TETRACYCLINE DEPOSITS IN CHILDREN'S TEETH IN RELATION TO ATMOSPHERIC POLLUTION

The tetracyclines have enjoyed astonishing popularity since their introduction in 1950. They appeared to have many advantages over other preparations then in vogue and soon became known as 'broad spectrum ' antibiotics, a euphemism which probably encouraged their widespread use as prophylactic agents for upper respiratory tract disease occurring in children (Banks, 1968; Banks and Ritchie, 1969). However, as they became more extensively prescribed, a catalogue of side effects accumulated which prompted caution in their use (Mull, 1966). One of the earliest hazards of tetracycline therapy to be suspected was discoloration of the teeth. This phenomenon was first observed in a highly selected series of child patients receiving prolonged courses of tetracycline (Shwachman and Schuster, 1956). Further reports quickly followed and amply confirmed the association between tooth discolora-tion and tetracycline therapy (Wallman and Hilton, 1962; Moynahan, 1962; Witkop and Wolf, 1963). Tetracyclines fluoresce a golden yellow in ultraviolet light, a characteristic which enables their presence to be detected in mineralized tissues such as teeth and bone (Saltzman, 1950; Milch, Rall and Tobie, 1957). Once they have been incorporated into mineralizing tissues the tetracyclines remain for prolonged periods. Bone undergoes remodelling and eventually will lose any evidence of past tetracycline deposition, but teeth provide a permanent record of any tetracycline incorporated during their mineraliza-tion (Lancet, 1966). The crowns of successional ('permanent') teeth become mineralized at various times which are more or less constant for a particular tooth form. The first ('permanent') molar tooth erupts into the mouth during the sixth year but its crown is formed and mineralized during the first four years after birth. Detection of tetracycline fluorescence in the crown of this tooth, therefore, indicates precisely defin-able areas of active mineralization incorporatin