Elmer R. Grossman

A quantitative estimation of the darkening effect of tetracyclines on permanent incisors was made by correlating tooth colors with the recorded history of tetracycline exposure in 160 children under our care since infancy. The average darkening caused by one 6-day course of oral tetracycline or demethylchlortetracycline during the years of permanent incisor formation was 0.3 of a shade on a 14 shade dental scale. Children with five such courses of tetracycline therapy during the first 4½ to 5 years of life had permanent incisors averaging about two shades darker than children with no tetracycline exposure, a nearly imperceptible and cosmetically negligible difference; however, 3 of these 14 children had moderately darkened teeth. With greater frequency of tetracycline exposure, the risk increases; four of our six patients with eight or more courses had noticeably dark teeth. After age 6 for girls and 7 for boys the risk of tetracycline staining can be ignored since the cosmetically important anterior teeth have all formed. When tetracycline therapy is indicated during the first 6 to 7 years, the use of oxytetracycline (or possibly doxycycline) may diminish tooth darkening.

This report describes a group of patients with hyperbilirubinemia treated with phototherapy at home. An account is made of methods used, advice given, problems encountered, and results obtained. It is suggested that home phototherapy can and should be carried out by pediatricians as part of routine outpatient pediatric care.

To the Editor. —In the Oct 16, 1987, issue of JAMA , 1 a physician asks if there is any scientific basis for the use of beer by lactating women as a stimulant to milk production. The four consultants agree that there is no such evidence, apparently having overlooked two pertinent studies. De Rosa et al 2 gave equal amounts of beer and ethanol to 11 normal women and showed significant increases in serum prolactin from mean basal levels of 11.6 ng/mL to mean peak levels of 27.1 ng/mL within 30 minutes of drinking 1 L of 6% ethanol-containing beer. There was no significant change after drinking 6% ethanol solution or sparkling water. Carlson et al 3 gave 800 mL of beer that contained 4.5% ethanol to five men and seven women and an equal amount of nonalcoholic beer to one woman. In men, the prolactin levels increased from a mean

<h3>To the Editor.—</h3> In their recent article on minocycline staining of already erupted permanent teeth, Poliak et al¹state that tetracycline stains teeth only when it is administered before the age of 7 years. They go on to speculate that "tetracycline's inability to stain the teeth beyond the age of 7 years may be a function of the unavailability of free calcium for complexing." The first statement is in error and the speculation is unnecessary. Tetracycline will bind to teeth (and to bone) whenever active calcification is taking place.²For teeth, this means from the second trimester of fetal life until the roots of the third molars are complete in late adolescence. In terms of clinical significance, tetracycline tooth staining of the usual type is important only for the highly visible anterior teeth (incisors, cuspids, and bicuspids). These teeth complete their crown formation by the age of 6