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BDS4 Paeds > Intrinsic staining > Flashcards

Intrinsic staining Flashcards

1
Q

What should be done or is required prior to commencing treatment for intrinsic staining?

A

Accurate diagnosis

Specialist led treatment plan

Informed consent (written is advisable)

Pre-operative records

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2
Q

What is it important to remind the patient of when consenting them for treatment of intrinsic staining?

A

Long term maintenance- at a cost as will be looked after in normal practice

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3
Q

Which pre-operative records would be required prior to commencing treatment of intrinsic staining?

A

Standardisation of recording of aesthetic procedures (SHADE sheet)
Clinical photos
Shade
Sensibility testing, check for sensitivity
Diagram of defect
Radiographs if clinically indicated
Patient assessment e.g VAS etc

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4
Q

What are the treatment options for intrinsic staining?

A

Do nothing

Veneers

Bleaching

Microabrasion

Localised composite restoration

Resin infiltrate (ICON)

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5
Q

What is micro abrasion?

A

The removal of the surface layer of opaque (stained) enamel

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6
Q

What are the advantages of MA?

A

Easily performed
Conservative
Inexpensive
Teeth need minimal subsequent maintenance
Fast acting
Removes yellow-brown, white and multi-coloured stains
Results are permanent
Can use before or after bleaching
Can be combined with addition of composite

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7
Q

What are the disadvantages of MA?

A

Removes enamel
-> Sensitivity
-> Teeth may become more susceptible to staining

HCl acid compounds are caustic

Requires protective apparatus for patient, dentist and
dental nurse

Teeth can appear more yellow as dentine can shine through

Must be done in dental surgery

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8
Q

What can be done to protect the gingival in MA?

A

Sodium bicarbonate

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9
Q

What are the stages in carrying out MA?

A
  1. PPE for patient and team
  2. Clean with pumice and water
  3. Vaseline on soft tissues
  4. Place rubber dam (essential)
  5. Place sodium bicarbonate guard on gingival
  6. Remove enamel with HCL/pumice slurry with slow speed rubber cup- maximum is 10 x 5 sec applications (review shade/shape each time)
  7. Apply FV- pro-fluoride
  8. Polish with finest sandpaper disc
  9. Polish with toothpaste
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10
Q

Why is fluoride varnish used? Why must it be white?

A

To prevent sensitivity and encourage remineralisation

-> to prevent staining

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11
Q

Why are sandpaper discs used at the end of MA?

A

Leaves almost prism-less enamel layer
-> alters optical properties making intrinsic staining less perceptible

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12
Q

How many of microns of enamel are removed by different dental treatments?

A

5-10 micron – prophy with toothpaste
5-50 micron – prophy with pumice
5-50 micron – ortho bracket bonding/debonding
10 micron – acid etching
100 micron – 10 x 5 secs HCL pumice microabrasion

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13
Q

Which proprietary kits are available for MA?

A

Opalustre

Prema-kit

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14
Q

What post-op instructions are given for MA?

A

Avoid anything highly coloured for 24 hours (anything that would stain a white tee)

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15
Q

What should be done at review? (4-6 weeks later)

A

Post-op radiographs

-> max cycles- 2

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16
Q

In what situations is bleaching allowed in children?

A

If it is used for the purpose of treating or preventing disease:

Hypo-mineralisation

Fluorosis

Trauma

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17
Q

What are the types of bleaching techniques used in treating intrinsic staining in children?

A

Vital bleaching (external vital bleaching):
Chairside- ‘power bleaching’
Night guard vital bleaching- ‘at home’

Non- vital (dead tooth) bleaching (internal non-vital bleaching):
‘inside outside’ technique
‘walking bleach’ technique

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18
Q

What % of Hydrogen peroxide is used in chair side bleaching?

A

15-38% (equivalent to 75% carbide peroxide)
-> unstable, rapidly reacting

-> risk to ST/eyes, expensive, can cause sensitivity

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19
Q

What concentration does night guard vital bleaching use?

A

10% carbide peroxide

20
Q

What does 10% carbide peroxide consist of?

A

3% HP, 7% urea

21
Q

What should be done to the tray if you do not want to bleach certain teeth?

A

Cut windows to avoid bleaching teeth (caries)

22
Q

What instructions are given to patient with nighguard bleaching?

A
  1. Brush teeth thoroughly
  2. Apply a little gel to tray (half grain of rice)
  3. Set over teeth and press down
  4. Remove excess
  5. Rinse gently, do not swallow
  6. Wear overnight (or for at least 2 hours)
  7. Remove, brush and rinse with cold water

-> Sensitive toothpaste may be required

-> do this for 3-6 weeks and check colour

23
Q

What are the side effects of vital bleaching?

A

Sensitivity

Gingival irritation

White opacities becoming whiter

24
Q

What causes sensitivity due to bleaching?

A

Hydrogen peroxide passes through intact enamel into dentine then pulp

25
Q

Why is sensitivity more minor in adolescent patients?

A

Increased quantity of enamel

Increased quality of enamel

Larger pulps- faster recovery

26
Q

What can be useful to treat sensitivity caused by bleaching?

A

Desensitising toothpaste

Tooth mouse (not suitable if milk allergy)

27
Q

What are the advantage of NV bleaching?

A

Simple

Tooth conserving- original tooth morphology

Gingival tissues not irritated by restoration

Adolescent gingival level not a restorative consideration

No laboratory assistance for ‘walking bleach’

28
Q

What are the pre-requisites for being a suitable case for NV bleaching?

A

Adequate root filling

No clinical disease/ no radiological disease

Anterior teeth without large restorations

No amalgam intrinsic discolouration

No fluorosis or tetracycline discolouration

29
Q

What are the steps in walking NV bleaching procedure?

A
  1. Remove root filling to level below CEJ
  2. Clean out tooth with ultrasonic
  3. Place CWP covered in bleaching agent
  4. Place dry CWP on top
  5. Seal with GIC/RMGIC
30
Q

What is the frequency for NV bleaching? (walking)

A

Renew within 2 weeks (can be done 6-10 times)
-> if no change after 3-4 renewals then stop

31
Q

What is the regression rate in NVB?

A

50% from 2-6 years

32
Q

What are the stages in the inside-outside NVB technique?

A
  1. Access cavity of tooth open
  2. Consider need for GIC lining
  3. Produce custom made mouthguard (cut windows in guard of the teeth you don’t want to bleach!)
  4. Patient applies bleaching agent to back of tooth and tray
  5. Patient keeps access cavity clean, replacing gel (10%carbamide peroxide) and removes food debris etc
  6. Worn all the time except eating and cleaning

-> Gel changed every 2 hours or so except during the night

33
Q

What restoration is placed following completion of NVB?

A

Non setting calcium hydroxide paste for 2 weeks, seal in with GIC. Then:
White GP and composite resin – facility to re-bleach

Or

Incrementally cured composite –no re-bleaching but stronger tooth.

-> place veneer or crown if regression

34
Q

What are the potential complications of NVB?

A

External cervical resorption

Spillage of bleaching agents

Failure to bleach

Over bleach

Brittleness of tooth crown (when no coronal filling present)

35
Q

How is external cervical resorption prevented?

A

Layer of cement over GP
-> Prevents bleaching agent from getting to
external surface of root (can prevent adequate bleaching of cervical area)

Non setting calcium hydroxide in tooth for 2 weeks before
final restoration
-> Reverses any acidity

36
Q

What are the potential short term effects of bleaching agents on soft tissues?

A

Minor ulceration/irritation

Plaque reduction

Aids wound healing

37
Q

What are the long term effects of bleaching agents on ST?

A

Delayed wound healing

Periodontal harm

Mutagenic potential

38
Q

When is CPPACP recommended

A

After bleaching- 2 weeks home application

After MA for poorly demarcated hypo-mineralised lesions and fluorosis (mild/moderate)- 4 weeks

39
Q

What is resin infiltration?

A

Infiltration (via capillary forces) of enamel lesions with low-viscosity light-curing resins

40
Q

What are the benefits of resin infiltration?

A

Good for diffuse white opacities (fluorosis)- camouflages it making it look similar to sound enamel

-> can be used as an adjunct to composite

41
Q

What are the steps in resin infiltration using ICON?

A

1.Rinse and clean teeth
2. Apply icon-etch- rub in (let it sit for 2 mins then rinse off)
3. Apply icon-dry (let it act for 30 sec)
4. Do second etch and repeat with icon-dry (repeat as required)
5. When lesions masked and accessible- apply icon-infiltrant for 3 mins
6. Remove excess and Light cure 40 secs
7. Do second infiltration- accounts for polymerisation shrinkage (leave for 1 min, remove excess and cure)
8. Polish

42
Q

What should be considered when deciding whether or not to removing enamel in a veneer prep in paeds?

A

Aesthetics
Relative tooth position- don’t remove if trying to move in line with arch
Masking dark stain- remove some
Age
Psyche
Plaque removal

43
Q

What is the issue with over contouring teeth prior to placing veneers?

A

Plaque stagnation

44
Q

What is the advantage in terms of bonding when enamel removed?

A

Bond strength of composite resin to enamel is significantly increased after partial removal of buccal enamel

45
Q

What are the types of composite veneers used in treatment of intrinsic discolouration in children?

A

Direct

Indirect- bell glass

BDS4 Paeds (2 decks)

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