Published: 6 June 2014

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Antibiotics and Tooth Staining

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Prescriber Update 35(2)
6 June 2014

Intrinsic, permanent tooth discolouration is well known to occur with the use of tetracycline antibiotics if taken during tooth development (ie, the last half of pregnancy, infancy and in childhood up eight years of age)¹. This is a result of tetracycline antibiotics binding to calcium and depositing in developing teeth and bones¹.

Healthcare professionals are also reminded that extrinsic or superficial discolouration of the teeth has been reported with both tetracycline and beta-lactam antibiotics. The Centre for Adverse Reactions Monitoring has received six reports of extrinsic tooth discolouration with the use of antibiotics in the past three years. Three of these reports were associated with the tetracycline class of antibiotics (doxycycline and minocycline) and three with the beta-lactam/penicillin class of antibiotics (phenoxymethylpenicillin and amoxicillin). The onset ranged from day one through to the third month of treatment.

It is thought that this discolouration may be due to formation of deposits on the tooth surface, with teeth appearing to have brown, yellow or grey stains². In most instances of extrinsic discolouration, the effect is reversible and can be removed by careful brushing or professional cleaning.

Some beta-lactam/penicillin antibiotic data sheets list superficial discolouration of the teeth as a rare adverse reaction and all tetracycline antibiotic data sheets list tooth discolouration as a general precaution. Medsafe is currently working with the sponsors to ensure data sheets are updated for all antibiotics where this is an issue.

References

1. Sanchez AR, Rogers RS, Sheridan PJ. 2004. Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity. International Journal of Dermatology 43(10): 709-15.
2. Garcia-Lopez M, Martinez-Blanco M, Martinez-Mir I, et al. 2001. Amoxycillin-Clavulanic Acid-Related Tooth Discoloration in Children. Pediatrics 108(3): 819-20.