intrinsic discolouration Flashcards
treatment options for intrinsic discolouration in permanent teeth of children and teenagers (4)
enamel microabrasion
bleaching
resin infiltration
localised composite restoration
composite veneers
what should pre op records contain for treatment on an anterior tooth with intrinsic discolouration
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
what treatments for intrinsic discolouration may increase sensitivity
microabrasion. bleaching
what treatments for intrinsic discolouration may decrease sensitivity
veneer
resin infiltration
what is used for microabrasion
pumice and 18% HCL acid
prior to beginning microabrasion, what should be done
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
what purpose does sodium bicarbonate have in microabrasion
should be placed on dam behind teeth to act as a guard so that if any acid is dropped it will be neutralised
what is used to apply the HCL slurry in microabrasion
cant use metal as it reacts with acid
either wooden stick or rotating rubber cup can be used as applicator
discuss the process of microabrasion
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)
what type of staining is microabrasion particularly good for
brown patches of fluorosis
how does microabrasion work
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
what volume of tooth does acid etch remove
around 10 microns
advantages of microabrasion (5)
easily performed
conservative
inexpensive
minimal maintenance
permanent results
fast acting
can be used in combination with bleaching
disadvantages of microabrasion (3)
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)
indications for microabrasion
hypermineralised enamel
discolouration limited to enamel surface
fluorosis
white spots
decalcification related to orthodontic bands
contraindications for microabrasion
discolouration related to aging
tetracycline staining
amelogenesis imperfecta and dentinogenesis imperfecta
deep decalcified lesion reaching dentine
what post op instructions should be given after micro abrasion
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
what does the EU directive dictate regarding bleaching of childrens teeth
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
what are the two different modalities of bleaching
vital bleaching (external)
non - vital bleaching (internal)
prior to bleaching treatment what should the patient be warned
effects are not permanent
what are the two options for delivery of external vital bleaching
chairside (power bleaching)
home whitening
discuss chairside whitening (power bleaching)
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
