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operative dentistry > Tooth whitening > Flashcards

Tooth whitening Flashcards

1
Q

Causes of discoloration

A

Caused by formation of chem. stable chromogenic products in tooth substance

Extrinsic
-Smoking
-Tannins
-Tea
-Coffee
-Red Wine
-Guinness
-Chromogenic Bacteria
-Chlorhexidine
-Iron supplements

Intrinsic
-Fluorosis
-Tetracycline
-Non-vitality (blood products)
-Physiological (age changes)
-Dental Materials
-Amalgam
-Root filling materials
-Porphyria (red primary teeth)
-Cystic Fibrosis (grey teeth)
-Thalassemia, Sickle Cell anaemia (blue, green or brown teeth)
-Hyperbilirubinaemia (green teeth)

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2
Q

What should first method of tooth whitening for extrinsic staining be

A

PMPr and polish

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3
Q

What are the types of bleaching

A

External Vital Bleaching
Internal Non-vital bleaching

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4
Q

Talk about external vital bleaching

A

Oxidisies componds in stain leading to smaller molecules not pigmented

Oxidation can cause ionic exchange in metallic molecules leading to lighter colour

Hydrogen peroxide is the active agent
-Forms an acidic solution in water
Breaks down to form water and oxygen
-Free radical per hydroxyl (HO2)is formed. This is the active oxidising agent

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5
Q

What are the consituents of Vital External Bleaching

A

Carbamide peroxide
Carbopol (thickening agent)
Urea (Raises pH
Stabilises Hydrogen Peroxide)
Surfactant (Allows the gel to wet the tooth surface)
Pigment dispersers
Preservative
Flavour
Potassium Nitrate
Calcium Phosphate
Fluoride

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6
Q

What factors affect external vital bleaching

A

time

cleanliness of tooth

conc. of solution

Temp. higher=quicker

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7
Q

What should you make sure with bleaching and what warnings do you give

A

check patient is dentally fit

Warnings for patient:
Sensitivity
Relapse
Restoration colour
Allergy
Might not work
Compliance with regime

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8
Q

What are the 2 types of vital external bleaching

A

Chair-side/In-office
Home

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9
Q

Adv and DisAdv of chair side

A

Adv:

your in cahrge
Can use heat/light
Quick results

Disadvantages:

Time for dentist
Can be uncomfortable
Results tend to wear off quicker
Expensive

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10
Q

Whats the chair side technique

A

Thorough cleaning of teeth
Ideally rubber dam
At least gingival mask
Apply bleaching gel to tooth
Apply heat/light
Wash/dry/repeat

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11
Q

Whats vital

A

Gingival mask for protection of the gingivae

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12
Q

What is home external vital bleaching

A

Much the commonest technique
10%-15% Carbamide Peroxide Gel

Patient uses solution at home

Custom made tray

Bleaches slowly, over several weeks

Easy for dentist and patient

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13
Q

Whats the at home technique

A

In Surgery
-Full mouth cleaning/polishing of teeth in surgery
-Fit trays and check extension/comfort
-Instruction in use

At Home
-Brush and floss teeth
-Load tray 1mm2 dot buccally on each tooth
-Fit tray in mouth, Requires to be in place for at least 2 hrs
Preferably overnight

Review at 1 week:
Most patient see a result within 2 – 3 days
Normally reached maximum by 3 – 4 weeks

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14
Q

When to do bleach (External)

A

Age related darkening/discolouration(yellow/orange discolouration respond better)

Mild fluorosis

Post smoking cessation

Tetracyclin staining

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15
Q

What are common bleaching problems

A

Sensitivity (Resolves over 2-3 days post bleaching)
Wears off
Cytotoxicity/Mutagenicity
Gingival irritation
Tooth damage
Damage to restorations
Problems with bonding to tooth

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16
Q

Do you use chlorine dioxide

A

NEVER

17
Q

What are the indications of internal bleaching

A

Indications
Non-vital tooth
Adequate RCT
No apical path

18
Q

What are the contraindications of internal bleaching

A

Heavily restored tooth
Better with crown or veneer
Staining due to amalgam

Limitations
Doesn’t always work but generally worth a go

19
Q

at are Adv and risks of internal bleaching

A

Advantages
-Easy
-Conservative
-Patient satisfaction

Risks
-External Cervical resorption

20
Q

Whats the internal whitening tech.

A

-Record shade
-Prophylaxis
-Rubber dam
-Remove filling from access cavity
-Remove GP from pulp chamber and 1mm below amelo-cemental junction
-Place 1mm RMGIC over GP to seal canal,Seals dentine and prevents root resorption
-Remove any very dark dentine
-Etch the internal surface of the tooth with 37% phosphoric acid
-Place 10% carbamide peroxide gel in cavity
-Cotton wool over this
-Seal with GIC
-Repeat procedure at weekly interval
-Repeat until,Required shade achieved,No change

Normally takes 3 – 4 visits

-Once final shade obtained restore the palatal cavity
-Place white GP or similar in pulp chamber
-Restore with light shade of composite
-Will gradually darken again
Retreatment every 4 – 5 years

21
Q

What is microabrasion and its indications

A

Removes discolouration limited to the outer layers of enamel
Combination of erosion (acid) and abrasion (pumice)

Fluorosis
Post orthodontic demineralisation
Demineralisation with staining
Prior to veneering if dark staining is prese

22
Q

Tech. of abrasion

A

-Clean teeth thoroughly
-Rubber dam (seal is very important)
-Mix 18% HCl and pumice
-Apply to teeth
-Gently rub with prophy cup 5 seconds/tooth
-Wash
-Repeat up to 10X
-Remove rubber dam
-Polish teeth with fluoride prophy paste
-Apply fluoride gel or varnish, fluoride to help reharden the surface and decrease sensitivity
-Review after one month

23
Q

AD and DisAdv of microabrasion

A

Advantages
Quick
Easy
No long term problems
Pulpal damage
caries

Disadvantages
Acid
Sensitivity
Only works for superficial staining
Works much better for brown staining than white marks

24
Q

What is whitening classed as and why

A

Cosmetic

The Cosmetic Products (Safety Amendment) Regulations 2012 (implementing Directive 2011/84 EU which amends directive 76/768/EEC) came into force in October 2012

25
Q

What are the contradictions to whitening

A

Very rare

Glucose-6-Phosphate dehydrogenase deficiency

Acatalasemia

26
Q

What are the medico legal issues

A

it is illegal for tooth whitening products which contain more than 6% hydrogen peroxide

Products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for the purpose of preventing disease

tooth whitening products containing or releasing between 0.1%-6% hydrogen peroxide should not be made directly available to the consumer, other than through treatment by a registered dentist

Whitening products can only be sold by dental practitioners
The first cycle of treatment must be supervised

operative dentistry (5 decks)

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