The overall prevalence of tetracycline induced staining has been reported to be 3-4% and 3-6% for minocycline.1,2  This adverse drug reaction can obviously create psychological and esthetic concerns for the patient and should be taken into consideration.1,3  

Is there anything that can be done to prevent this from occurring in patients receiving tetracycline or minocycline?
Regarding the prevention of teeth staining or discoloration, the easiest thing to do with tetracycline is avoid use during periods of mineralization (or calcification).  However, there has been a case report of tetracycline staining the teeth in an adult with long term use.4  This is not normal for this population since mineralization ends at or before the age of 8 years in most people.  Regarding the prevention of staining with minocycline use, several interventions may offer some benefit.  The first is to decrease the duration of therapy.  The longer minocycline is used, the greater the chance for tooth discoloration to occur.  At times, this may be a difficult or a clinically inappropriate intervention, especially when the dosage form approved for acne (Solodyn) is being used.  The Solodyn product package insert recommends treatment of acne for up to 12 weeks.5  The second potential method of prevention is to reduce the dose of minocycline to less than 100 mg per day in patients receiving long-term therapy.  Recommending this would obviously be dependent on the indication for minocycline therapy.  Some evidence suggests that reducing the dose of minocycline from 100 mg a day down to 50 mg a day after 15 days was effective at preventing staining when used to treat acne.6  The third potential method of prevention is administering vitamin C with the minocycline, which has been shown to decrease the formation of the degradation product (the quinine ring structure) that is a component of the actual stain.7  This study was done on rats and would need to be validated in humans to determine if the coadministration of vitamin C actually does help prevent staining (although it should not harm anything either).   

Can anything be done if the staining has already occurred?
Regardless of which antibiotic (tetracycline or minocycline) caused the staining or discoloration, nothing can eliminate the stains completely, especially with tetracycline.1  However, treatment options include bleaching, composite or porcelain veneers, or crowns.  The preferred method is the use of vital or nonvital bleaching since this avoids the need to remove tissue and does not cause any known damage to the enamel or dentine (inside the teeth).  In general, bleaching only lightens the discoloration and may leave a translucent appearance.1,8  The use of porcelain laminate veneers or full coverage porcelain crowns requires the removal of at least 0.7 mm of sound tooth substance for there to be enough depth of porcelain to mask the discoloration.9-11

While tetracycline and minocycline induced teeth staining or discoloration is not a significant problem with general use in the adult population, it can obviously occur and result in permanent effects, which can then translate into additional treatments and possible psychological and esthetic concerns for the patient.  As such, their use should not occur in children less than 8 years old for any reason.  Therefore, clinicians should be aware of this adverse drug event and consider ways to prevent it from occurring or, at least, minimize the risk for it occurring.

References:

1. Sanchez AR, Rogers RS 3^rd, Sheridan PJ.  Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity.  Int J Dermatol  2004;43:709-15.         
   
2. Berger RS, Mandel EB, Hayes TJ et al.  Minocycline staining of the oral cavity.  J Am Acad Dermatol  1989;21:1300-1.        
   
3. Scopp IW, Kazandjian G.  Tetracycline-induced staining of teeth.  Postgrad Med  1986;79:202-3.  
   
4. Di Benedetto DC.  Tetracycline staining in an adult.  J Mass Dent Soc  1985;34:183, 217.         
   
5. Minocycline (Solodyn®) product package insert.  Medicis, The Dermatology Company.  Scottsdales, AZ.  2008.
6. Bernier C, Dreno B.  Minocycline.  Ann Dermatol Venereol 2001;128:627-37.         
   
7. Bowles WH.  Protection against minocycline pigment formation by ascorbic acid (vitamin C).  J Esthet Dent  1998;10:182-6.  
8. Livingston HM, Dellinger TM.  Intrinsic staining of teeth secondary to tetracycline.  Ann Pharmacother  1998;32:607.  
9. Good ML, Hussey DL.  Minocycline: stain devil?  Br J Dermatol  2003;149:237-9.  
10. Sadan A, Lemon RR.  Combining treatment modalities for tetracycline-discolored teeth.  Int J Periodontics Restorative Dent  1998;18:564-71. 
11. Wragg PF, Tulloch EN.  A rationale for treating tetracycline discolored teeth.  Restorative Dent  1987;3:28,30,33-4.

• Pharmacology: The Mechanism for Tetracycline Induced Staining of the Teeth
  

Minocycline, Tetracycline, Medication Related Teeth Stain, Teeth Staining