1a - tooth whitening/ bleaching Flashcards
What is tooth discolouration?
any change in hue, transparency or colour of tooth
Aetiology of discolouration
INTRINSIC
local, generalised (several teeth affected)
EXTRINSIC
superficial not coming from deeper, food drink, smoking, chromagenic bacteria
Intrinsic discolouration causes (local)
- trauma and pulp death
- Caries
- Tooth wear
Intrinsic discolouration causes (General)
- aging
- Fluorosis
- Tetracycline staining
- Illnesses
- Amelogenisis/dentinogenesis imperfecta
- Trauma and pulp death
- Caries tooth wear (localised)
TIPS FOR EXAMS + PRACTICE
Important to mention about to aetiology and preoperative assessment and patient history when asked in essay Q’s
Important to talk before and after photos or patients may not notice difference is bleaching colour diff is slight
Get idea from history - if pain go into full pain history, trauma go into full trauma history, etc
- illnesses
- Pregnancy
- Social history - occupation and how much aesthetic demand they have
- Diet history
- Intra oral + extra oral exam
- Important for mouth to be healthy first before carrying out these treatments (periodontium + teeth stable)
- Assess caries risk
- Assess occlusion
- Take radiographs + sensibility tests if needed
- Severity of discolouration
- ensure you have valid informed consent before treatment begins
- Consider all the treatment options and consider least invasive option first
- Do nothing is also an option if no problem
Methods of treatment of tooth discolouration
Simple scale and polish
●Bleaching
- internal
- external
- micro-abrasion
●Direct Composite Veneer
●Indirect Veneers (Composite or Porcelain)
●Crowns
●Combination of the above
- CONSIDER LEAST INVASIVE OPTION FIRAT
- DO NOTHING IS ALSO AN OPTION if not problem for patient
Types of bleaching
- external
- internal
- micro-abrasion
What do you use for bleaching? (Max conc?)
- hydrogen peroxide - max conc can use is 6%)
- carbamide peroxide - may be used at a higher % eg 10-15 but breaks into 1/3 of hydrogen peroxide
1 Contraindications of bleaching?
- Pregnant and lactating mothers
- Under 18
- Those with sensitivity to hydrogen peroxide
Use bleaching with caution for
- If patient has sensitivity that can worsen
- Caution with smoking as peroxide can increase cariogenity of cigarette smoke
- Need to warn patient that if have restoration that won’t get bleached so that needs to be redone if they want a colour match
- Make sure patients expectations are realistic
Indications for internal bleaching
● Discolouration as a result of pulp necrosis (Caries, trauma or tooth wear)
●Usually single tooth or a couple of teeth therefore localized discolouration
●Results can be unpredictable and procedure needs to be repeated a few times
●May have to be followed by other treatment such as veneers
Indications for external bleaching
Generalised discolouration due to:
●Aging
●Fluorosis
●Illnesses during tooth formation
●Tetracycline staining
Indications for microabrasion
Intrinsic but superficial enamel discolouration and opacities
●Areas of Enamel fluorosis
●White and brown patches and spots (not due to caries)
●Developmental intrinsic, superficial stains and discolouration
Contraindications of microbarasion
Age – related staining
●Tetracycline staining
●Amelogenesis/Dentinogenesis Imperfecta
●Areas of deep enamel/dentine staining
Micro-abrasion materials used
●18% Hydrochloric acid and pumice
●Proprietary kit with hydrochloric acid and silicon carbide micro particles
