Paedodontics - Intrinsic Discolouration Flashcards
What pre-op records do we need before starting treatment? (7)
- Standardisation of recording of aesthetic procedures
- Clinical photos
- Shade taken
- Sensibility testing and check for sensitivity
- Diagram of defect
- Radiographs (if clinically indicated)
- Patient assessment
List the treatment options for intrinsic discolouration of permanent anterior teeth. (6)
- Enamel microabrasion
- Bleaching
- Vital
- Non-vital - Resin infiltration with ICON
- Localised composite restoration
- Veneers – composite
- Direct
- Indirect - Nothing
What is micro abrasion?
The removal of the surface layer of opaque enamel
What are the advantages of micro abrasion? (9)
• Easily performed
• Conservative
• Inexpensive
• Teeth need minimal follow up maintenance
• Fast acting
• Removes yellow-brown, white an multi-coloured stains
• Effective
• Results are permanent
• Can use before or after bleaching
What are the disadvantages of micro abrasion? (5)
• Removes top layer of enamel - Sensitivity or Teeth may become more susceptible to staining
• HCl acid compounds are caustic - Requires protective apparatus for patient, dentist and dental nurse
• Prediction of treatment outcome is difficult, (teeth may appear more “yellow” as the normal colour of crown revealed under white opacity)
• Must be done in dental surgery
• Has to be carried out by a dentist
Why do we use soft flex discs to finish after micro abrasion?
Changes the optical properties of the enamel = defect/staining becomes less obvious
How much enamel is removed after the use of a trophy cup and toothpaste?
5-10 micron
How much enamel is removed after the use of a trophy cup and pumice?
5-50 micron
How much enamel is removed after bonding and debunking orthodox brackets?
5-50 microns
How much enamel is removed after the use of acid etch?
10 microns
How much enamel is removed after the use of 10 x 5 secs of HCL pumice micro abrasion?
100 microns
What post op instructions are provided after micro abrasion? (2)
Warn patient to avoid highly coloured food and drinks for at least 24 hours however recommend up to a week (anything that would stain a white t-shirt should be avoided)
Advise patient that we Can offer a second cycle of microabrasion (maximum) if first cycle has been effective
When do we review patients after micro abrasion?
Review patient 4- 6 weeks after microabrasion and take post op photographs
What is the new guidance regarding the use of bleaching products on children?
Products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for the purpose of treating or preventing disease e.g. hypomineralisation, trauma, fluorosis.
List the bleaching options we can offer for a vital tooth.
- Chairside- ‘power bleaching’
- At Home: Night guard vital bleaching
List the bleaching options we can offer for a non-vital tooth. (2)
- ‘inside outside’ technique
- ‘walking bleach’ technique
What kind of bleach do we use for vital external bleaching?
hydrogen peroxide usually 15-38%
(equivalent to 75% carbamide peroxide).
What kind of bleach do we use for at home external bleaching?
10% carbamide peroxide
What patient instructions do we provide with at home external bleaching? (7)
- Brush teeth thouroughly
- Apply a little gel to tray (half a grain of rice)
- Set over teeth and press down
- Remove excess
- Rinse gently, do not swallow
- Wear overnight (or for at least 2 hours)
- Remove the trays, brush with toothpaste and rinse with cold water (Sensitive toothpaste may be required)
What are the instructions for use for at home external bleaching?
Use for 3-6 weeks until a desired colour is achieved
How long after vital external bleaching should restorative work be carried out and why?
- Should be done before restorative work/composite and give teeth 2 weeks to settle
What are the side effects of at home vital external bleaching? (2)
Tooth sensitivity
Gingival irritation
Why is tooth sensitivity post vital external bleaching less significant in adolescent patients?
tooth sensitivity was relatively minor in adolescent patients - could be attributed to the increased enamel quantity and quality of the adolescent teeth and also to the larger pulp complexes in adolescent patients’ teeth which allow faster recovery from the acute inflammation experienced during a sensitivity episode
What products can be used to treat the symptoms of sensitivity post vital external bleaching (or post micro abrasion)?
Toothmousse e.g. recaldent
What are the advantages of using tooth mousse? (2)
- Improve the appearance of poorly demarcated hypomineralised lesion (milk/moderate fluorosis)
- Improves sensitivity
What are the instructions for use of tooth mousse?
Use for 2 weeks post bleaching/microabrasion – via rubbing on to the teeth after brushing or via the trays
What are the risks of using tooth mousse?
Caution with milk allergy as it is a milk derived protein
What are the advantages of non-vital bleaching? (6)
Simple
Tooth conserving
Maintains original tooth morphology
Gingival tissues not irritated by restoration
Adolescent gingival level isn’t completely mature until 17 – can be used instead of restorative techniques
No laboratory assistance for ‘walking bleach’
What teeth are suitable and non-suitable for non-vital bleaching? (4)
Teeth with Adequate root fillings suitable;
= no clinical disease
= no radiological disease
Anterior teeth without large restorations = suitable
Unsuitable;
amalgam intrinsic discolouration
fluorosis or tetracycline discolouration
What kind of bleach do we use for the inside-out non-vital bleaching technique?
10% carbamide peroxide gel
When using the walking bleach technique, how often do we renew the bleach?
every 2 weeks
How many unsuccessful attempts are given before stopping using the walking bleach technique?
3-4
What percentage of px have staining reappear 2-6 years after tx
50%
What are the complications of non-vital bleaching? (5)
External cervical resorption
Spillage of bleaching agents
Failure to bleach – might not been successful
Over bleach – doesn’t match the surrounding teeth
Brittleness of tooth crown
What short term effects does bleaching have on the soft tissues?
- Minor ulceration/irritation
- Plaque reduction
- Aids wound healing
What long term effects does bleaching have on the soft tissues? (3)
- Possibly delay wound healing
- Possible cause perio harm
- Possibly have a mutagenic potential
How do we prevent external cervical resorption from occurring after non-vital bleaching? (2)
Place a layer of cement over GP - Prevents bleaching agent from getting to the external surface of root (not effective for inside-out technique)
Non setting calcium hydroxide placed in tooth for 2 weeks before the final restoration - Reverses any acidity in PL that might have occurred
What is resin infiltration (ICON)?
Infiltration of enamel lesions with low-viscosity light-curing resins
How does resin infiltration work?
The Surface layer of enamel is eroded, the lesions are broken down and a resin infiltrant is applied - Infiltrated lesions lose their discolored appearance and look similar to sound enamel.
(Resin penetrates lesion via capillary forces)
What occurs if a composite veneer is overcontoured? how do we combat this?
can increase plaque retention and stagnation at the gingival margin (esp in those with poor OH)
– may want to consider more enamel reductions
