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Dealing with Difficult Tooth Stains?

You may not know this, but not everyone's teeth whiten the same way. There are a lot of factors that determine what kind of results different people might get. (This is one reason it's important to talk to your dentist about whitening before you begin.) Some peoples' teeth are more challenging to whiten than the average whitening case. Fluorosis, tetracycline stains, or decalcification—while seemingly difficult to fix—can actually be improved and frequently corrected with the proper treatment.


What causes fluorosis?

Fluorosis is an enamel defect that occurs when people receive too much fluoride during tooth development. The result can take the form of mild spots ranging in color from white to yellow or brown.

What are the treatment options for fluorosis?

Fluorosis can usually be treated with take-home teeth whitening products. If that doesn't provide satisfactory results, your dentist can perform an in-office microabrasion treatment that can further correct the staining. The treatment time and success rate will vary from patient to patient, depending on the severity of the staining.


What causes tetracycline staining?

Tetracycline is a broad-spectrum antibiotic used to treat infections, and it's commonly prescribed to treat acne. This drug calcifies in the dentin (the layer of your tooth under the enamel) if there is exposure during dental development, which spans from fetal development to the age of eight. This calcification shows up as brown or gray banding on the teeth, sporadic stains, or overall tooth shade.

What are the treatment options for tetracycline stains?

Whitening timeframes will vary from case to case for tetracycline stains. Where normal whitening can take anywhere from 2–6 weeks, tetracycline stains can take 2–6 months to lighten with consistent, overnight custom-tray whitening. 1 If you have tetracycline stains, it's important to keep realistic expectations and to make sure you're willing to comply with the extended timeframe needed to whiten these stains.


What causes decalcification?

Plaque buildup can cause decalcification, which creates white spots on the tooth. This enamel defect is common in orthodontic patients once their brackets are removed.

What are the treatment options for decalcification?

White spots from decalcification can be frustrating for anyone. We suggest teeth whitening as a first course of action, since it can help blend the white spots with the rest of the tooth. The decalcified enamel whitens more quickly than the rest of the tooth, so the spots will often become more pronounced in the first few days of treatment. At this point, you might be tempted to stop your whitening treatment for fear that the spots will become worse. But don't worry, after a couple more days of whitening, the rest of the tooth will usually match or blend with the decalcification. If bleaching doesn't provide the results you're looking for, talk to your dentist about other options, like a chemical and mechanical microabrasive treatment, as this may further correct the appearance of the teeth.

  1. Haywood VB. Bleaching tetracycline-stained teeth. Esthetic Dentistry Update. 1996 February;7(1).