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BDS3 CLINICAL Optech > Tooth Whitening > Flashcards

Tooth Whitening Flashcards

1
Q

What are the extrinsic causes of tooth discoloration

A 
smoking
tannins
chromogenic bacteria
chlorhexidine 
iron supplements
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2
Q

What are the tannins

A

tea
coffee
red wine
guinness

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3
Q

What are the intrinsic

A 
fluorosis 
tetracycline
non vitality blood products
physiological
dental materials
porphyria
cystic fibrosis
thalassemia, sickle cell anaemia 
hyperbilirubinaemia
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4
Q

What are red primary teeth indicative of

A

porphyria

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5
Q

What are grey teeth indicative or

A

CF

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6
Q

What are blue green or brown teeth indicative of

A

thalassemia / sickle cell

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7
Q

What are green teeth indicative of

A

hyperbilirubinaemia

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8
Q

What should always be the first method of tooth whitening for extrinsic

A

hygiene phase therapy

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9
Q

What are the two types of tooth bleaching

A

external vital bleaching
internal non vital bleaching

can be used together in non vital teeth

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10
Q

What is the extrinsic discoloration due to

A

caused by formation of chemically stable, chromogenic products within the tooth substance

long chain organic molecules

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11
Q

What does vital external bleaching do

A

oxidizes the compounds
oxidation leads to smaller molecules which are often not pigmented
oxidation can cause ionic exchange in metallic molecules leading to lighter color

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12
Q

What is the active agent in vital external bleaching

A

hydrogen peroxide

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13
Q

How does hydrogen peroxide work

A

an acidic solution in water
breaks down to form water and oxygen
free radical per hydroxyl (HO2) is formed
this is the active oxidizing agent

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14
Q

What are the constituents of bleaching gel

A 
carbamide peroxide
carbopol
urea
surfactant
pigment dispersers
preservative
flavour
potassium nitrate
calcium phosphate
fluoride
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15
Q

What is carbamide peroxide

A

active ingredient
breaks down to produce hydrogen peroxide and urea
urea increases pH

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16
Q

What is carpool

A

thickening agent
slows the release of oxygen, increasing the viscosity of the gel and stays where you put it
it slows diffusion into enamel

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17
Q

What is the function of urea

A

raises pH

stabilises hydrogen peroxide

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18
Q

What is the function of surfactant

A

allows the gel to wet the tooth surface

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19
Q

What is the function of potassium nitrate and calcium phosphate

A

tooth desensitizing agents

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20
Q

What is the function of fluoride

A

prevents erosion

desensitizing effect

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21
Q

What are factors that effect bleaching

A

time
cleanliness of tooth surface
concentration of solution
temperature

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22
Q

What is the effect of time

A

more time = more effect

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23
Q

What is the effect of cleanliness of the tooth surface

A

cleaner –> better

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24
Q

What is the effect of concentration of solution

A

higher conc, more and quicker effect

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25
Q

What is the effect of temperature

A

higher –> quicker effect

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26
Q

What should you check before u start bleaching

A

that px is dentally fit
any leakage around carious cavity margins –> plural damage

take initial shade check and record in notes

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27
Q

What are warning for px on external vital bleaching

A 
sensitivity 
relapse
restoration color
allergy
might not work 
compliance with regime
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28
Q

What are the two types of vital external bleaching

A

chair side/in office

home

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29
Q

What are advantages of in office bleaching

A

controlled by px
can use heat or light
quick results

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30
Q

What are disdavtanges of in office bleaching

A

time for dentist
can be uncomfortable
results tend to wear off quicker

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31
Q

What is the technique for in office bleaching

A 
clean teeth
rubber dam/gingival mask
apply bleaching gel to tooth
apply heat / light
wash/dry/repeat
take 30 mins to an hour
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32
Q

When is heat / light / laser used

A

with in office bleaching
no evidence of better bleaching with these additional procedures
light and laser are really just heart sources

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33
Q

What are the good initial results with laser due to

A

dehydration

wears off quick

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34
Q

What does home vital bleaching use

A

10-15% carbide peroxide gel (16.7% is = 6%)

35
Q

What are advantages of at home bleaching

A

custom made tray
bleaches slowly over several weeks
easy for dentist and px

36
Q

What is the technique for the custom trays for at home bleaching

A

alginate impression
0.5mm thick soft acrylic vacuum formed soft splint made
should stop short of GM at 1mm
buccal spacer to allow for placement of gel

37
Q

What is in surgery part of the technique for at home bleaching

A

full mouth cleansing and polishing of teeth in surgery
fit trays and check extension and comfort
instruction in use

38
Q

What is the at home part of the technique for at home bleaching

A

brush and floss teeth
load tray with 1mm dot ducally on each tooth
fit tray in mouth
wear for at least 2 hrs, preferably overnight

39
Q

What are the results for at home bleaching

A

usually see results within first 2-3 days
normally reached max by 3-4 weeks
if no change in 2 weeks then not going to work

40
Q

When can we bleach

A

age related darkening and discoloration
mild fluorosis
post smoking cessation
tetra cyclin staining ?

41
Q

What teeth with age related darkening respond better to tx

A

those with yellow / orange discoloration respond better than those with bluish/grey discoloration

42
Q

What color of teeth with tetra cyclin staining respond better

A

prolonged tx
better with yellow and brown than grey
can take months

43
Q

What are bleaching problems

A 
sensitivity
wears off 
cytotoxicity 
mutagenicity
gingival irritation 
tooth damage
damage to restorations
problems with bonding to tooth
44
Q

When is sensitivity worse

A

initially

resolves over 2-3 days post bleaching

45
Q

What are predictors of sensitivity

A 
pre existing sensitivity 
high conc of bleaching agent
frequency change
bleaching method
gingival recession
46
Q

Why does the effect wear off

A

oxidises chromogens gradually reduce with time

retreat in 1-3 yrs

47
Q

What is the risk of cytotoxicity / mutageneicity

A

no evidence for 10% CP

high conc of HP can cause issues

48
Q

What is the risk of gingival irrational

A

related to conc

must check tray extension is correct and it is to overextended

49
Q

What are issues with restorations and bleaching

A

composite doesn’t bleach
px must be aware before
if u change restorations to match the bleached teeth, continued bleaching is required

50
Q

What are issues with bonding

A

residual oxygen from the peroxide remains within the enamel structure initially

gradually dissipates over a short time

delay restorative procedures for at least 24h post bleaching

better to delay for a week

51
Q

When should chlorine dioxide be used

A

never

52
Q

What is the issue with chlorine dioxide

A

it has a pH of around 3 and will soften the tooth surface

as a result of chlorine dioxide use, the teeth are more prone to re-staining develop a rough surface and become extremely sensitive

53
Q

What are causes of internal staining in non vital teeth

A

dead pulp bleeds into dentine and the blood products diffuse and darken leading to grey discoloration

54
Q

What are indications for internal non vital bleaching

A

non vital tooth
adequate RCT
no apical path

55
Q

What are contraindications of internal non vital bleaching

A

heavily restored teeth
better with crown or veneer
staining due to amalgam

56
Q

What is limitations of internal non vital bleaching

A

doesn’t always work

worth a go

57
Q

What are advantages of internal non vital bleaching

A

easy
conservative
px satisfaction

58
Q

What are risks of internal non vital bleaching

A

easy
cosnervative
px satisfaction

59
Q

What are risks of internal non vital bleaching

A

external cervical resorption

60
Q

What is external cervical resorption due to

A

diffusion of hydrogen peroxide through dentine into periapical tissues
high conc of hydrogen peroxide and heat
trauma is important

61
Q

What is the technique for internal non vital bleaching

A 
record shade
prophylaxis
rubber dam
remove filling from access cavity
remove GP from pulp chamber and 1mm below ACJ
place 1mm RMGIC over GP to seal canal 
remove any v dark dentine
etch internal surface of tooth 
place 10% carbide peroxide in cavity
cotton wool over this
seal with GIC
repeat procedure at weekly intervals
62
Q

What is the function of the 1mm RMGIC over GP to seal the canal

A

seals dentine and prevent root resorption

63
Q

When do we repeat the internal non vital bleaching until

A

required shade achieved
no change
can take 3-4 visits
if no change after 4 visits won’t work and consider crown

64
Q

Once the final shade is obtained in the non vital bleaching what is done

A 
restore 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?
65
Q

What is combination bleaching

A

inside outside bleaching

66
Q

What is technique for combination bleaching

A

remove gp as before and cover with RMGIC
make bleaching tray (palatal not buccal reservoir)
bleach placed in access cavity and in tray
replaced frequently over about a week
tricky for px, must wear tray whole time

67
Q

What is micro-abrasion

A

removes discoloration limited to outer layers of enamel

combination of erosion (acid) and abrasion (pumice

68
Q

What are the indications of micro abrasion

A

fluorosis
post ortho demineralisation
demineralization with staining
prior to veneering if dark staining is present

69
Q

What is the technique for micro abrasion

A 
clean teeth thoroughly
rubber dam (seal is v important) 
mix 18% HCL and pumice
apply to teeth
gently rub with prophylaxis cup 5 seconds/tooth
wash
repeat up to 10 x
remove dam
polish teeth with fluoride prophylaxis paste
apply fluoride gel or varnish 
review after one month
70
Q

Why is fluoride gel applied after micro abrasion

A

help re harden surface and decrease sensitive

71
Q

What can be happen if micro abrasion is repeated too much

A

too much can lead to yellowing of tooth as dentine begins to show through
too much will lead to permanent sensitivy

72
Q

What are advantages of micro abrasion

A

quick
easy
no longer term problems as long as u stick to outside

73
Q

What are disadvantages of micro abrasion

A

acid
sensitivty
only works for superifical staining
works much better for brown staining than white marks

74
Q

Why is HCL used over phosphoric in micro abrasion

A

HCL removes 100 microns, PA removes 10

75
Q

What is resin filtration

A

don’t remove surface layer
infiltrate the white area with resin
changes the refractive index of the white area
masks it and makes it look like the surrounding enamel

76
Q

How was resin infiltration used for treatment of white spot lesion

A

hydrophilic resin impregnation of the porous enamel surface in the white area

77
Q

What are the adv and disadvantages of resin information

A

appears to demonstrate immediate masking effect

durability of aesthetic results requires longer term study
due to potential staining a
aging of low viscosity resins used

78
Q

Why is an appropriate clinical exam carried out before whitening

A

free of dental pathology

medical contra indications

79
Q

What are the medical contraindications

A

glucose-6-phosphate dehydrogenase deficiency
acatalesmia
neither group can metabolism hydrogen peroxide

80
Q

What are the laws with tooth whitening

A

cannot contain more than 6% hydrogen peroxide

cannot use under age of 18 unless for prevention disease

81
Q

What is % of hydrogen peroxide allowed on market

A

0.1%

82
Q

How should the whitening products >00.1% be used

A

exposure to these products should be limited to ensure products are only used in terms of frequency and duration of applications

the products should not be directly available to the consumer, only through a dentist, hygienist, therapist, or clinical dental technician

83
Q

What are the guidelines that must eb followed

A

whitening products must be sold by dentist

first cycle of tx must be supervised

after then can be used at home

cannot exceed 6% unless for prevention disease

BDS3 CLINICAL Optech (4 decks)

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