williams WT. Doxycycline and staining of permanent teeth. Pediatr Infect Dis J. 1998;17:429-431.
- Cale DF, McCarthy MW. Treatment of Rocky Mountain spotted fever in children. Ann Pharmacother. 1997;31:492-494.
- Volovitz B, Shkap R, Amir J, Calderon S, Varsano I, Nussinovitch M. Absence of tooth staining with doxycycline treatment in young children. Clin Pediatr (Phila). 2007;46:121-126.
- Den-Besten PK. Mechanism and timing of fluoride effects on developing enamel. J Public Health Dent. 1999;59:247-251.
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