Paeds Discoloration Flashcards
What is required pre commencing treatment?
Accurate diagnosis
Clinical photos
Shade
Sensibility testing, check for sensitivity
Diagram of defect
Radiographs if clinically indicated
Patient assessment (VAS)
What are the treatment options for discolouration?
Enamel micro abrasion
Bleaching - vital/ non-vital
Resin infiltration (ICON)
Localised composite restoration
Veneers (composite- direct/ indirect)
Do nothing
What is microabriasion
Removal of the surface layer opaque enamel
What are some disadvantages of micro abriasopnm?
Removes enamel - sensitivity, teeth may be more susceptible to staining, may become more yellow (not predictable)
Must be done in dental surgery
HCl acid compounds are caustic
What are some advantages of micro abrasion?
Easily performed
Conservative
Inexpensive
Minimal maintenance and fast acting
Permanent results
Can be used in combination with bleaching
Clinical technique of micro abrasion
Clean teeth with pumice and water
Soft tissue protection - petroleum jelly, rubber dam, sodium bicarbonate guard
Dry teeth
HCl pumic slurry used in slow hand piece and rubber cup for 5 seconds on each tooth (max 10 x 5 secs on each tooth).
Wash after every 5 second application
Fluoride varnish application (helps with remineralisation and sensitivity) - use pro fluoride as is white (duraphat is yellow)
Polish with finest sandpaper disc
Polish with toothpaste
What is the purpose of using sandpaper disc
Soft flex disc changes optical properties of enamel - areas of intrinsic discolouration becomes less perceptible by smoothing enamel
Why might teeth start to appear flattened when using HCl
Due to removing layers of enamel
How much enamel does acid etch remove?
10 microns
How much enamel does 10x 5sec HCl pumic micro abrasion remove?
100 microns
How much enamel does prophy paste with pumice remove?
5-50 microns
Post op instructions for micro abrasion?
Teeth are dehydrated - avoid any food/ drinks which will stain teeth for up to a week (at least 24 hours)
Review in 4-6 weeks and take post op photographs
What are the rules surrounding bleaching and under 18s
Products containing 0.1- 6% hydrogen peroxide cannot be used on any person under 18 years, except where its use is for the purpose of treating/ preventing disease
Eg. Discolouration due to hypomineralisation, trauma, fluorosis
What are the bleaching options?
Vital bleaching (external) - chairside, night guard at home
Non vital - inside outside technique, walking bleach technique
How long does at home external bleaching take?
3-6 weeks
What are the side effects of external bleaching?
Sensitivity
Gingival irritation
Why may adolescents experience less sensitivity than adults?
Larger pulp- greater capacity for healing
Better enamel quality
At what age is gingival level completely matured?
17-18 years
What are some advantages of non-vital bleaching
Simple, conservative
Gingival tissues not irritated
No lab assistance
What are the indications for non vital tooth bleaching
Adequate RCT, no clinical or radiological disease
Anterior teeth without large restorations
No amalgam or intrinsic discolouration
Not fluorosis or tetracycline discolouration
What is walking bleaching?
Oxidising process is allowed to proceed gradually over days
What is inside outside method?
10% carbamide peroxide gel sealed in (if cooperation is an issue).
Where should GP be removed to for internal bleaching?
GP should be removed to below CEJ
Technique of internal bleaching?
Remove GP to below CEJ
Clean with ultrasonic
PLace bleaching agent on cotton pledget and cover with dry cotton pledget
Seal with RMGI
Renew bleach no more than 2 weeks between appts
If no change 3-4 weeks, renewals stop
How many bleaching changes can you do for internal bleaching?
6-10 changes
What is the long term success rate of internal bleaching?
Regression 50% at 2-6 years
What is combination inside out bleaching?
Access cavity is left open for duration of bleaching treatment
Custom made mouth guard, apply bleaching agent into access cavity and tray.
Use 10% carbamide peroxide
Wear mouthquard all the time and replace gel every 2 hours
Restoration- place non setting CaOH for 2 weeks and seal with GIC, then white GP and composite restoration or incrementally cure composite (no option for re bleaching but stronger).
What are some complications of internal bleaching?
External cervical resorption
Spilling of bleaching agents
Failure to bleach
Over bleach
Brittleness of tooth crown
How is external cervical resorption prevented?
Place layer of cement over GP - prevents bleaching agent getting to external surface of root (can prevent adequate bleaching of cervical area)
Or
Non setting calcium hydroxide in tooth 2 weeks before final restoration - reverses acidity
What are the effects of bleach on soft tissue?
Short term - minor ulceration, plaque reduction, aids wound healing
Long term - delayed wound healing, periodontal harm, mutagenic potential
What is the use of tooth mouse
Milk derived protein
Use 2 weeks at home after bleaching
Can help poorly demarcated hypomineralised lesions (mild/ moderate fluorosis) - after microabrasion, 4 weeks at home before bed.
What is resin infiltration?
Infiltration of enamel lesions with low viscosity light cured resin.
Surface layer is eroded, lesions are desiccated and a resin infiltrant is applied.
What should be considered when placing veneers?
Aesthetics
Relative tooth position
Masking dark stains?
Age
Psyche
Plaque removal
What is the result in over contouring the tooth?
Increases plaque retention and stagnation at the gingival margin
