Adult Consequences of Childhood Trauma

Question 1

when is root development complete for deciduous and permanent teeth

Answer 1

deciduous - 1.5 years after eruption
permanent - 3 years post eruption

Question 2

what timings are acute , subacute and delayed treatment in regards to dental trauma

Answer 2

acute - within 3 hours
subacute - 3 to 24 hours
delayed - more than 24 hours before treatment received

Question 3

why might a tooth see yellow discolouration post trauma

Answer 3

canal obliteration
should monitor for loss of vitality

Question 4

why might a tooth see pink discolouration post trauma

Answer 4

haemmhorage in pulp chamber seeing blood leak into dentinal tubules
if no necrosis of pulp discolouration may reverse as pulp revascularises
if necrosis , discolouration may worsen

Question 5

why might a tooth see brown/grey/black discolouration after trauma

Answer 5

in non vital teeth pulp death sees bleeding into dentine.
Hydrogen sulphates from bacteria can convert iron within blood to dark coloured iron sulphates making it darken over time.

Question 6

Why might pulp necrosis and apical periodontitis occur after trauma

Answer 6

if revascularisation has failed
pulp will undergo sterile necrosis but subsequent bacterial infection may occur

Question 7

diagnostic indicators of pulp necrosis and apical periodontitis

Answer 7

no response to vitality tests
TTP
possible sinus tract
periapical radiolucency on radiographs
grey/brown discolouration of crown

Requires endo or extraction

Question 8

what is infra occlusion and why might it occur

Answer 8

occluding surface/ incisal edge of affected tooth is at insufficient height in comparison to adjacent teeth (think intrusion)
Most likely in teeth that have experienced severe PDL trauma e.g intrusion
occurs if ankylosis or replacement root resorption as a result of injury
not easily fixed with ortho

Question 9

Extrinsic causes of tooth discolouration

Answer 9

smoking
tannins (red wine, tea, coffee, guiness)
chlorhexidine - in excess
iron supplements
chromogenic bacteria (more common in children , leaves black/green stains)

Question 10

intrinsic causes of tooth discolouration

Answer 10

fluorosis
tetracycline (old antibiotic that can cause banded discolouration if taken during tooth development)
non vitality (blood products leach into dentine)
dental materials staining (amalgam)
physiological age changes
medical conditions (porphyria sees red deciduous teeth, cystic fibrosis pts may have grey teeth)

Question 11

What should the first stage of treating extrinsic vital staining always be

Answer 11

hygiene phase therapy

Question 12

What is the science behind external vital tooth bleaching

Answer 12

discolouration is caused by formation of chromogenic products which are long chain organic molecules, the aim of bleaching is to oxidise these compounds which leads to smaller molecules which are lighter in colour

Question 13

What is the active agent in vital external bleaching and how does it work

Answer 13

active agent = hydrogen peroxide
Forms an acidic solution in water that breaks down to form hydrogen and oxygen. The free radical hydroperoxyl (HO2) is formed which is the active oxidising agent

Question 14

What is the hydrogen peroxide containing chemical normally used in teeth whitening products

Answer 14

carbamide peroxide
consists of hydrogen peroxide and urea

Question 15

what is in carbamide peroxide and what are each ingredients purpose during teeth whitening (6)

Answer 15

hydrogen peroxide - active ingredient
urea - increases pH to counteract H2O2
thickening agent - Carbopol
surfactant - allows gel to wet tooth surface
desensitising agent e.g Ca phosphate
Fluoride - prevents erosion by acidic H2O2 and has a desensitising effect

Question 16

what effect does temperature have on tooth bleaching

Answer 16

increased temperature = quicker effects

Question 17

what effect does time have on tooth bleaching

Answer 17

increased time = increased effects

Question 18

what effect does hydrogen peroxide concentration have on tooth bleaching

Answer 18

increased concentration = quicker and increased effect

Question 19

why must restorations seal be checked prior to tooth bleaching

Answer 19

any leakage arounds margins risks pulpal damage

Question 20

what warnings should you give a pt prior to starting tooth bleaching

Answer 20

they may experience temporary sensitivity
their teeth wont stay whitened forever - results will diminish over time
restorations don’t whiten as much as natural tooth tissue
rare risk of allergy
might not work

Question 21

what are the pros and cons of chairside (in office) tooth whitening

Answer 21

pros: controlled by dentist, can use heat (light) to achieve quick results
cons: time consuming, results wear off quicker, expensive, long time for pt with mouth open

gingiva must be protected

Question 22

discuss light/ laser whitening

Answer 22

same bleaching products with addition of light / laser to add heat
result is quicker effect but no evidence of better bleaching
initial result in particular looks good due to dehydration

Question 23

What is the max legal strength of hydrogen peroxide for tooth bleaching in the uk and what strength of carbamide peroxide contains this

Answer 23

max H2O2 conc = 6%
16% carbamide peroxide contains 6% H2O2

Question 24

for at home bleaching , how much bleach should the patient be advised to put in the trays

Answer 24

1mm^2 dot buccally on each tooth
there is no advantage to increased quantity in the trays

Question 25

how long should a pt carrying out at home bleaching wear the trays for

Answer 25

preferably overnight but at least 2 hours