teeth whitening Flashcards
for at home bleaching , what are the timings for
- first expect to see results
- first review appointment
- maximum effect
- if no results will be no results
first results within 2-3 days
first review appt - 1 week
max effect 3-4 weeks
if no results in 2 weeks no results will come
in what circumstances would external vital bleaching be of value
- age related darkening/ discolouration
orange/yellow discolouration bleaches better than blue/grey
(14 y/o with no staining wont see much results) - mild fluorosis
- post smoking cessation (waste of time bleaching current smokers)
- tetracyclin staining (possible but will take months)
discuss sensitivity as a problem of external vital bleaching including predictors
affects around 60% of patients
worse initially and usually stops 2-3 days post bleaching
Predictors: pre-existing sensitivity , high concentration bleaching agent (no a UK issue), gingival recession , in office bleaching
why does relapse occur post bleaching and when would retreatment be necessary
oxidised chromogens gradually reduce over time
retreatment after 1-3 years
how long should restorative procedures be delayed after bleaching and why
ideally 1 week but at least 24 hours
residual oxygen from peroxide can remain in enamel causing issues with bonding
why should chlorine dioxide not be used for tooth whitening
ph3 - acidity strips enamel and softens tooth surface
teeth become more prone to restaining , develop a rough surface and become extremely sensitive
what are the indications and contraindications for internal non vital bleaching
indications: non vital tooth with an adequate RCT that is experiencing discolouration due to darkened blood products in the dentine. no apical path
contraindications: heavily restored tooth, amalgam staining
what are the pros and cons to internal non vital bleaching
pros: easy, conservative, patient satisfaction
cons: might not work, small risk of cervical root resorption if H2O2 diffuses through dentine into perio tissues - more likely if previous trauma, high heat or high concentration use
discuss micrabrasion as a tooth whitening technique
removes discolouration limited to outer layers of enamel by utilising a combination of erosion (acid) and abrasion (pumice)
what would be some indications for microabrasion
fluorosis
post orthodontic demineralisation
demineralisation with staining
what acid is microabrasion done with
ideally HCL acid but unlikely to have this in general practice
instead, 37% phosphoric acid can be used - might require more repetition and will take longer
discuss resin infiltration as a tooth whitening technique
aimed at white stains
dont remove the surface layer instead they aim to infiltrate the white area with resin making changes in the refractive index. This makes it appear more like the surrounding enamel
Long term results have yet to be established - relatively new technique
In the UK , is tooth whitening considered a medical or cosmetic procedure
cosmetic
what is the rules surrounding bleaching concentrations and under 18s
products containing/ releasing between 0.1-6% hydrogen peroxide cannot be used on under 18s unless the purpose is for preventing disease
(over 6% is illegal for anyone of any age)
what strength of tooth whitening products can the public buy in the UK
0.1% - available as toothpastes, bleaching products , mouthrinses etc
