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Operative V > L2: Tooth Whitening-Part I > Flashcards

L2: Tooth Whitening-Part I Flashcards

1
Q

Tooth Whitening today:

A
  1. Toothpastes
  2. Do it yourself (DIY)
  3. Non – vital tooth whitening
  4. In office
  5. Take home
  6. Assisted
  7. Over the counter (OTC)
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2
Q

Diagnosis and Tx planning:

A

Nature of the discoloration.

  • Intrinsic stains
  • Extrinsic stains
  1. Expectations of the patient.
  2. Restorative status.
  3. Caries status.
  4. Vital or non vital tooth discoloration (single dark tooth)
  5. Root exposure
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3
Q

Extrinsic vs Intrinsic discoloration:

A
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4
Q

Chromophore theory:

A
  • H2O2 interacts with organic chromophores within the tooth structure.
  • When H2O2 encounters stain molecules, the chromophore chains are oxidized and converted into simpler structures or alter their optical properties and diminish the appearance of the stain.
  • H2O2 diffuses easily all over dentin, interacts with chromophors and changes the color.
  • Whitening effect is time and dosage dependent.
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5
Q

HP vs CP:

A
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6
Q

Safety of tooth whitening:

A
  1. H2O2 produces hydroxyl free radicals that are associated with toxic effects. Results in animal studies vary.
  2. Accidental consumption resulted to death in humans.
  3. Stomach and chest pain.
  4. No evidence of carcinogenicity.
  5. H2O2 is a tissue irritant, concentration dependent.
  6. Mild to moderate changes can happen to enamel and dentin.
  7. Concentration, time and pH dependent.
  8. Other studies show that these effects can be reversible.
  9. Most studies are in-vitro.
  10. It does not appear to have any clinical evidence of problems.
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7
Q

Safety of tooth whitening: Approval:

A
  • Over 500 research projects in 50 years document the safety of HP and CP in tooth whitening concentrations in humans.
  • Carbamide Peroxide: FDA approved since 1974
  • Whitening Products: ADA approval since early 90s.
  • Since 1989, in millions of tooth whitening cases, there is no published case reports with erosion or any other non reversible problems.
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8
Q

Tooth whitening and Dental materials:

A
  • Controversial in-vitro studies show possible effects on:
  1. Surface roughness
  2. Microhardness
  3. Color
  • Microleakage.
  • No evidence of a lower clinical performance of Dental materials exist.
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9
Q

Adverse effects:

A
  • Cold/air sensitivity in up to 80% of the patients.
  1. Due to dehydration mainly.
  2. Mild to severe.
  • Gingival tissue irritation.
  1. Mechanical trauma.
  2. Toxic effect.
  • Pulpal effects.
  1. H2O2 definitely reaches the pulp.
  2. The lower the concentration the faster the regeneration
  • Decrease in Enamel and Dentin Bond Strengths Immediately After Whitening.
  • REVERSIBLE IN A FEW DAYS
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10
Q

Vital Tooth Whitening:

A
  1. In office
  2. Take home
  3. Assisted
  4. Over the counter (OTC)
  5. Whitening Toothpastes
  6. Do it yourself(DIY)
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11
Q

OTC Whitening:

A
  • TV, drug stores.
  • Some contain citric Acid, titanium dioxide, and other potentially DANGEROUS PRODUCTS.
  • Not customized trays.
  • Report of serious enamel erosion (CubbonT, Ore D, 1991)
  • Not approved by any dental organization

MOST IMPORTANT, THERE IS NO DENTIST SUPERVISION

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12
Q

Whitening Toothpastes:

A
  • Very low concentration of H2O2 to work.
  • High abrasiveness.
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13
Q

Case Selection: Indications :

A
  1. Teeth of a uniform color.
  2. Few restorations.
  3. The Shade before whitening does not matter.
  4. Tetracycline discoloration ???
  5. Fluorosis ???
  6. White spots
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14
Q

Case Selection Contra- indications:

A
  • Caries or Periodontal problems.
  • Cervical abrasions or erosions.
  • Large aesthetic restorations.
  • Pregnancy and breast feeding.
  • Children.
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15
Q

Two parameters effect the results:

A
  • Contact time
  • H2O2 concentration
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16
Q

In – Office Tooth Whitening:

A
  • 20-50%Η2Ο2
  • Light andTemperature
  • Chemical activation
  1. Zoom2, Beyond
  2. NDYAG, KTP, ILT, Argon Lasers
  3. Plasma Arc
  4. Xenon
  • THE TRUTH IS THAT ONLY H2O2 GEL DOES THE JOB!
  • EVERYTHING ELSE IS PURE MARKETING.
17
Q

In – Office Tooth Whitening:

Advantages vs Disadvantages

A
  1. Toxic Η2Ο2 concentration.
  2. Rubber dam, liquidam.
  3. Pretty uncomfortable for the patient.
  4. Time consuming for the office.
  5. Immediate Results.
  6. Full control remains to the dentist.
  7. Marketing.
  8. Whitening in patients with cervical sensitivity.
  9. Whitening both arches at the same time.

Operative V (12 decks)

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