Paeds Discolouration

Question 1

Tx options of intrinsic discolouration in permanent anterior teeth

Answer 1

1. Enamel microabrasion
2. Bleaching: Vital- at surgery/home
   Non-vital: inside outside technique/ walking bleach technique
3. Resin infiltration technique (ICON)
4. Localised composite restoration
5. Veneers: composite: direct-free hand/putty guide
   Indirect- lab made

Question 2

Enamel colour modification by controlled hydrochloric acid pumice microabrasion technique

Answer 2

1. PPE
2. Clean teeth with pumice and water
3. Petroleum jelly to gingiva
4. Rubber dam
5. Place sodium bicarbonate guard
6. HCL pumice slurry in slowly rotating rubber cups- maximum 10 x 5 seconds application
7. Wash direct into aspirator after every 5 second application
8. Fluoride varnish application- profluoride not duraphat
9. Polish with finest sandpaper disc
10. Final polish with toothpaste

Question 3

Microabrasion advantages

Answer 3

Easily performed/effective
Conservative/can be used before or after bleaching
Removes yellow-brown, white and multicoloured stains/results are permanent
Fast-acting
Inexpensive

Question 4

Microabrasion disadvantages

Answer 4

Removes enamel/requires protective apparatus for pt, dentist, nurse
HCL acid compounds are caustic
Prediction of tx outcomes difficult
Must be done in dental surgery
Cannot be delegated

Question 5

Microabrasion review

Answer 5

Teeth are dehydrated after procedure
Warn pt to avoid highly coloured food/drink for at least 24 hours
Review 4-6 weeks after procedure and take post op photos

Question 6

Features of chairside vital bleaching

Answer 6

Unstable
Rapidly reacting 15-38% H2O2
Risk to eyes/soft tissues

Question 7

Example of vital bleaching home systems

Answer 7

Nightguard vital bleaching with 10% carbamide peroxide

Question 8

Instruction to pt on using nightguard vital bleaching

Answer 8

Brush teeth thoroughly
Apply little carbamide peroxide gel to tray
Set over teeth and press down
Remove excess/rinse gently, do not swallow
Wear overnight
Remove brush try brush and rinse with cold water

Question 9

Non-vital bleaching advantages

Answer 9

Simple
Tooth conserving
Original tooth morphology
Gingival tissues not irritated by restoration
Adolescent gingival line not a restorative consideration
No laboratory assistance for walking bleach

Question 10

Non-vital bleaching tooth selection

Answer 10

Adequate root filling: no clinical disease/no radiographic disease
Anterior teeth without large restorations
Not amalgam intrinsic discolouration
Not fluorosis or tetracycline discolouration

Question 11

Non-vital bleaching complications

Answer 11

Brittle tooth crown
External cervical resorption
Failure to bleach
Overbleach
Spillage of bleaching agents

Question 12

Walking bleach technique

Answer 12

Record initial shades for records
Rubber dam and access- root filling removed to below gingival margin
Clean pulp chamber with ultrasonic
Apply bleaching agent on cotton wool and place in tooth
Seal with GIC/RMGIC

Appt 2 (less than 2 wks between appt )- renew bleach- stop renewing if shade unchanged after 3-4 bleaches- 6-10 changes total- 50% regression between 2-6 yrs

After shade achieved restore pulp chamber- NSCaOH paste for 2 weeks sealed with GIC to prevent cervical resorption- after 2 weeks white GP and composite resin/ incrementally cured composite