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BDS3 Operative Dentistry > Tooth Whitening > Flashcards

Tooth Whitening Flashcards

1
Q

what are extrinsic causes of tooth discolouration

A

smoking
teas
coffee
red wine
guinness
chromogenic bacteria

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2
Q

what are intrinsic causes of tooth discolouration

A

fluorosis
tetracycline
non-vitality
dental materials

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3
Q

what colour does the teeth go in primary teeth of a patient with porphyria

A

red

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4
Q

who are the group of people who you can still see disoclouration effects caused by tetracyclines

A

teenagers - tetracyclines used as a treatment for acne

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5
Q

what is the first method of treatment for trying to sort discoloured teeth

A

hygiene phase therapy

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6
Q

what are two types of tooth bleaching

A

external vital bleaching
internal vital bleaching

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7
Q

what is discolouration caused by

A

formation of chemically stable, chromogenic products in the tooth substance that are long chain organic molecules

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8
Q

how does bleaching sort discoloured teeth

A

they oxidise the long chain organic molecules which leads to smaller molecules that are not pigmented

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9
Q

what is the bleach used to whiten teeth

A

hydrogen peroxide

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10
Q

what is then oxidising agent of hydrogen peroxide

A

HO2

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11
Q

what other constituents are found in bleaching solutions

A

carbamide peroxide
urea
surfactant
preservative
flavour

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12
Q

what is the active component of external bleaching solutions

A

carbamide peroxide which breaks down into hydrogen peroxide and urea

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13
Q

what does urea do in the external bleaching solutions

A

increases pH so you dont end up with as acidic a solution

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14
Q

what is the function of carbopol in bleaching agents

A

thickening agent so that the solution actually sticks to the teeth

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15
Q

what is the function of potassium nitrate and calcium phosphate in bleaching agents

A

tooth desensitisation

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16
Q

what factors affect the success of bleaching

A

time
cleanliness of tooth surface
concentration of solution
temperature

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17
Q

what aspects of being dentally fit do you need to ensure before undertaking external bleaching

A

no leakage around carious cavity margins

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18
Q

what are warnings you need to give the patient when whitening teeth

A

sensitivity
relapse
restoration colour
allergy
might not work
compliance with regime

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19
Q

what are the two types of external bleaching

A

in office or at home

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20
Q

what are advantages of in office bleaching

A

controlled by dentist
quick results

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21
Q

what are disadvantages of in office bleaching

A

time consuming for dentist
can be uncomfortable
results wear off
expensive

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22
Q

what needs to be used for protection when bleaching teeth

A

rubber dam or gingival mask to protect the gums

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23
Q

what is laser whitening

A

good initial result due to dehydrating the teeth

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24
Q

what concentration of hydrogen peroxide is used to bleach teeth

A

35%

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25
Q

what is the concentration of carbamide peroxide gel that is used in at home bleaching

A

10-15%

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26
Q

what is the maximum strength of solution allowed for at home bleaching

A

6%

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27
Q

what material is used to form the mouthguards for at home bleaching

A

0.5mm thick soft acrylic

28
Q

how far away from the gingival margin should the mouthguard stop

A

1mm

29
Q

how much gel should patients put in their tray at home

A

1mm squared dot on buccal surface of each tooth

30
Q

how long does at home whitening trays need to be in for to work

A

2 hours at least, preferably overnight

31
Q

when can you bleach teeth

A

age related darkening
mild fluorosis
post smoking cessation
tetracyclin staining

32
Q

when does sensitivity resolve from bleaching

A

2-3 days

33
Q

what are predictors of sensitivity

A

previous sensitivity
high concentration of bleaching agent
gingival recession

34
Q

why does tooth whitening wear off over time

A

the oxidised chromogens gradually reduce with time and return to their normal state

35
Q

is there damage to restorations during tooth whitening

A

no - but need to warn patients that the teeth will be bleached but the composite restorations they may have will not

36
Q

why might there be difficulty bonding to teeth that have been whitened

A

residual oxygen from peroxide remains within the enamel structure but gradually dissipates over time

37
Q

what is chlorine dioxide

A

a bleaching agent that we NEVER use as it strips the enamel of the tooth - has a pH of 3 and softens tooth surface

38
Q

what causes tooth to internally discolour

A

the dead pulp bleeds into dentine which diffuse and darken causing grey discolouration

39
Q

what are indications of internal non-vital bleaching

A

non-vital tooth
adequate RCT
no apical pathology

40
Q

what are contraindications of internal non-vital bleaching

A

heavily restored tooth
staining due to amalgam

41
Q

what are advantages of internal non-vital bleaching

A

easy
conservative
patient satisfaction

42
Q

what are risks of internal non-vital bleaching

A

external cervical resorption due to diffusion of hydrogen peroxide through dentine into periodontal tissues - normally a potential risk in trauma

43
Q

how do you carry out internal non-vital bleaching

A

remove access cavity and GP from pulp chamber and 1mm below ACJ - place 1mm RMGIC over GP to seal canal and root dentine
remove any dark dentine and etch
place the bleach and then repeat until desired shade
then replace GP with a whiter GP

44
Q

what percentage of phosphoric acid is used to etch internal surface of the tooth

A

37%

45
Q

what is placed in the canal to internally bleach the tooth

A

10% carbamide peroxide gel

46
Q

when should you rebook the patient in to reassess

A

1 week and repeat this for 3 or 4 visists

47
Q

when will you need to retreat internal bleaching

A

4-5 years

48
Q

what is combination bleaching

A

using external and internal bleaching at the one time

49
Q

what are micro-abrasions

A

removes discolouration limited to outer layers of enamel

50
Q

when would you use microabrasions

A

fluorosis
post ortho demineralisation
demineralisation with staining

51
Q

what percentage of HCl is used in microabrasion

A

18%

52
Q

what is the treatment for microabrasion

A

clean teeth and apply rubber dam
mix 18% HCl with pumice
apply to teeth and gently rub for 5 seconds per tooth
wash and repeat up to 10 times

53
Q

what do you polish teeth with post HCL and pumice

A

fluoride prophy paste

54
Q

what is applied to teeth after micro abrasion treatment

A

fluoride gel or varnish

55
Q

advantages of micro abrasion

A

quick
easy
no long term problems

56
Q

disadvantages of micro abrasion

A

acid
sensitivity
only works for superficial staining

57
Q

what might you use instead of HCl in practice

A

37% phosphoric acid

58
Q

what is resin infiltration

A

you dont try to remove the surface layer - this is particularly used for white discolouration

59
Q

what is the treatment used for white spot lesions

A

resin infiltration

60
Q

what must happen prior to prescribing whitening solution

A

appropriate clinical examination to ensure patients teeth is free of dental pathology

61
Q

what percentage of hydrogen peroxide is it illegal to use for cosmetic purpose

A

anything over 6%

62
Q

when can products containing any more than 0.1% hydrogen peroxide not be used

A

under 18 years of age

63
Q

what are some consumer products that contain 0.1% hydrogen peroxide

A

mouthrinse

64
Q

what is the only way patients should be able to buy 6% hydrogen peroxide

A

from a dental practitioner - they should not be able to buy it directly

65
Q

what aspect of treatment should be supervised

A

the first cycle of treatment must be supervised

66
Q

who would you be prosecuted by if you were found to be using solutions containing more than 6% hydrogen peroxide

A

trading standards

BDS3 Operative Dentistry (6 decks)

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