Friday, July 20, 2012
Peter's gray and brown striped teeth
These are the photos of Peter's teeth. As stated before, they are this color due to very prolonged, quite elevated bilirubin as an infant/toddler. Peter's bilirubin levels were elevated from about age five or six months through age two, with a good handful of prolonged high bili levels ranging from above 10 to low 30s. Usually bili-stained teeth are only seen on primary teeth, I have been told. Peter's primary teeth are the ones that have some white visible, and the gray in his primary teeth is quite dark for bili-staining. Peter' bilirubin levels were also elevated when his secondary teeth were forming, so we see the staining in those teeth as well. The front six brown and gray striped teeth are his secondary teeth.
The choices of how to fix the color are realistically only two so far: hide them with Snap-On-Smile or veneers that are non-bonded as to keep the teeth in best condition for adulthood. With both choices, the plan is to crown the teeth as an adult. As a growing child, crowning cannot be done because the gums normally recede quite a bit throughout childhood and the dark teeth would become visible between the crown and the gumline. This is the same rationale for using a non-bonded technique for the veneers, as they would have to be replaced every year or two.
I am hoping that someone in the world of pediatric dentistry has come up with another solution and can share it here. We may post the images online elsewhere too, in hopes of finding an answer. The skilled dentists we have seen have solicited many, many colleagues, so there may not be another answer anywhere yet, but maybe someone will be inspired in finding a solution upon seeing Peter's teeth. Dr. Kamin has pondered whether laser might be effective in rendering the dark bilirubin stains invisible, as bili lights do for the newborn with high bilirubin, but he is a GI doctor and has suggested that as something to ask about. The stains are throughout the teeth, so microdermabrasion will not work. The teeth can be bleached from the inside out, but to do so will mean a root canal for each tooth and then Peter is left will a mouth full of dead teeth.
So, if anyone has ideas, please share them here. Thank you!