Expert: Mark Bornfeld DDS - 6/15/2005

Question
Dr. Bornfield-

I am 37 years old and have tetracycline stains on all my teeth. When I was 18 yrs old I
decided to have bonding(composite) work done my 6 front teeth to hide the tetracylcine
stains. Every 8 years I go back to the dentist and have re-bonding done. Enamel is being
removed each time I have bonding work done. This concerns me. By the time I'm 60 yrs
old I wont have any enamel left! How much enamel is being removed from bonding or
veneers? Are these procedures safe? Should I stop re-bonding my teeth and just use Crest
White Strips to reduce the tetracycline stains?

Thanks, Todd

Answer
Dear Todd,

The amount of enamel that is removed during the bonding process is largely up to the discretion of the dentist. He may desire to offset the thickness of the resin veneer by deliberately removing enamel, but you've already grasped the drawback of this approach: over time, more enamel will be lost. This is significant, since the removal of all of the enamel exposes the deeper layers, which are composed of dentin, which does not offer the same bond strength as enamel.

A more logical approach would be to use a more durable means of covering the stain. This might be done with either full porcelain crowns or porcelain laminate veneers. Porcelain is much better at resisting discoloration and wear than resin, and providing you exercise caution against engaging in activities that may break the porcelain, will last many years longer. Although the initial costs will be greater than resin veneers, the longer life span of these stronger restorations will eventually re-coup the difference.

Bleaching, whether with an over the counter product such as the Crest WhiteStrips or a professional treatment, is generally inappropriate for tetracycline staining as it is usually manifest. The discoloration is not uniform, but usually presents as horizontal bands on the teeth. Although the teeth will be brightened by bleaching, the technique cannot eliminate the inconsistencies in the tooth coloration.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY