Internal Bleaching Flashcards

1
Q

What are 7 causes of internal tooth discoloration?

A
  1. Pulp necrosis
  2. Intrapulpal hemorrhage
  3. Calcifica metamorphosis
  4. Internal resorption
  5. Age
  6. Developmental defects
  7. Systemic diseases
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2
Q

Chemical, mechanical, or bacterial irritation of the pulp can cause what and what can this lead to?

A

Causes pulp necrosis. Tissue degradeation byproducts deposit in dentinal tubules typically discoloring the tooth to a grey color.

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3
Q

What can result from an impact injury without pulpal necrosis but with an extensive formation of tertiary (irregular) dentin?

A

Calcific metamorphosis

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4
Q

Calcific metamorphosis decreases the translucency of the tooth and results in what color discoloration?

A

Yellow/brown

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5
Q

Is calcific metamorphosis quick or gradual over time?

A

Gradual

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6
Q

What is an inflammatory condition resulting in progressive destruction of dentinal walls of canal caused by some form of canal wall injury (trauma, caries) and odontoclasts begin resportion?

A

Internal resorption

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7
Q

What can bacteria do to the odontocalsts as they begin resorption?

A

Continue to stimulate internal resorption

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8
Q

What is the pink tooth of mummery?

A

If internal resorption lesion is located coronally in the canal

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9
Q

When will internal resorption resolve?

A

After RCT

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10
Q

Is internal bleaching necessary on a tooth that has NSRCT for internal resorption?

A

No

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11
Q

What are the factors of age that lead to tooth discoloration?

A

Extensive dentin formation (secondary dentin)
Thinning of enamel to expose dentin
Decreased translucency of enamel
Extrinsic discoloration due to food and beverages
Previous restorations, especially amalgam

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12
Q

Ingestion of excessive amounts of fluoride during tooth formation will result in what appearance?

A

Chalky, white porous enamel that stains easily. Endemic fluorosis.

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13
Q

Tetracycline in children and minocycline in adults can result in what type of internal discoloration?

A

Yellow, brown, dark grey

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14
Q

What are 2 treatments for systemic drug staining?

A
  1. External bleaching

2. Elective NSRCT and internal bleaching

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15
Q

What systemic disease has a massive lysis of RBC’s leaving hemosiderin in tubules causing dark staining of primary teeth?

A

Erythroblastosis Fetalis

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16
Q

Linear banding hypoplasia of several teeth is due to what?

A

High ever during tooth formation

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17
Q

What is a genetic condition where heme is not made properly and the teeth have a red/brown discoloration?

A

Porphyria

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18
Q

What is a genetic disorder causing abnormal form of hemoglobin, causing destruction of red blood cells leading to anemia (causes blue/brown/green discoloration)?

A

Thalassemia

19
Q

What is a genetic disorder causing red blood cells to form a sickle-shape, delivering less oxygen to the body, and are easily trapped in veins (causes blue/brown/green discoloration)?

A

Sickle Cell anemia

20
Q

What is a tooth development disorder with the teeth covered with a thin, abnormally formed enamel (causes yellow/brown discoloration)?

A

Amelogenesis imperfecta

21
Q

Are erythroblastosis fetalis, high fever during tooth formation, porphyria, thalassemia, sickle cell anemia, amelogenesis imperfecta, dentinogenesis imperfecta amenable to bleaching?

A

No

22
Q

What can be cause by obturation material leading to a dark discoloration?

A

Endodontic iatrogenic discoloration

23
Q

What is the most common iatrogenic etiology related to tooth discoloration?

A

Endodontic iatrogenic discoloration

24
Q

What can make endodontic iatrogenic discoloration hard to bleach?

A

Metallic sealer (Zinc Oxide Eugenol)

25
Q

What will endodontic iatrogenic discoloration require, and is it expected to completely resolve?

A

Requires internal bleaching and complete resolution may not occur?

26
Q

How can endodontic iatrogenic discoloration be avoided?

A

Remove gutta percha to below gingival margin/CEJ

27
Q

Beyond obturation materials, what is another cause of endodontic iatrogenic discoloration?

A

Remnants of pulpal tissue

28
Q

What are 2 other sources of discoloration provided by the dentist?

A
  1. Intracanal medicaments

2. Coronal restorations

29
Q

What do we use as our bleaching materials?

A
  1. Hydrogen peroxide

2. Sodium perborate

30
Q

Is hydrogen peroxide (Superoxyl), which is 30% hydrogen peroxide, used along for internal bleaching?

A

No. Acidic pH will increase the risk of external cervical root resorption.

31
Q

What is another concern with 30% hydrogen peroxide?

A

Caustic to tissue

32
Q

What is the material of choice for internal bleaching that comes as a dry powder and can be mixed with hydrogen?

A

Sodium perborate

33
Q

Is sodium perborate safer than hydrogen peroxide?

A

Yes, it has an alkaline pH

34
Q

What is the most commonly used material for external bleaching?

A

3-15% solutions of Carbamide peroxide

35
Q

What are 3 indications for internal bleaching?

A
  1. Discoloration of pulp chamber origin
  2. Dentin discoloration
  3. Discoloration that is not amenable to external bleaching
36
Q

What are 5 contraindications to internal bleaching?

A
  1. Superficial enamel discoloration
  2. Defective enamel formation
  3. Severe dentin loss
  4. Presence of caries
  5. Discolored proximal composites
37
Q

What are 2 complications associated with internal bleaching?

A
  1. External root resorption

2. Chemical burns

38
Q

The external root resorption risk is increased by what 2 factors?

A

30% hydrogen peroxide

Heat

39
Q

How does external root resorption occur during internal bleaching?

A

Bleach materials diffuse through dentinal tubules and cementum defects into PDL causing an acidic environment leading to an inflammation response

40
Q

What blocks dentinal tubules from penetration by bleaching agent to decrease risk of external root resorption?

A

2mm seal of glass ionomer or composite resin above the CEJ

41
Q

The thermocatalytic bleaching technique does what to the hydrogen peroxide and increase what?

A

Creates hydroxyl radicals and increased diffusion of hydrogen peroxide to the root surface causing damage to the cementum and PDL leading to external cervical resorption.

42
Q

What technique is recommended for all internal bleaching?

A

Walking bleach technique

43
Q

What is the mix for the walking bleach technique?

A

Hydrogen peroxide 30% and sodium perborate mixed to sand-in-water consistency

44
Q

What is the recall schedule for walking bleach technique?

A

Patient returns every 7 days to replace bleaching material and check progress