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BDS 3 - CDS - Operative Dentistry > Teeth Whitening > Flashcards

Teeth Whitening Flashcards

1
Q

what are the extrinsic (external) causes of tooth discoloration?

A
  • smoking
  • drink/food with stain agents
  • chromogenic bacteria
  • chlorhexidine
  • iron supplements
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2
Q

what are the intrinsic (internal) causes of tooth discoloration?

A
  • fluorosis
  • tetracycline
  • physiological (getting older)
  • dental materials (amalgam)
  • Diseases
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3
Q

what are the 2 types of tooth bleaching?

A
  • external vital bleaching
  • internal non-vital bleaching
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4
Q

what is external vital tooth bleaching?

A

your standard tooth whitening, custom tray filled with bleaching solution and it bleaches the external surfaces of vital teeth

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5
Q

what is internal non-vital bleaching

A

bleaching agent placed INSIDE tooth to lighten tooth. Usually access made to inside of a non-vital tooth and solution penetrates from the inside out which breaks down pigments causing the discoloration

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6
Q

what is the active agent for external vital bleaching?

A

Hydrogen peroxide H2O2

(acidic solution formed in water, fast reacting oxidising agent)

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7
Q

what are some of the main constituents of bleaching gel?

A
  • carbamide peroxide (active ingredient - broken down, produces H2O2)
  • Carbopol
  • Urea
  • Surfactant
  • Preservative & Flavour
  • Potassium Nitrate
  • Calcium Phosphate
  • Fluoride
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8
Q

what are factors that affect bleachings effectiveness?

A
  • Time (more time -> more effect)
  • Cleanliness of tooth surface (cleaner = better)
  • Concentration of solution (higher = more & quicker effect)
  • Temperature (higher -> quicker effect)
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9
Q

what are warnings of risks for a patient who wants external vital bleaching?

A
  • sensitivity
  • relapse
  • restoration colour
  • allergy
  • might not work
  • compliance dependent
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10
Q

what are the advantages & disadvantages of tooth bleaching at a dental practice?

A

+VE:
- controlled by dentist
- can use heat/light
- quick results for patient

-VE:
- Time for dentist
- can be uncomfortable
- results tend to wear off quicker
- expensive

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11
Q

what is the technique used for teeth whitening at the dentist?

A
  1. thorough cleaning of teeth
  2. ideally rubber dam isolation protecting gingiva
  3. apply bleaching gel to tooth/teeth
  4. apply heat/light
  5. wash/dry/repeat
  6. Takes 30-60mins
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12
Q

what is one of the most important considerations to take when bleaching a patient at your practice?

A
  • protection of gingiva

very easy to cause burns & soft tissue damage

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13
Q

What is home vital bleaching?

A
  • most common technique
  • 10-15% [6% H2O2] Carbamide Peroxide Gel
  • patient uses solution at home in custom tray
  • bleaches slowly -> several weeks
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14
Q

what are the requirements of a bleaching tray for a patient?

A
  • 0.5mm soft splint made,
  • SHOULD STOP 1MM SHORT OF GINGIVAL MARGIN
  • Buccal spacer to allow for placement of gel
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15
Q

how do you bleach your teeth at home?

A

brush & floss teeth

  • load tray (1mm^2 dot buccally on each tooth)
  • fit tray in mouth (minimum 2hrs, ideally overnight)
  • Review after 1 week [results start within 2-3 days, if no change 2 weeks in, wont work]
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16
Q

when should a patient bleach their teeth?

A
  • age related darkening/discoloration (yellow/orange discoloration responds better)
  • mind fluorosis (white spots)
  • post smoking cessation (bleaching active smokers = waste of time)
17
Q

what should you tell a patient about tooth sensitivity when they are getting bleaching?

A
  • common 60%+ people experience it
  • worse initially
  • resolves over 2-3 days post bleaching
18
Q

what is the contraindication of a patient who has composite restorations and wants bleaching?

A
  • teeth bleach, shade of composite won’t change.
19
Q

when would you need to use internal non-vital bleaching?

A
  • dead pulp -> bleeding into dentine
  • blood products diffuse & darken
  • grey discoloration
20
Q

what are the contraindications of internal non-vital bleaching?

A
  • heavily restored teeth (better getting crowns/veneers)
  • staining due to amalgam
21
Q

what are the advantages & disadvantages of internal non-vital bleaching?

A

+VE:
- easy
- conservative
- patient satisfaction

-VE:
- external cervical resorption (due to diffusion of H2O2 through dentine into periodontal tissues)

22
Q

what is the technique for internal non-vital bleaching?

A
  • record shade -> prophylaxis
  • rubber dam -> remove filling from access cavity
  • remove GP from pulp chamber & 1mm below ACJ
  • Place 1mm RMGIC over GP to seal canal (seals dentine & prevents root resorption)
  • etch internal surface of tooth
  • place carbadide peroxide gel in cavity
  • cotton wool over this & seal with GIC
  • repeat procedure at weekly intervals (usually 3-4 visits)
23
Q

what is micro-abrasion?

A
  • removes discoloration limited to OUTER LAYERS of enamel
24
Q

when is micro-abrasion usually used?

A
  • fluorosis
  • post orthodontic demineralisation
  • demineralisation with staining
25
Q

what is the technique for micro-abrasion?

A
  • clean teeth thoroughly
  • rubber dam
  • mix 18& HCl & pumice
  • apply to teeth
  • gently rub with prophy cup 5 seconds/tooth
  • wash
  • repeat up to 10x
  • polish teeth & apply fluoride gel or varnish after. Review and repeat if needed
26
Q

what are the advantages & disadvantages of micro-abrasion?

A

+VE:
- quick
- easy
- no long term problems

-VE:
- acid
- sensitivity
- only works superficial staining
- much better for brown staining than white marks

27
Q

what are the medico-legal issues surrounding hydrogen peroxide?

A
  • products containing/releasing between 0.1-5% H2O2 cant be used U18 UNLESS intended WHOLLY for purpose of preventing disease
  • 0.1% H2O2 is the MAX conc to be sold in shops
  • Dentists can only use a maximum of 6% H2O2, anything more is prohibited UNLESS for fully preventing disease [criminal offence - GDC]

BDS 3 - CDS - Operative Dentistry (7 decks)

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