tooth whitening Flashcards

Question

surfactant in external vital bleaching

Answer 1

allows gel to wet the tooth surface

Answer 2

tooth desensitising agents ## Footnote *sensitivity problem in tooth whitening*

Answer 3

prevents eroision densensitising effect

Answer 4

time cleanliness of tooth surface concentration of solution temperature

Answer 5

more time -\> more effect

Answer 6

cleaner -\> better ## Footnote *nothing in between tooth and bleach*

Answer 7

higher -\> quicker effect

Answer 8

higher concentration -\> more and quicker effect

Answer 9

Before you start always check patient is dentally fit. * Any leakage around carious cavity margins will lead to pulpal damage

Answer 10

**Take an initial shade,** agree it with the patient and record it in their notes. Better still take a photo with a shade guide included in the picture * Prevents future disagreement

Answer 11

* Dehydration of tooth from rubber dam emphasise change* * tooth no longer natural colour* * *Remember to select shade before doing any work*

Answer 12

* Sensitivity * Relapse * Restoration colour * Allergy * Might not work * Compliance with regime

Answer 13

won't last forever worse intially

Answer 14

doesn’t change like organic tooth

Answer 15

chair side/in office home

Answer 16

controlled by dentist can use heat/light - help speed up process quick results for pt

Answer 17

time for dentist - *1hr of dentist not really doing much* can be uncomforatble - *dam, open for long* results tend to wear off quicker - *dehydration of tooth in procedure emphasises change* expensive

Answer 18

* Thorough cleaning of teeth * Ideally rubber dam * At least gingival mask – *light cure guard* * Apply bleaching gel to tooth * Apply heat/light * Wash/dry/repeat * Takes 30mins to an Hour

Answer 19

* Often used with In-office bleaching * Mainly a marketing technique * No evidence of better bleaching with these additional procedures * Light and Laser are really just heat sources * Often a good initial result * Mainly due to dehydration * Wears off quickly

Answer 20

protection of gingiva *esp as everything is very dry* * Historically higher concentrations of bleaching gel were used 35% H₂O₂ * now 6% max * Even with weaker solutions care is necessary

Answer 21

commonest 10%-15% Carbamide Peroxide Gel * **16.7% Carbamide Peroxide equates to 6% hydrogen peroxide which is the maximum strength of solution**. *15% tends to be the highest accessible* * Anything stronger than this is illegal * Patient uses solution at home * Custom made tray * Bleaches slowly, over several weeks * Easy for dentist and patient

Answer 22

6% hydrogen peroxide which is the maximum strength of solution. 15% tends to be the highest accessible (10-15% in home vital bleaching kits)

Answer 23

home vital bleaching

Answer 24

custom made set of mouth guards are required * Alginate impressions of teeth * 0.5mm thick soft, acrylic, vacuum formed soft splint made Should stop short of gingival margin (1mm) * Don’t want bleaching solution to be in contact Buccal spacer to allow for placement of gel

Answer 25

should stop short of gingival margin (1mm) Don’t want bleaching solution to be in contact

Answer 26

0.5mm thick soft, acrylic, vacuum formed soft splint made from alginate impressions

Answer 27

make custom vacuum formed splint surgery app home care

Answer 28

* Full mouth cleaning/polishing of teeth in surgery * Fit trays and check extension/comfort * Instruction in use * Clear written instructions given * Review at 1 week

Answer 29

* Brush and floss teeth * Load tray * 1mm² dot buccally on each tooth – only a small amount * No advantage to having excess, no harm to swallow * Fit tray in mouth * Requires to be in place for at least 2 hrs * Preferably overnight

Answer 30

1mm² dot buccally on each tooth – only a small amount No advantage to having excess, no harm to swallow

Answer 31

Results are variable * Most patient see a result within 2 – 3 days * Normally reached maximum by 3 – 4 weeks If no change in 2 weeks it is not going to work

Answer 32

* age related darkening/discolouration * mild fluorisis *light brown stains* * stopped smoking * tetracyclin staining

Answer 33

*more exposure to extrinsic stains* Teeth with yellow/orange discolouration respond better than those with bluish/grey discolouration

Answer 34

don't bleach active smokers - waste of time only bleach smokers when successfully stopped

Answer 35

*debatable - pt choice ultimately* * Prolonged treatment * Better with yellow and brown than grey * Can take months

Answer 36

* Sensitivity * Wears off * Cytotoxicity/Mutagenicity * Gingival irritation * Tooth damage * Damage to restorations * Problems with bonding to tooth * pt expectations need to be realistic

Answer 37

* Common 60%+ *most* * Worse initially * Resolves over 2-3 days post bleaching *

Answer 38

Few have to stop treatment due to it Can do bleach day, day off, bleach day, day off * Needs regular to work (weeks off doesn’t work)

Answer 39

* Pre-existing sensitivity * High concentration of bleaching agent * Frequency of change – *change solution multiple times quickly* * Bleaching method * Gingival recession

Answer 40

* Oxidised chromogens gradually reduce with time * Retreatment 1-3 years, varies

Answer 41

*carcinogenic risk* * No evidence for 10% Carbamine peroxide * High conc H2O2 can cause problems *not in dental conc*

Answer 42

tend to be uncommon related to conc must check tray extension correct (1mm short of gingival margin)

Answer 43

no evidence and been in use for 15+ years

Answer 44

Probably not Teeth bleach, composite doesn’t. * Patients must be aware of this before treatment starts If you change the restorations to match the bleached teeth continued bleaching will be required or fillings will be too light in colour - *cycle*

Answer 45

Residual oxygen from the peroxide remains within the enamel structure initially Gradually dissipates over a short time * Delay restorative procedures for at least 24hrs post bleaching * Better to delay for a week *Oxygen inhibited layer when bond to composite normally - REVISE*

Answer 46

product used in some beauty salons and cruise liners NEVER USE

Answer 47

Softens and strips enamel from tooth surface * Chlorine dioxide has a pH of around 3 and will soften the tooth surface. As a result of chlorine dioxide use, * teeth are more prone to re-staining, * develop a rough surface and become extremely sensitive.

Answer 48

dead pulp -\> bleeding into dentine * blood products diffuse and darken * grey discolouration

Answer 49

* non-vital tooth * adeqaute RCT * no apical pathology

Answer 50

dead pulp -\> bleeding into dentine * Blood products diffuse and darken * Grey discolouration *Try to oxidise blood products to get back to correct tooth colour*

Answer 51

* Heavily restored tooth * Better with crown or veneer * staining due to amalgam

Answer 52

doen't always work but generally worth a go as non-invasive unsure why

Answer 53

* Easy * Conservative * Patient satisfaction

Answer 54

external cervical resorption - not common due to diffusion of H2O2 through dentine into periodontal tissue tend to be seen more in * high conc H2O2 * trauma *less heat and lower conc used now = lower risk*

Answer 55

* Record shade * Prophylaxis, clean externally * 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 * Prevent leaching of H₂O₂ * Remove any very dark dentine * Etch the internal surface of the tooth with 37% phosphoric acid * Open pores in dentine * Place 10% carbamide peroxide gel in cavity * Cotton wool over this * Seal with GIC Repeat procedure at weekly intervals

Answer 56

* Repeat until * Required shade achieved * No change Normally takes 3 – 4 visits. If no change after 4 visits it is not going to work and consider crown /veneer/ composite build up.

Answer 57

all GP from pulp chamber and 1mm below ACJ

Answer 58

to seal canal seals dentine and prevents root resorption and leaching of H2O2

Answer 59

37% phosphoric acid

Answer 60

open pores in dentine

Answer 61

restore the palatal cavity * Place **white** GP or similar in pulp chamber * Restore with light shade of composite But ensure easy to regain access – as not permanent Will gradually darken again * Retreatment every 4 – 5 years? Variable

Answer 62

Inside-outside bleaching * Remove GP, as before, cover with RMGIC * Make bleaching tray * Palatal not buccal reservoir * Bleach placed in access cavity and in tray * Replaced frequently over about a week (pt in charge) * Tricky for patient, must wear tray whole time – wear 24 hours a day *Bit more complicated than internal non-vital bleaching– can be faff for pt; but good results*

Answer 63

Removes discolouration limited to the outer layers of enamel * Combination of erosion (acid) and abrasion (pumice) * Polishing off outer layers of enamel *like giving pt tooth wear*

Answer 64

* Fluorosis * Post orthodontic demineralisation * Demineralisation with staining * Prior to veneering if dark staining is present superficial staining only *deeper stains in enamel not suited*

Answer 65

* Clean teeth thoroughly * Rubber dam (seal is very important) * *crucial- HCl = damage gingiva* * 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 F gel or varnish * Fluoride to help reharden the surface and decrease sensitivity * Review after one month * Can be hard to tell success as teeth can appear frosty due to acid used Can be repeated *– cannot be used too often as removing enamel*

Answer 66

* Too much can lead to yellowing of the tooth as the dentine begins to show through * Too much will lead to permanent sensitivity

Answer 67

as softened teeth with HCl

Answer 68

18% HCl and pumice * Apply to teeth * Gently rub with prophy cup 5 seconds/tooth

Answer 69

* Quick * Easy * No long-term problems * Pulpal damage * caries

Answer 70

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

Answer 71

37% phosphoric acid rather than HCl * HCl removes 100microns * Phosphoric acid only removes 10microns (10% of HCl) Etch first with phosphoric acid and for longer (30s) prior to using pumice. * Takes longer **Not as effective but this acid is readily available to GDP**

Answer 72

white stains

Answer 73

Don’t remove the surface layer * Infiltrate the white area with resin *(more porous enamel)* * Changes the refractive index of the white area * Masks it and makes it look like the surrounding enamel *Marketed initially as a method of treating early caries by resin infiltration* * *Used for treatment of white spot lesions* * *Hyrdophilic resin impregnation of the porous enamel surface in white area*

Answer 74

Resin infiltration appears to demonstrate an immediate masking effect BUT * The durability of esthetic results requires longer term study * due to potential staining * Aging of the low viscosity resins used * Resin – long term benefits unclear currently* * Can be good as adjunct as non-invasive management*

Answer 75

UK tooth bleaching products are considered a cosmetic as opposed to the USA (and most of the rest of the world) where they are a medical device.

Answer 76

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

Answer 77

pt must be deemed dentally fit An appropriate Clinical Examination is carried out * Free of Dental Pathology – *caries, cavities, perio, apical etc* * Medical contraindications * Very rare * Glucose-6-Phosphate dehydrogenase deficiency * Acatalasemia * Neither group can metabolise hydrogen peroxide

Answer 78

* Glucose-6-Phosphate dehydrogenase deficiency * Acatalasemia

Answer 79

6% for cosmetic purposes

Answer 80

cannot be used on any person under 18 years of age * except where such use is intended wholly for the purpose of preventing disease. * E.g. mental health benefit due to discoloration central incisor

Answer 81

Products containing, **0.1% hydrogen peroxide**, including mouth rinse, toothpaste and tooth whitening or bleaching products

Answer 82

0.1%-6% hydrogen peroxide should not be made directly available to the consumer, other than through treatment by a registered dentist (or dental hygienist or dental therapist or clinical dental technicians working to a dentist’s prescription). * Breach of these regulations is a criminal offence. * This is enforced through trading standards

Answer 83

**Exposure to these products should be limited to ensure that the products are only used in terms of frequency and duration of application** * The products should not be directly available to the consumer * only through a dentist, hygienist, therapist or clinical dental technician Whitening products can only be sold by dental practitioners * The first cycle of treatment must be supervised * After the first cycle the product may be provided for use by the consumer _Concentrations exceeding 6% hydrogen peroxide remain prohibited, unless wholly for the purpose or prevention of disease._ **It is a criminal offence to breach these guidelines**

Answer 84

Dentists supplying bleaching products if in excess of 6% will be prosecuted by Trading Standards. If a dental professional is found to be using a product in excess of 6% for cosmetic purposes, they will face fitness to practice proceedings (after prosecuted by Trading Standards) * Non registrants providing tooth whitening will be prosecuted by the GDC under the Dentists Act 1984 for illegal practice of dentistry