Tooth Whitening Flashcards
What are the extrinsic causes of tooth discolouration?
Smoking
Tannins - tea, coffee, red wine, Guinness
Chromogenic bacteria
Chlorhexidine
Iron supplements
What are the intrinsic causes of tooth whitening?
Fluorosis
Tetracycline
Non-vitality
Physiological (age changes)
Dental materials - amalgam
Porphyria (red primary teeth)
Cystic fibrosis (grey teeth)
Thalassaemia, sickle cell anaemia (blue, green or brown teeth)
Hyperbilirubinaemia (green teeth)
What is the first method of tooth whitening for extrinsic staining?
PMPR
What are the types of tooth bleaching?
Externa vital bleaching
Internal non-vital bleaching
How does vital external bleaching work?
Discolouration is caused by the formation of chromogenic products within the tooth substance
Bleaching oxidises these compounds
Oxidation leads to smaller molecules which are often not pigmented
Oxidation can cause ionic exchange in metallic molecules leading to lighter colour
What is used for vital external bleaching and why is it used?
Hydrogen peroxide (H2O2)
It forms an acidic solution in water, breaking down to form the free radical HO2
What are the constituents of bleaching gel?
Carbamide peroxide
Carbopol
Urea
Surfactant
Potassium nitrate
Calcium phosphate
Fluoride
What factors affect external vital bleaching?
Time
Cleanliness of tooth surface
Concentration of solution
Temperature
What should you do before external vital bleaching?
Check patient is dentally fit - any leakage around cavity margins will lead to pulpal damage
Take an initial shade, agree it with patient and record it in notes - clinical photo with shade guide is even better
What are the patient warnings for external vital bleaching?
Sensitivity
Relapse
Restorations won’t change colour
Allergy
Might not work
Requires compliance
What are the advantages of in office bleaching?
Controlled by dentist
Can use heat/light
Quick results for patient
What are the disadvantages of in office bleaching?
Time consuming
Can be uncomfortable for patient
Results wear off quicker
Expensive
Describe technique for in office bleaching
Thorough cleaning of teeth
Ideally rubber dam used but at least gingival mask
Apply bleaching gel to tooth
Apply heat/light
Wash/dry/repeat
Takes 30 minutes to an hour
How does a light affect teeth whitening?
Mainly a marketing technique
No evidence of better bleaching
Just heat sources
Often a good initial result due to dehydration but wears off quickly
Describe home vital bleaching
Commonest technique
10-15% carbamide peroxide gel
Patient uses solution at home with custom made tray
Bleaches slowly over several weeks
Easy for dentist and patient
Describe the technique for at home vital bleaching
Alginate impression of teeth
0.5mm thick soft, acrylic, vacuum formed soft splint made
Should stop 1mm short of gingival margin
Buccal spacer to allow for placement of gel
What are the possible results of at home vital bleaching?
Most patients see a result within 2-3 days
Normally reached max by 3-4 weeks
If no change in 2 weeks - it’s not going to work