Extrinsic & Intrinsic Stains and Cosmetic Polishing

Question 1

Understand and Identify the difference between intrinsic and extrinsic stain and how to test for the difference:

what does pink staining indicate?

Answer 1

Question 2

List 4 predisposing factors that an operator needs to consider when thinking about Extrinsic staining

Answer 2

1. Salivary dysfunction: has pt. Had salivary damage/infection, systemic disease (Sjogren’s syndrome), head neck cancer radiation, polypharmacy? Low saliva leads to extrinsic staining.
2. Poor OH: when leaving stains or deposits over time, staining will occur.
3. Smoking & Dietary habits: wine, coffee, tea, any food or bev that is dark can prod staining.
4. Tooth anatomy: mini pits, fissures, defects on surface enamel = prone sites of deposits (food, drinks, tobacco and topical agents)

Question 3

List the common causes of extrinsic stains and elaborate on the Chromogenic Bacterial component

Answer 3

Dental plaque, calculus
Topical meds: chlorhexidine mouth rinse, stannous fluoride
Metallic compounds (industrial exposure to iron, manganese, silver may stain teeth black. Mercury and lead dst can cause blue-green stain)

Question 4

Answer 4

Question 5

Where is staining caused by Chromogenic Bacterial normally localised?

Answer 5

Question 6

What medications can cause staining?
Identify related to photo.

Answer 6

Question 7

List the common causes of intrinsic stains and be able to briefly describe each one

Answer 7

1. Amelogenesis: improper enamel growth
2. Certain dental materials:
3. erosion
4. caries
5. Meds Tetracyclines- a class of AB med, when pt’s were 3- 5 y.o
6. excess F
7. genetic/ Hereditary

Question 8

Certain dental materials that can cause staining:

Answer 8

intrinsic stains

Question 9

Identify these stains

Answer 9

intrinsic stains

Question 10

Identify these stains

Answer 10

intrinsic stains

Question 11

Identify these stains

Answer 11

intrinsic stains

Question 12

Answer 12

Question 13

Answer 13

Question 14

Answer 14

Question 15

Answer 15

Question 16

List and describe what Pre-treatment Considerations an operator must consider before proceeding with Oral Prophylaxis

Answer 16

Discuss medical care: inform pt if there is an meds/ mouth rinses they use. E,g savacol, stannous fluoride.
Discuss diet + habits: extrinsic staining (food, drinks), advise to rinse after coffee or chew sugar free gum, encourage smoking cessation
Discuss tooth brushing + ID cleaning: brush 2x/day effectively with dentifrice helps to prevent extrinsic staining. Electric tb helps slow staining. If spaces allow, recc. ID brushes.

Question 17

Define Oral Prophylaxis and briefly discuss the purpose, precautions and considerations the dental operator needs to take into account

Answer 17

Prophy = Polishing tooth surface with rubber cup/ brush by slow speed handpiece or air polisher
Purpose of Oral prophylaxis: cleaning teeth surfaces by SCALING and PROPHY to remove primary (biofilm) and secondary calculus/stains to help prevent periodontal disease. Smoothing of surface= less accumulation of plaque.
Precautions: Research says polishing doesn’t improve uptake before a professional applied F tx. Arguments: polishing over time can cause abrasion and remove 1m f fluoride layer of enamel.
Considerations: Don’t overpolish. Tooth structure and restos could be abraded. Advise pt. That research indicates polishing is no longer performed for all pt. Only in case of stain build up. Therefore if you do get a pt. Who really wants polishing but has no staining advise that it can lead to loss of tooth structure. If insistent, the use prophy paste with fine grit OR USE TOOTHPASTE only to polish their teeth.

Question 18

Describe safe and be able to perform effective Oral Prophylaxis
What is ideal rpm

Answer 18

• Polishing HP = green, should be 3000 RPM, NOT FASTER than that (can cause gingival abrasion, pt discomfort + excessive heat can damage pulp.
• green indicates max speed safe for polishing 5500 rpm.
• high speed= more prophy paste splatter, bad infection control.
• brushes = higher risk of mild gingival laceration if used near gingival margin
• use soft brush and limit use to clean occlusal sf b4 sealants

Question 20

What is prophy paste? What are some special types of prophy?

Answer 20

Question 21

how do you safely prophy?

Answer 21

Question 22

Be familiar with the “Recommended Removal” advice for the various kinds of Extrinsic stains

Answer 22

Staining may reappear, brush gently, avoid staining food and drinks or rinse after consumption, avoid smoking.