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BDS4 PAEDIATRICS > Treatment of Intrinsic Discolouration in Permanent Anterior Teeth (in children & adolescents) > Flashcards

Treatment of Intrinsic Discolouration in Permanent Anterior Teeth (in children & adolescents) Flashcards

1
Q

What treatment options are available for intrinsic discolouration?

A
  • enamel microabrasion
  • bleaching (vital/non-vital)
  • resin infiltration technique (ICON)
  • localised composite restoration
  • veneers
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2
Q

What pre-op records are required for all discoloured teeth when patients attend GDP?

A
  • standardisation of recording of aesthetic procedures
  • clinical photos
  • shade [defect tooth & normal tooth]
  • sensibility testing (check for sensitivity)
  • diagram of defect
  • radiographs (if clinically indicated)
  • patient assessment
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3
Q

What are the pre-op steps involved in HCL pumice technique for treatment of discolouration?

A
  • PPE & patient wears glasses and bib
  • clean teeth with pumice & water (to remove pellicle/plaque)
  • petroleum jelly to gingivae & lips
  • rubber dam MUST be placed
  • place sodium bicarbonate guard behind the teeth to neutralise any misplaced HCL
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4
Q

What percentage of HCL is used in microabrasion? what risk are associated?

A

18% HCL
- can burn mucosa/skin/eyes
- can bleach clothes if comes in contact

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5
Q

What is the maximum number of rotary applications of HCL in microabrasion?

A

10 x 5 second applications [no more than this]

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6
Q

What are the operative steps involved in HCL pumice technique for treatment of discolouration?

A
  • HCL pumice slurry in slow rotating rubber cup [ MAX 10 x 5 SEC APPLICATION ]
  • wash tooth directly into aspirator every 5 second application
  • polish with fine sandpaper disk
  • fluoride varnish application [profluorid]
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7
Q

Why are sandpaper discs used after microabrasion?

A

SEM evidence shows a compacted, relatively prismless layer of surface enamel
- This changes the optical
properties of the enamel so that areas of intrinsic
discolouration become less perceptible.

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8
Q
A
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9
Q

How many microns of enamel is lost after acid etching?

A

10 microns

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10
Q

How many microns of enamel is lost after HCL pumice microabrasion?

A

100 microns

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11
Q

What proprietary kits for microabrasion are available?

A
  • Opalustre (Ultradent)
  • Prema Kit 10% HCL
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12
Q

what are the advantages of microabrasion for discolouration?

A
  • easy
  • conservative
  • inexpensive
  • teeth need minimal subsequent maintenance
  • fast acting
  • removes yellow-brown, white & multicolour stains
  • effective
  • permanent results
  • can use before & after bleaching
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13
Q

What are the disadvantages of microabrasion as a discolouration treatment?

A
  • removes enamel
  • HCL acid compounds are caustic
  • requires protective apparatus for patient, dentist & dental nurse [PPE]
  • prediction of treatment outcome is difficult
  • must be done in dental surgery
  • cannot be delegated to therapist
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14
Q

When should patients be reviewed after microabrasion?

A

4-6 weeks after microabrasion & take post-op photographs

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15
Q

What post-op instructions should be given to patients after microabrasion for treatment of discolouration?

A

warn pt to avoid highly coloured food & drinks for at least 24 hours

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16
Q

What types of vital bleaching are there?

A
  • Chairside bleaching
  • Night guard vital bleaching
17
Q

What bleaching options are available to treat discolouration?

A
  • Vital bleaching
  • Non-vital bleaching
18
Q

What product is used in nightguard vital bleaching?

A

10% carbamide peroxide gel

19
Q

What instructions would you give to a patient who is going to do nightguard vital bleaching?

A
  • brush teeth throughly
  • apply a little gel to tray
  • set over teeth & press down
  • remove excess
  • rinse gently, do not swallow [can skip this sometimes]
  • wear overnight (or for at least 2 hours)
  • remove guard, brush tray & rinse with cold water
  • keep going for 3-6 weeks until acceptable colour
20
Q

how does carbamide peroxide break down?

A

10% carbamide peroxide —> 3% hydrogen peroxide & 7% urea —> water ammonia and CO2

21
Q

What are the advantages of non-vital bleaching?

A
  • simple
  • tooth conserving
  • original tooth morphology
  • gingival tissues not irritated by restoration
  • adolescent gingival level not a restorative consideration
  • no lab assistance
22
Q

How are teeth selected for non-vital bleaching?

A
  • adequate root filling
  • anterior teeth without large restorations
  • not amalgam intrinsic discolouration
  • not fluorosis or tetracycline discolouration
23
Q

How is non-vital bleaching carried out? [the clinical steps]

A
  • drill into tooth & remove root filling below gingival margin
  • bleaching agent on cotton wool
  • over with dry cotton wool
  • seal with GIC
  • renew bleach within 2 weeks
24
Q

When do you decide if the ‘walking bleach’ non-vital whitening technique isn’t going to work?

A

If no change after 3-4 bleach renewals

25
Q

What are the steps of combination/inside out non-vital bleaching?

A
  • access cavity of tooth open
  • custom made mouth guard [cut windows in teeth not being bleached]
  • pt applies bleaching agent to back of tooth & tray [10% carbamide peroxide]
  • gel changes every 2 hours & worn all the time [except eating]
26
Q

What are the potential complications of non-vital bleaching?

A
  • external cervical resorption
  • spillage of bleaching agents
  • failure to bleach
  • over bleach
  • brittleness of tooth crown
27
Q

How can external cervical resorption be prevented in non-vital bleaching?

A

Layer of cement over top of GP
- prevents bleaching agent from getting to external surface of root

28
Q

What effects can occur from short term exposure of bleaching agents to soft tissues?

A
  • minor ulceration/irritation
  • plaque reduction
  • aids wound healing
29
Q

What effects can occur from long term exposure of bleaching agents to soft tissues?

A
  • delayed wound healing
  • periodontal harm
  • mutagenic potential
30
Q

What can dentists prescribe after microabrasion or bleaching to help with sensitivity?

A

tooth mousse
- after bleaching = 2 weeks home application
- after microabrasion = 4 weeks home application

31
Q

What is resin infiltration, used for discolouration of teeth?

A

Infiltration of enamel lesions with low-viscosity light-curing resins
- surface layer is eroded first

32
Q

What are the uses of veneers?

A
  • aesthetics
  • relative tooth position
  • masking dark stain
  • age
  • psyche
  • plaque removal
33
Q
A

BDS4 PAEDIATRICS (5 decks)

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