Which groups of drugs cause tooth discoloration? An updated review

This summary is based on the article published in Clinical Pediatrics: Drug-Induced Discoloration of Teeth: An Updated Review (February 2012)

Arun Kumar, MDS, Vijay Kumar, BDS, Janardhan Singh, PhD, Anita Hooda, MDS, and Samir Dutta, MDS

Context

• 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.

Key Findings

• 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.

References

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