Dr. Mike Malone’s Blog

I have severe tetracycline stains, and have had porcelain veneers for the past eighteen years. My teeth look gray with the porcelain veneers, but it is much better than the awful stains I had before.

I wanted to get new porcelain veneers, but my dentist says I should get crowns, so that the stain will be completely covered. What do you think?

- Ann from Louisiana

Ann,
I don’t think you need crowns.

Tetracycline stains are very difficult to treat, and you really need a lot of training and experience with cosmetic dentistry to do them right. The stain is very dark, and go to the core of the tooth. When general dentists try to fix them they end up at one extreme or another — either the veneers are too translucent so that the dark stain shows through, or they’re too opaque, so that they look chalky and fake. Or sometimes they get over-aggressive and grind the teeth down for crowns and then put an opaque crown over them. None of these approaches results in a truly beautiful smile.

But there are ways to make a beautiful smile with conservative porcelain veneers over tetracycline stained teeth. You may want to visit our smile gallery where we show Dawanna, who had brown tetracycline stains, that we treated with porcelain veneers.

So my advice is to stick with the porcelain veneers, but to go to an expert cosmetic dentist. We’d be happy to help you if you’d like to come here.

Related links:
Porcelain crowns

I have several old large silver fillings that are not bothering me but my dentist feels they all need crowned is this reasonable?
- Karen in Tennessee

Karen,
Yes, this sounds reasonable. Once a large silver amalgam filling has been in your mouth for a number of years, it begins to break down. It’s reasonable to take out the amalgam and do a crown before the tooth breaks.

And one of the disadvantages of the old-fashioned amalgam fillings is that it is very difficult to tell if they have decay under them until the decay has grown considerably. This is one of the reasons we like to do the white fillings in our office. The standard of care when you have large amalgam fillings would be to replace them with crowns when the margins of the filling begin to separate from the tooth or the margins develop defects.

If you wait until a tooth bothers you, that can be the most expensive way to do dentistry. Once they start bothering you, you will not only need crowns but may also need root canals.

Related links:
Read more about porcelain crowns