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BDS4 CDS Restorative, Pros & Endo > Rest: Treating Discolouration > Flashcards

Rest: Treating Discolouration Flashcards

1
Q

EXTERNAL VITAL BLEACHING

Extrinsic causes for tooth discolouration ?

A

Smoking, tannins (tea, coffee, red wine), chromogenic bacteria, chlorhexidine, iron supplements.

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2
Q

EXTERNAL VITAL BLEACHING

Intrinsic causes for tooth discolouration ?

A

Fluorosis, tetracycline use in first year of life, non-vitality, physiological age changes, dental materials, medical conditions.

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3
Q

EXTERNAL VITAL BLEACHING

Name some medical condition which can cause tooth discolouration ?

A

Porphyria, cystic fibrosis, thalassemia, sickle cell anaemia, hyperbilirubinemia.

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4
Q

EXTERNAL VITAL BLEACHING

The active agent in vital external bleaching is hydrogen peroxide - how does it work ?

A

Forms acidic solution, breaks down into water and oxygen, hydroxyl free radical is formed (oxidising agent) which oxidises long chain organic molecules and breaks them into smaller non-pigmented ones.

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5
Q

EXTERNAL VITAL BLEACHING

What is the active agent in bleach ?

A

Carbamide peroxide - breaks down to produce hydrogen peroxide and urea (urea creates acidic environment and stabilised hydrogen peroxide).

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6
Q

EXTERNAL VITAL BLEACHING

What is the purpose of surfactant ?

A

Wets tooth surface.

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7
Q

EXTERNAL VITAL BLEACHING

What are the desensitising agents in bleach ?

A

Potassium nitrate and calcium phosphate and contains fluoride.

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8
Q

EXTERNAL VITAL BLEACHING

What is the function of carbopol ?

A

Thicknening agent.

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9
Q

EXTERNAL VITAL BLEACHING

What factors affect bleaching ?

A

Time, cleanliness of tooth, concentration, temperature.

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10
Q

EXTERNAL VITAL BLEACHING

What advice should you give to your patient regarding how long their sensitivity will last after treatment ?

A

2-3 days.

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11
Q

EXTERNAL VITAL BLEACHING

What will make a patient likely to experience sensitivity ?

A

Pre-existing sensitivity, gingival recession.

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12
Q

EXTERNAL VITAL BLEACHING

At home bleaching - what % of gel is prescribed to the patient ?

A

10-15% carbamide peroxide gel.

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13
Q

EXTERNAL VITAL BLEACHING

At home bleaching - what is the maximum strength of bleaching gel ?

A

16.7% carbamide peroxide = 6% hydrogen peroxide.

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14
Q

INTERNAL NON-VITAL BLEACHING

What are the indications for internal non-vital bleaching ?

A

Successful RCT, no PA pathology, non-vital tooth.

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15
Q

INTERNAL NON-VITAL BLEACHING

What are the contraindications for internal non-vital bleaching ?

A

Staining due to amalgam.
Heavily restored tooth.

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16
Q

INTERNAL NON-VITAL BLEACHING

What are the risks of internal non-vital bleaching that you should warn the patient of ?

A

External cervical root resorption due to diffusion of H2O2 through dentine/cementum into PD tissues - 1mm GP to be removed from pulp chamber.
Sensitivity.

17
Q

INTERNAL NON-VITAL BLEACHING

Why should 1mm of RMGI be placed over the RCT after 1mm removal prior to internal bleaching ?

A
  • Reduces risk of root resorption.
  • Seals dentinal tubules.
  • Prevents leaching of hydrogen peroxide into PD tissues.
18
Q

INTERNAL NON-VITAL BLEACHING

What % of gel is used for internal non-vital bleaching ?

A

10% carbamide peroxide gel.

19
Q

INTERNAL NON-VITAL BLEACHING

How often should internal bleaching be carried out and at what intervals ?

A

3-4 times at weekly intervals.
Should be repeated every 4-5 years.

20
Q

MICRO-ABRASION

What are the indications for micro-abrasion ?

A

Fluorosis, post-orthodontic demineralisation, demineralisation with staining, prior to veneering if dark staining is present.

21
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What special investigations would you carry out prior to planning treatment for discolouration ?

A

Clinical images, shade, sensibility testing, diagram of defect, radiographs if indicated.

22
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What are the treatment options for treating intrinsic discolouration ?

A

Enamel microabrasion.
Bleaching.
Resin infiltration.
Localised composite restoration.
Veneers - lab or composite.
Nothing.

23
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

Define microabrasion.

A

Removal of surface layer of opaque enamel.

24
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What are the advantages of microabrasion ?

A

Easy, conservative, inexpensive, minimal subsequent maintainance, fast acting, removes all stains, effective, permanent results.

25
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What are the disadvantages of microabrasion ?

A

Removes enamel, sensitivity, more suseptible to staining, requires protective apparatus, difficult to predict outcome, done in dental surgery, cannot be delegated.

26
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What protective equipment should you use for a patient when carrying about acid microabrasion ?

A

PPE - patient and operators.
Soft tissue vaseline.
Sodium bicarbonate guard.
Rubber dam.
Clean teeth with pumice and water.
Sodium bicarbonate available.

27
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

Describe microabrasion technique.

A
  1. Clean and dry teeth.
  2. HCl pumice slurry in rubber cup for 5 seconds with sodium bicarb behind teeth.
  3. 10 x 5 second applications - max.
  4. Wash directly into aspirator.
  5. Review colour.
  6. Fluoride varnish (Profluorid).
  7. Polish with finest sandpaper.
  8. Polish with toothpaste.
28
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What is the maximum applications of microabrasion (HCl pumice) ?

A

10 x 5 second applications.

29
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

Why are teeth polished with finest disc after microabrasion ?

A

SEM shows compacted, relatively prismless layer of surface enamel after microabrasion so this changes optical properies of enamel so that areas of intrinsic discolouration become less perceptible.

30
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

How many microns of enamel surface is lost after microabrasion treatment vs. toothpaste ?

A

100 microns.
5-10 microns with toothpaste.

31
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What % of HCl pumice do proprietary kits used for microabrasion ?

A

Opalustre 6.6%
Prema Kit 10%

32
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What post-op advice should be given following microabrasion ?

A

Avoid highly coloured foods and drinks for at least 24 hours.

33
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

When should a patient be reviewed following microabrasion ?

A

4-6 weeks and take post-op photos.

34
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

How many cycles of HCl pumice microabrasion can you undertake ?

A

2

35
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

How do you prevent external cervical root resorption due to internal bleaching ?

A

GI over GP.
Non-setting CaOH 2 weeks before final restoration - reverses acidity in PDL.

36
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

Describe resin infiltration.

A

Infiltration of enamel lesions with low-viscosity light-cure resins - resin penetrates through capillary forces and corrects discolouration to same refractive index as enamel.

37
Q

PAEDATRICS TREATMENT OF INTRINSIC DISCOLOURATION

What are the two indications for resin infiltration ?

A

Decal and MIH.

BDS4 CDS Restorative, Pros & Endo (13 decks)

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