Tooth Discoloration

Aka: Tooth Discoloration, Drug-Induced Tooth Staining, Tooth Discoloration due to Medication

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II. Causes: Extrinsic Staining (typically temporary staining of teeth after eruption)

  1. Amoxicillin-Clavulanate (Augmentin)
    1. Superficial yellow or brown stain
    2. May persist for weeks to months
    3. May be confused with Tooth Decay
  2. Chlorhexidine (Peridex)
    1. Yellow or brain stain
    2. Reduce use of red wine coffee, tea or beats, chromogens that may compound peridex staining
  3. Iron Preparations (liquids)
    1. Superficial brown or black staining
    2. Mix dose with water or juice and drink with straw (or take as tablet instead)
    3. Stains are removed by brushing with Baking Soda or Hydrogen Peroxide
  4. Linezolid
    1. Brown staining occurs with >1 week of use (at 600 mg twice daily) and is reversible in most cases
  5. Trimethoprim-Sulfamethoxazole (Septra, Bactrim)
    1. Rare yellow, brown or black staining, primarily associated with liquid preparation
  6. Miscellaneous other agents in medications
    1. Iodine
    2. Sulfides
    3. Silver Nitrate
    4. Manganese
    5. Copper
    6. Nickel
    7. Cadmium
    8. Essential Oils

III. Causes: Intrinsic Staining (typically permanent staining of teeth before eruption)

  1. Tetracycline
    1. Yellow, brown or gray staining
    2. DO NOT use in children under age 8 (age 12 in Canada)
    3. Incorporated into developing enamel
    4. Even a single dose can stain teeth
  2. Doxycycline
    1. Yellow, brown or gray staining, that is much less common with Doxycycline than with Tetracycline
    2. Avoid in age <8 years, except in certain vector borne illness where alternative options are lacking
  3. Minocycline
    1. Green, blue or gray staining
    2. Typically seen with prolonged use over 100 mg/day
    3. Staining risk may be reduced with Vitamin C supplementation
  4. Fluorosis (Chronic excessive fluoride intake)
    1. See Fluoride Toxicity
    2. Results in mottled dental enamel

IV. Management

  1. See Tooth Whitener
  2. Professional dental cleaning

V. Prevention

  1. Rinse mouth after using causative agents

VI. References

  1. Bryant (2016) Presc Lett 23(9)

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