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Stage 3 Child Dental Health > BDS3_ODHS2.CDH.3.10 & 3.11 - Anterior aesthetics for the child and adolescent I & II > Flashcards

BDS3_ODHS2.CDH.3.10 & 3.11 - Anterior aesthetics for the child and adolescent I & II Flashcards

1
Q

There are several classifications for discolouration of teeth. Clinical management
lends itself to the classification identifying tissue type, because …..

A

it is the site of the

anomaly which dictates the most appropriate treatment method.

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2
Q

classifications for discolouration of teeth: ((5)

A 
 Extrinsic staining
Intrinsic enamel (local causes)
Intrinsic enamel (systemic causes)
Intrinsic dentine (local causes)
Intrinsic dentine (systemic causes)
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3
Q

What are the Intrinsic dentine (systemic causes)staining causes: (5)

A 
o dentinogenesis imperfecta
o hereditary opalescent dentine
o tetracycline
o congenital porphyria
o bilirubin (haemolytic disease of newborn).
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4
Q

What are the Intrinsic enamel (systemic causes)staining causes: (5)

A 
o amelogenesis imperfecta
o fluorosis
o systemic illness during tooth formation
o idiopathic
o tetracycline
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5
Q

What are the Intrinsic enamel (local causes)staining causes: (4)

A

injury/infection of primary predecessor
o idiopathic
o caries
o internal resorption

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6
Q

What are the Intrinsic dentine (local causes)staining causes: (5)

A 
o necrotic pulp tissue
o metallic restorations
o root canal filling materials
o caries
o internal resorption
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7
Q

what are the causes of extrinsic staining of teeth?

A 
o food and drink
o smoking
o chromogenic bacteria
o chlorhexidine
o drugs (iron supplements, minocycline)
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8
Q

1)What is acid-pumice miceoabsrasion?
2) is it a bleaching technique?
what teeth types is it not suitable for?

A

1) This is a controlled method of removing surface enamel to improve discolouration
that is limited to the outer layer of enamel.
2) This is NOT a bleaching technique, more
an ‘abrosion’.
3) It is not suitable for non-vital teeth or tetracycline stains.

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9
Q

What are the clinical indications fro acid-pumice microabrasion? (6)

A 
 White/brown stains in surface enamel
 Turner teeth
 Fluorosis
 Idiopathic speckling
 Post-orthodontic treatment demineralisation
 Prior to veneering
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10
Q

what is turner teeth?

A

an area of localized enamel hypoplasia on a permanent tooth usually resulting in an area of white or yellow discoloration.

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11
Q

What materials are required for acid- pumice microabrasion?

A 
rubber dam
 Copalite varnish or GIC varnish
 Sodium Bicarbonate/water paste
 pumice/18% hydrochloric acid paste
 rubber prophylaxis cup
 non-acidulated fluoride varnish (Pro-fluorid varnish)
 Soflex discs
 Fluoridated toothpaste (white)
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12
Q

what is the technique of acid-pumice microabrasion? (12 steps)

A
  1. Pre-operative vitality tests, radiographs and photographs
  2. Clean teeth with pumice and water, wash and dry
  3. Isolate teeth to be treated with rubber dam and paint Copalite varnish at junction
    of tooth and dam
  4. Place sodium bicarbonate water paste around the working area to neutralise any
    drips/splashes of acid
  5. Mix 18% HCl and pumice to a slurry and apply a small amount to the tooth
    surface on a rubber cup. The cup should be rotating slowly and in contact with the
    tooth for 5 seconds
  6. Wash for 5 seconds directly into the aspirator tip
  7. Repeat up to a maximum of 10 applications
  8. Apply fluoride varnish for 3 minutes…NOT Duraphat as it is yellow!
  9. Polish with finest Soflex discs
    10.Prophylaxis with toothpaste
    11.Warn not to eat highly coloured foods for 24 hours
    12.Review in 1 month.
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13
Q

what thickness of enamel is removed from 10 5sec applications of 18% HCl and pumice mix in the pumice-micro-abrasion technique?
2) what thickness is that for each 5 sec application?

A

74µm

2) 1/10 mm each 5 second application

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14
Q

If pumice-microabrasion technique is used why might follow-up localised composite ‘veneers’be needed?
2) Why can this technique cause pt dissatisfaction?

A

Only 50-70% of white enamel defects are sufficiently superficial to be removed with
this technique.
2)When white flecking removed, the residual colour is quite creamy yellow -

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15
Q

What are the 2 broad divisions of bleaching?

A

vital and non-vital

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16
Q

what are the subdivisions of non-vital bleaching? (2)

A

(a) In surgery ‘powerbleaching’ - thermocatalytic

(b) Walking bleach

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17
Q

what are the subdivisions of vital bleaching? (3)

A

(a) Over the counter preparations (e.g. toothpaste, boil and form kits)
(b) In surgery vital bleaching
(c) Matrix bleaching (Nightguard vital bleaching)

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18
Q

How does bleaching work?

A

Thought to be an oxidation process, whereby pigmented carbon ring structures are
broken down into colourless structures.

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19
Q

Why is there staining of teeth from trauma or from incomplete extirpation fo coronal pulp tissue during root canal in non-vital teeth?

A

Pulpless teeth discolour often as a result of haemolysis of red blood cells. Haemolysis of rbc’s releases haemoglobin which combines with
hydrogen sulphide from bacteria, producing iron sulphide.

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20
Q

Pulpless teeth discolour often as a result of haemolysis of red blood cells. When can this staining happen?

A

trauma or from incomplete extirpation fo coronal pulp tissue during root canal in non-vital teeth

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21
Q

What is are the indications for non-vital bleaching of teeth?

A

 discoloured, well root obturated permanent teeth; no pathology seen on rads

22
Q

What are the contraindicaitons for non-vital bleaching of teeth?

A

discolouration due to metal ions

 extensive coronal restoration

23
Q 
What is this materials list for:
 Vaseline
 rubber dam
 pumice and water
 miniature air turbine head and round steel burs-or normal turbine head and goosenecked burs
Anterior Aesthetics
5 Paula\word\lectures\discteethundergrad
 zinc phosphate cement or IRM
 37% phosphoric acid
 Sterile water
 sodium perborate granules (Bocasan)
 Cotton wool
 GIC
 non-setting calcium hydroxide paste
 White GP
 Composite resin
A

non-vital bleaching

24
Q

What burs are required in order to emove GP to just beyond the level of the dento-gingival junction in walking bleach technique?

A

miniature air turbine head and round steel burs-or normal turbine head and goosenecked burs

25
Q

what is the percentage of phosphoric acid required ot etch the pulp chamber in the walking bleach technique. how long is it applied for?

A

Etch pulp chamber with 37% phosphoric acid for 30 seconds. Wash and dry

26
Q

which aspect of the access cavity is perborate and sterile water mix applied in the walking bleach technique?

A

labial

27
Q

what is the technique of walking bleach?

A
  1. Pre-operative radiographs are essential to assess root filling and periradicular
    status.
  2. Clean teeth with pumice and check shade of discoloured tooth with Vita shade
    guide. Note shade of discoloured tooth and the shade to aim for.
  3. Apply Vaseline to gingivae.
  4. Place rubber dam isolating the tooth to be bleached. Eye protection for all.
  5. Remove palatal access restoration and pulp chamber restoration.
  6. Remove GP to just beyond the level of the dento-gingival junction - need to use
    mini head and adult burs.
  7. Place 1mm of zinc phosphate cement over GP.
  8. Etch pulp chamber with 37% phosphoric acid for 30 seconds. Wash and dry.
  9. Mix perborate and sterile water to a THICK paste. Apply to the labial aspect of the
    access cavity.
  10. Cover with a dry piece of cotton wool.
  11. Seal cavity with GIC.
  12. Repeat process at weekly intervals until the tooth is slightly overbleached.
  13. Place non-setting calcium hydroxide in pulp chamber for 2/52 and seal with GIC
  14. Finally restore tooth with white GP and composite resin.
28
Q

Success of walking bleach
1) Rediscolouration appears to occur at a rate of approx ____ at 6 years
2) When rediscolouration occurs it is not as darkas the original
discolouration. True or false
3) A success rate of ___% was seen at 18 months post bleaching in
Newcastle (Waterhouse and Nunn 1996)

A

1) 55%
2) true
3) 83%

29
Q

what are the problems with Non-Vital Bleaching Walking Bleach?

A

 External cervical resorption (ECR)
 Spillage
 Failure to bleach
 Brittleness of tooth crown

30
Q

why are we moving away from the use of hydrogen peroxide in Non-Vital Bleaching Walking Bleach?

A

because of case reports

highlighting ECR.

31
Q

what does ECR stand for?

2) what can be done to prevent it?
3) what is ECR?
4) what is it linked to?

A

External cervical resorption
2) Particularly if H2O2 is used it is suggested that at the end of treatment it is sensible to
place non-setting calcium hydroxide for 2/52 in an attempt to prevent ECR.
3External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth.
4)o thermocatalytic methods
o previously traumatised teeth
o no lining placed over GP
o H2O2 stimulating odontoclastic activity

32
Q

What are the indications for vital bleaching?

A 
 Severe extrinsic stain
 Age related discolouration
 Calcified pulp
 Fluorosis especially brown stain
 Mild tetracycline stain
33
Q

vital bleaching involves what?

2)what can it be used fir? and when shouldn’t it be used?

A

1) This involves the external application of H2O2, heat and light to the labial surfaces of
the teeth in the dental chair.
It can be used to lighten teeth at the darker end of the ‘normal’ spectrum.
2) NO PLACE IN CHILDREN!!!

34
Q

what is the percentage of H2O2 used in vital bleaching? in surgery?
2) and the phosphoric acid?

A

30% (vol) H2O2 solution

2) 37%

35
Q

what are the 12 steps of insurgery vital pulp bleaching?

A

Technique
1. Pre-operative radiographs and vitality tests. Check for leaking restorations
2. Clean teeth with pumice and water to remove extrinsic stain
3. Apply topical anaesthetic gel to the gingival margins
4. Coat buccal and palatal gingivae with Orabase gel to protect from bleaching
solution
5. Isolate each tooth to be bleached using floss ligatures, except the end teeth which
should be clamped
6. Cover the metal clamps with water moistened gauze to prevent overheating under
the heat-light source
Anterior Aesthetics
7 Paula\word\lectures\discteethundergrad
7. Etch the buccal and 1/3 of palatal surfaces with phosphoric acid for 60 seconds,
wash and dry. Soak a strip of gauze in the H2O2 and cover the teeth to be
bleached with it
8. Set the heat lamp 13-15” from teeth. Set the rheostat to a mid temperature range
- turn until the pt can just feel the warmth in the teeth and turn down a little
9. Maintain damp gauze by reapplying the bleach every 3-5 minutes using a cotton
bud. Always replace the lid on the bottle as H2O2 deactivates in air.
10. After 30 minutes remove rubber dam and polish teeth. Apply fluoride drops for 2-
3 minutes.
11. Post-op sensitivity can be relieved with Paracetamol/Tooth Mousse
12. Assess the change - it may be necessary to repeat the process (in the USA up to
10 times…). Review periodically, it may need to be repeated every year

36
Q

1) WHat is the active ingredient in Matrix Bleaching (Home, nightguard/tray vital bleaching)? +%
2) the mode of action is unclear what is it thought to be?
3) what does the active ingredient brake down into?
4) what is the significance of the the molecular weight of 2 of the final products?

A

1)10% carbamide peroxide gel
2) oxidising process
3) Carbamide
peroxide breaks down into approx 3% H2O2, and urea. These then break down to
oxygen, water, ammonia and carbon dioxide.
4) Urea and H2O2 have small molecular
weight and can therefore diffuse rapidly through enamel and dentine. This may
explain the transient pulpal sensitivity sometimes experienced.

37
Q

what 5 materials are required for Matrix Bleaching (Home, nightguard/tray vital bleaching)?

A

Upper impression and working model
 custom-fabricated soft mouthguard, avoiding gingivae
 syringes of gel for home application

38
Q

what are the in surgery steps in providing atrix Bleaching (Home, nightguard/tray vital bleaching)?

A
  1. Alginate impression of appropriate arch
  2. Pour up a stone working model
  3. Relieve the labial surface of the model with wax spacer (0.5mm)
  4. Produce a 2mm thick soft pull-down vacuum formed splint. Carefully trim away
    from the gingival margin as there should be no contact with the gingivae. Some
    kits advocate grooving the cervical region of the teeth on the model to ensure an
    extra tight fit.
  5. Determine initial shade using a Vita shade guide and record. OHI to patient. Full
    mouth prophylaxis. Instruct patient to apply gel onto the internal labial aspect of
    the splint, just on those teeth to be bleached.
  6. The length of time the splint should be worn varies with different systems, from 2
    hours per day to all night. Low viscosity gels need topping up.
  7. Review pt 2 weeks later and again at 6 weeks. 80% of colour change should have
    occurred by then
39
Q

what are the side effects on the gingivae of Matrix Bleaching (Home, nightguard/tray vital bleaching)?

A

 gingivitis
 number of micro-organisms
 cell necrosis if concentrated directly on tissue
 mutagenic potential seen in mice

40
Q

what are the side effects on the pulp of Matrix Bleaching (Home, nightguard/tray vital bleaching)?

A

Mild sensitivity to temperature changes - due to small molecular weight urea and hydrogen peroxide
Cellular pulp changes seen with higher concentrations, but thought to be insignificant
with carbamide peroxide (Anderson 1999). Problems occur with overheated or
traumatised teeth.

41
Q

what are the side effects on the enamel of Matrix Bleaching (Home, nightguard/tray vital bleaching)?

A

Insignificant change in enamel surface morphology or subsurface enamel hardness
after 6 weeks use.
Concern that lower pH solutions/gels would cause demineralisation. CP produces
urea which is known to neutralise the acidic effects of carbohydrates and inhibits
acidogenicity of plaque.
There is an initial decrease in bond strength to composite resins placed immediately
after bleaching. This is thought to be because of residual O2 on the tooth surface,
which inhibits polymerisation

42
Q

what are the benefits of good teeth bleaching?

A

1) may offer an effective alternative to restoring discoloured vital and nonvital teeth to a more normal colour. 2) can replace more invasive and
expensive procedures such as crowns.
3) can provide initial or supplementary
lightening of teeth, increasing the efficacy of other treatment such as veneers.

43
Q

EU legislation has lead to changes. how is this affected the conc of hydrogen peroxide used in under 18s

2) What does the CDO say about who under 18 are able to receive tx using this conc of H2O2?
3) who can’t?

A

must be less than 6%
2) for therapeutic reasons (eg vital
teeth with fluorosis, hypomineralisation, idiopathic mottling and dark non-vital teeth)
for young people before their 18th birthday
3) Young patients (usually females) exhibiting no enamel discolouration but
who want ‘whiter smiles’ are not included

44
Q

what is ncl moving away from using and towards due to he 2012 legislation of EU?

A

from using walking
bleach with sodium perborate (walking bleaching) to using the inside/outside NV bleach technique with 10%CP(carbamide peroxide gel) (less than 6% HP)

45
Q

What are the steps to doing inside/outside NV bleaching (brief)?

A

Single root-filled tooth, no signs of pathology
• Imp for tray, baseline records
• Prepare access cavity and seal over GP
• Fit tray, instruct on OH and use, give syringe
of CP
• 2 hr application in/out up to twice per day
(young pt)
• Stop at desired shade/if overwhitening

46
Q

what are the affects of an over-contoured restoration?

2) and under?

A

1) inadequate stimulation of gingivae, food lodgement, increase plaque retention (halitosis and caries), gignigvl inflam, PD, mobile teeth= atrophy of gingivae
2) direct impact of food- trauma to supporting tissues

47
Q

when removing enamel for composite veneers what should be considered in children?

A

Bond strength of composite resin to enamel is
significantly increase after partial removal of buccal
enamel
• Young patients have large pulp chambers and
unstable soft tissue

48
Q

what are the indications for composite veneers?

A 
Morphology
• Diastemata
• Fractures
• Failed acid pumice
• Inherited disorder
• Growing child
49
Q

what are the indications for porcelain veneers (indirect technique)?

A
  • Discolouration
  • Enamel defects
  • Diastemata
  • Malpositioned teeth
  • Malocclusion
  • Poor restorations
  • Ageing
  • Wear patterns
50
Q

what are the contraindications for porcelain veneers?

A
  • Available enamel

* Oral habits

Stage 3 Child Dental Health (2 decks)

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