intrinsic discolouration

Question 1

treatment options for intrinsic discolouration in permanent teeth of children and teenagers (4)

Answer 1

enamel microabrasion
bleaching
resin infiltration
localised composite restoration
composite veneers

Question 2

what should pre op records contain for treatment on an anterior tooth with intrinsic discolouration

Answer 2

clinical photograph
shade match - both of defect and surrounding tooth tissue
sensibility test
sensitivity test
diagram of defect (if photos not taken)
radiographs if indicated

Question 3

what treatments for intrinsic discolouration may increase sensitivity

Answer 3

microabrasion. bleaching

Question 4

what treatments for intrinsic discolouration may decrease sensitivity

Answer 4

veneer
resin infiltration

Question 5

what is used for microabrasion

Answer 5

pumice and 18% HCL acid

Question 6

prior to beginning microabrasion, what should be done

Answer 6

teeth should be cleaned with pumice and water to remove pellicle layer, plaque and food
petroleum jelly should be applied to lips and gingivae for protection
rubber dam must be placed - with opal dam if necessary
sodium bicarbonate guard on dam behind teeth

Question 7

what purpose does sodium bicarbonate have in microabrasion

Answer 7

should be placed on dam behind teeth to act as a guard so that if any acid is dropped it will be neutralised

Question 8

what is used to apply the HCL slurry in microabrasion

Answer 8

cant use metal as it reacts with acid
either wooden stick or rotating rubber cup can be used as applicator

Question 9

discuss the process of microabrasion

Answer 9

either 5x10s or 10x5s applications per tooth
wash remains directly into aspirator
polish with finest sandpaper disc when finished
fluoride should be applied at end (not duraphat varnish as this is yellow)

Question 10

what type of staining is microabrasion particularly good for

Answer 10

brown patches of fluorosis

Question 11

how does microabrasion work

Answer 11

permanently removes about 100 microns of tooth substance
creates a compact, smooth, relatively prismless layer of surface enamel which changes the optic proerties so that areas of intrinsic discolouration become less perceptible

Question 12

what volume of tooth does acid etch remove

Answer 12

around 10 microns

Question 13

advantages of microabrasion (5)

Answer 13

easily performed
conservative
inexpensive
minimal maintenance
permanent results
fast acting
can be used in combination with bleaching

Question 14

disadvantages of microabrasion (3)

Answer 14

permanently removes enamel
prediction of treatment outcome is difficult
strongly erosive materials used
must be done in dental surgery and cannot be delegated
protection of dentist, patient and nurse needed (PPE)

Question 15

indications for microabrasion

Answer 15

hypermineralised enamel
discolouration limited to enamel surface
fluorosis
white spots
decalcification related to orthodontic bands

Question 16

contraindications for microabrasion

Answer 16

discolouration related to aging
tetracycline staining
amelogenesis imperfecta and dentinogenesis imperfecta
deep decalcified lesion reaching dentine

Question 17

what post op instructions should be given after micro abrasion

Answer 17

full effects arent seen immediately after due to teeth being dehydrated
highly coloured foods (anything that would stain a white t shirt) should be avoided as teeth will uptake stain for 24-48 hours

review appointment in 4-6 weeks time

Question 18

what does the EU directive dictate regarding bleaching of childrens teeth

Answer 18

products containing or releasing between 0.1 and 6% hydrogen peroxide can only be used on under 18s if for the sole purpose of treating or preventing disease

Question 19

what are the two different modalities of bleaching

Answer 19

vital bleaching (external)
non - vital bleaching (internal)

Question 20

prior to bleaching treatment what should the patient be warned

Answer 20

effects are not permanent

Question 21

what are the two options for delivery of external vital bleaching

Answer 21

chairside (power bleaching)
home whitening

Question 22

discuss chairside whitening (power bleaching)

Answer 22

gives immediate results with less participation needed from patient
expensive, more visits required, possibility of gingival and soft tissue burns, higher incidence of post op sensitivity