Teeth Whitening

Question 1

Extrinsic-

Answer 1

Stains on the external surface of teeth

Question 2

Extrinsic
▶ due to (4)
▶ Usually, can be removed with —

Answer 2

Poor oral hygiene, eating habits, chromogenic microorganisms, tobacco

prophylaxis

Question 3

Intrinsic-

Answer 3

Deeper internal stains or enamel defects

Question 4

Intrinsic-
▶ due to (4)
▶ More complex to treat and usually requires — to treat

Answer 4

Advancing age, metabolic drug staining, trauma, endodontic therapy
(tooth dehydration, effects of restorative materials)

dental professional

Question 5

Tetracycline Staining
(3)

Answer 5

▶ Most commonly long-term use of minocycline
▶ Dark blue-gray stains more difficult to treat than mild
yellow-orange discolorations
▶ Can require up to 6 months of consistent use of vital
bleaching products

Question 6

A — to ensure dental health must precede a bleaching
treatment

Answer 6

diagnosis

Question 7

Treat caries in the non-esthetic zone prior to whitening and
address failed restorations and/or areas of caries in the esthetic
zone with —

Answer 7

temporary restorations

Question 8

It’s possible to place esthetic restorations prior to whitening in
a lighter shade, but the patient need to be aware these may
need to be

Answer 8

replaced following whitening if the color match is
unacceptable

Question 9

— in the esthetic zone will most likely need
to be replaced, and patient needs to be informed.

Answer 9

Existing restorations

Question 10

Exposed root surfaces may experience —, and if large
areas are exposed, or if restorations are inadequate, patients
may develop

Answer 10

sensitivity
mild to moderately severe pain

Question 11

Remove (2). If tissue is traumatized,
wait — before beginning bleaching treatment
to minimize possible gingival sensitivity.

Answer 11

calculus and extrinsic stains

one to two weeks

Question 12

Whitening does not alter shade of restorations; wait — following the bleaching procedure before matching and
placing resin-bonded restorations. Color stabilization requires
time and — may interfere with bond
strengths. This is important before placing definitive tooth-
colored restorations

Answer 12

two weeks
residue peroxide ions

Question 13

Teeth with large amalgam restorations may appear darker
than other bleached teeth because the —
becomes more visible through the bleached enamel. The
patient should be made aware that this may require a more
— following bleaching.

Answer 13

internal restoration

extensive esthetic restoration

Question 14

▶ Enamel:

Answer 14

A semi-translucent, prismatic, primarily inorganic

Question 15

▶ Dentin:

Answer 15

A yellow opaque, tubular, primarily organic

Question 16

Tooth Whitening Mechanism

Answer 16

▶ Enamel:
▶ Dentin:
▶ Hydrogen peroxide migrates through the enamel and breaks
down organic pigment molecules in the enamel and dentin
(primarily dentin)
▶ Colgate Optic White:

Question 17

▶ Colgate Optic White:

Answer 17

Electrochemical reaction to increase pH
making the conducting gel more effective, faster, and less
sensitive

Question 18

Colgate in office whitening kit components (5)

Answer 18

tray
cheek retractors
charging stand and plug
brush on pen containing 10% whitening serum
brush pen with alcohol to remove layer

Question 19

Colgate Optic White Professional In-office

Answer 19

 Charge the light at least 4 hrs or overnight prior to treatment.
 Pt must pay in advance in order to get the kit from the dispensary to charge prior to the
appointment. Dispensary personnel can charge it, or the student can charge it.
 Take starting shade and confirm with patient.
 Place cheek retractor and dry teeth with 2 x 2 gauze.
 Click pen several times until you see a drop of serum, then paint a thin coat on each tooth. The
serum does not have to be perfectly even but avoid the gingival tissue. If some gets on the tissue,
wipe away with gauze, cotton roll or swab.
 Allow serum to dry 10-15 secs; teeth will look shiny.
 Remove cheek retractor and place LED device. It will beep once at 5 minutes then twice at 10
minutes and turn off.
 Remove device, place cheek retractor and use Ethanol pen to remove dried serum. Apply to 2-3
teeth at a time, then remove serum with gauze, cotton roll or swab. (Gauze seems to work best)
 Re-apply whitening serum and repeat this process 2 more times for a total of 3 cycles.
 Take final shade and compare to starting shade.
 Patient takes home kit, but not the whitening serum-it is too strong for home use. Refill pens are
available for purchase and used with the LED device.

Question 20

Colgate Optic White At-home kit
6% Hydrogen Peroxide serum

Answer 20

 Available for purchase; patient pays for the kit and student picks it up
at the dispensary.
 Similar pen with whitening serum that is a lower concentration for
home use.
 Patient dries teeth with tissue or gauze.
 Paint serum on upper and lower teeth.
 Insert LED device for 10 minutes.
 Leave dry serum on teeth overnight.
 Brush off dry serum in the morning.

Question 21

Dentist Supervised Nightguard Vital Bleaching
▶ Active Ingredient is (2)
▶ Patients notice whitening effect after — days with a two-week regimen
▶ Rebound of — shade should be expected
▶ Bonding should be delayed for 2 weeks: residual peroxide ions could interfere with —
▶ For sensitivity, have patients use (2); either as
toothpaste or a gel within the whitening trays

Answer 21

10%-22% Carbamide Peroxide or 3%-6% Hydrogen Peroxide
4-5
½
bond
strength and shade needs to stabilize to final shade
Potassium Nitrate or Stannous Fluoride

Question 22

Hydrogen Peroxide vs Carbamide Peroxide
 Carbamide peroxide contains (2) with
the amount of hydrogen peroxide at a — ratio.
 Therefore, –% carbamide peroxide contains –% hydrogen
peroxide whereas a –% carbamide peroxide would contain –%
hydrogen peroxide

Answer 22

hydrogen peroxide and urea
3:1
30
10
10
3.33

Question 23

Patients are sometimes confused why something –% is the same
strength as something –%- be prepared to explain the
difference.

Answer 23

10
30

Question 24

It is the — that is whitening the teeth

Answer 24

hydrogen peroxide

Question 25

— is the most important component in shade selection because it is the
…

Answer 25

Value
lightness to darkness of a hue

Question 26

A shade guide oriented in this way is helpful in evaluating whitening results
from

Answer 26

pre-treatment to post-treatment shades

Question 27

Shades

Answer 27

B1A1B2D2A2C1C2D4A3D3B3A3.5B4C3A4C4

Question 28

Professional brands for use with custom trays (available only at dental
office):
(3)

Answer 28

▶ Opalescence (Ultradent) 10% and 22 % Carbamide Peroxide
▶ NiteWhite ACP (Discus Dental) 10%, 16% and 22% Carbamide Peroxide
▶ SDI Poladay 3% Hydrogen Peroxide, 6 % Hydrogen Peroxide, PolaNight 10% Carbamide
Peroxide 16% Carbamide Peroxide
▶ And more.

Question 29

Over the counter whitening products:
(4)

Answer 29

▶ Crest Whitestrips
▶ Opalesence Go
▶ Colgate Optic White at home kit
▶ Go Smile
▶ And many, many more!

Question 30

▶ — alone is usually not effective for whitening

Answer 30

Toothpaste

Question 31

Discoloration can be from (3)

Answer 31

bleeding into dentin from trauma, residual pulp
tissue left after RCT, or staining from restorative materials

Question 32

 Do NOT promise anything you can’t deliver.
 Don’t guarantee —.
 Be sure PATIENT EXPECTATIONS are
REASONABLE regarding the proposed
procedure.
 Agree upon the — & the — of visits
to be involved in this TRIAL bleaching
attempt.
 — the starting place with shade
guides and photos. Obtain photos and shade
of the end result

Answer 32

RESULTS
fee, NUMBER
DOCUMENT

Question 33

DOCUMENT the starting place with shade
guides and photos. Obtain photos and shade
of the end result.
(3)

Answer 33

 Pt. will forget how bad it was to start
with.
 Result may not meet their expectations.
 Patients often forget the original
agreement in the heat of expected
payment

Question 34

it is legal and ethical to display
your results in similar situations
in a — manner.

Answer 34

professional

Question 35

Discuss Risk vs Benefit to patient
 Risks:
(3)

Answer 35

 May not achieve full bleaching of the tooth-results not
guaranteed
 Existing composites may need to be replaced
 Chance of leakage of bleaching agents into root canal
causing irritation/pain

Question 36

Benefits:
(2)

Answer 36

 Whiter/matching tooth
 Lower cost than crown or veneer

Question 37

 Explain procedure, number of visits and cost
 Document starting shade with shade guides and photos; this will
help patients to see the

Answer 37

improvement because they may forget
where the tooth started.

Question 38

Internal bleaching technique
The technique is Super Simple:
MOST IMPORTANT:
- Make sure you have a Successful — in place
- Make sure you have a Substantial — over GP
- Make sure access is thoroughly —
- Crush — granules and mix with sterile water or
anesthetic
solution to a stiff paste consistency & place in access.
- Cover with — and substantial temporary restoration
- Schedule patient for — weeks (repeat up to 2 times)

Answer 38

RCT
SEAL
cleaned
Sodium Perborate
cotton
1-2

Question 39

Make Sure:
– All — materials are out of pulpal space
– All — are adequately cleaned
– All defective fillings are (2)
– This alone with a light shade of composite
may help clear up a lot of the discoloration

Answer 39

metallic
pulp horns
cleaned & replaced

Question 40

The “Walking Bleach technique”
Improvement after – applications

Bleach — than desired – there will be some rebound – Finish w/ — composite

Answer 40

2
lighter, lightest

Question 41

Sodium Perborate
(3)

Answer 41

 Recommended for use at UMKC
 Does not cause internal resorption so is safer
 “Walking bleach”

Question 42

Superoxyl- 35% hydrogen peroxide
(3)

Answer 42

 Not used at UMKC due to safety concerns
 Hazardous causing burns to skin, mucosa, and eyes and toxic to
inhalation or ingestion
 Frequently causes resorption, especially when heated

Question 43

Sodium Perborate
is a far —

Answer 43

safer

Question 44

Sodium Perborate
is a far safer
No evidence of —

Answer 44

resorption

Question 45

Vitrebond barrier
(3)

Answer 45

 Critical to place additional seal of Vitrebond over
gutta percha to ensure bleaching agents do not leak
through and destroy the RCT seal
 Lack of a seal could allow bleaching agents to leak
through to the periapical tissues causing PAIN
 This can occur due to percolation of nascent oxygen
from bleaching agents through the gutta percha

Question 46

Fruits
 Fiction:
The approach maintains you can make your
teeth whiter and brighter using household
staples that are naturally acidic (like lemons,
oranges, apple cider vinegar), contain
digestive enzymes (such as pineapple or
mango) and something that is abrasive (like
baking soda).
 Fact:

Answer 46

When eaten as usual, fruit is a great choice.
However, fruit and vinegar contain acid, and
you put your pearly whites at risk when you
prolong their contact with your teeth or use
them to scrub your teeth because acid can
wear away your enamel. Enamel is the thin
outer coating of your teeth that protects you
from tooth sensitivity and cavities

Question 47

Scrubs
 Fiction:
These methods claim that scrubbing your teeth with
ingredients like activated charcoal or a baking soda-
hydrogen peroxide paste will bring a shine back to
your smile.
 Fact:

Answer 47

 There is no evidence that shows dental products with
charcoal are safe or effective for your teeth,
according to the September 2017 issue of the Journal
of the American Dental Association.
 Also, using materials that are too abrasive on your
teeth can actually make them look more yellow.
Enamel is what you’re looking to whiten, but if
you’re using a scrub that is too rough, you can
actually wear it away. When that happens, the next
layer of your tooth can become exposed – a softer,
yellow tissue called dentin.
 Instead, choose a whitening toothpaste with the ADA
Seal of Acceptance. The Seal lets you know the
toothpaste you choose is safe, effective and won’t
damage your teeth

Question 48

Spices
 Fiction:
Swishing oils like coconut oil in
your mouth (oil pulling) or using
spices like turmeric can help
whiten your teeth.
 Fact:

Answer 48

There is no reliable scientific
evidence to show oil pulling or
turmeric whitens teeth. Save the
oil and spices for healthy meals
instead.