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BDS4 Paediatrics > Tx of intrinsic discolouration > Flashcards

Tx of intrinsic discolouration Flashcards

1
Q

What is intrinsic discolouration

A

occurs beneath the surface of the tooth and occurs when stain causing-particles are able to work their way through the outer layer of your tooth and accumulate within enamel/dentine

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2
Q

What is extrinsic staining

A

lies on the tooth surface usually caused by tannings

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3
Q

What is required prior to commencing treatment

A

diagnosis
specialist led treatment plan
informed consent
pre-operative records

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4
Q

What should patient be told to gain informed consent

A

diagnosis
treatment plan
risk of treatment (including risk of no success)

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5
Q

What pre-operative records do we require

A

photos
shade sheet

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6
Q

What is on the shade sheet

A

tooth to be treated
shade of defect
sensibility EPT
sensibility ethyl chloride

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7
Q

What are the treatment options for intrinsic discolouration

A
  • enamel microabrasion
  • bleaching
  • resin infiltration (ICON)
  • localised composite restoration
  • veneers
  • crowns
  • do nothing
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8
Q

What is microabrasion

A

o Removal of the surface layer of stained opaque enamel to reveal less stained enamel

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9
Q

What are the advantages of microabrasion

A

 Easy
 Conservative
 Inexpensive
 Teeth need minimal subsequent maintenance other than taking care with staining food and drink
 Fast acting
 Removes yellow/brown, white and multicoloured stain
 Effective
 Permanent result
 Can use before or after bleaching

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10
Q

What are the disadvantages of microabrasion

A

 Removes enamel - sensitivity and prone to stianing
 HCL acid - soft tissue damage
 Prediction of treatment outcome can be difficult as teeth may appear more yellow as the normal dentine shows through the opaque enamel
 Must be done in the dental surgery
 Cannot be delegated
 100 micron of enamel loss with microabrasion

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11
Q

What is the clinical technique for microabrasion

A

 PPE worn by patient and team
 Teeth cleaned with pumice and water
 Soft tissue protected using Vaseline
 Rubber dam placed
 Sodium bicarbonate guard used for gingival protection
 HCL pumice slurry used in slowly rotating rubber cup
 Should be washed off after every 5 second application, review the colour and the shape
 To aid remineralisation, fluoride varnish should be applied
 Teeth should be polished with finest sandpaper disc
 Polish with toothpaste
 Review

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12
Q

How long should the HCl be in contact with the tooth

microabrasion

A

5 seconds

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13
Q

What is the maximum amount of applications of HCl to the tooth surface

A

10

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14
Q

What is the name of the fluoride varnish used post-microabrasion

A

profluorid NOT duraphat

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15
Q

Why is duraphat not used as the varnish of choice

microabrasion

A

it is yellow
tooth is more prone to stain post microabrasion
profluorid is white

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16
Q

What is the benefit of polishing teeth with finest sandpaper disc

post microabrasion

A

it helps in changing the optical properties of enamel so that the area of intrinsic discolouration becomes less perceptible (prismless layer of surface enamel created)

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17
Q

What should the patient be warned of (POI microabrasion)

A
  • Teeth are dehydrated after the procedure
  • Warn the patient to avoid highly coloured food and drinks for at least 24h, if not longer (avoid food/drinks that would stain a white shirt)
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18
Q

When should the patient be reviewed

A
  • Review patient 4-6 weeks after microabrasion and take post-op photographs
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19
Q

Can a second cycle of microabrasion be taken

A

Yes but only if maximum result hasn’t been achieved
if no change, second cycle should not be undertaken

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20
Q

Can a third cycle of microabrasion be undertaken

A

no
second cycle is maximum

21
Q

What are the 2 microabrasion kits

A

ultradent
prema kit

22
Q

What does the GDC state in regards to children + bleaching

A

GDC stated that tooth whitening products exceeding 0.1-6% hydrogen peroxide shouldn’t be used on under 18s except for when used for the purpose of treating/preventing disease

fluorosis, AI, trauma ect all come under treatment of disease

23
Q

What is the legal % of hydrogen peroxide that can be used by a dentist

A

6% unless for treatment/prevention of disease

24
Q

What is the difference between carbamide peroxide and hydrogen peroxide

A

 Carbamide peroxide breaks down into hydrogen peroxide and urea in an aqueous solution
 10% carbamide peroxide turns into 3% hydrogen peroxide
 Eventually the hydrogen peroxide turns into water, ammonia and carbon dioxide

25
Q

What are the 2 types of bleaching

A

vital and non-vital

26
Q

What is vital bleaching

A

it is external bleaching
can still be used on non-vital teeth (if for extrinsic staining)

27
Q

What are the two types of vital staining

A

chairside
home

28
Q

What is chairside bleaching

A

o Uses unstable, rapidly reacting hydrogen peroxide usually 15-38% which is equivalent to 75% carbamide peroxide
o It poses a greater risk of soft tissues and eyes

29
Q

What is home bleaching

A

o Nightguard vital bleaching with 10% carbamide peroxide gel
o Tray designed for bleaching, windows should be cut in the tray over any teeth that you do not want to use

30
Q

What are the patient instructions for home bleaching

A

 Brush teeth
 Apply gel to tray
 Wear tray and remove excess
 Rinse gently
 Wear overnight
 Brush teeth day
 Keep going for 3-6 weeks until colour achieved

31
Q

What are the side effects of bleaching

A

tooth sensitivity
gingival irritation

32
Q

Why is tooth sensitivity a less common side effects for younger patients

A

probably due to increased enamel quantity + quality and also larger pulp complexes in adolescent patients teeth which allows faster recovery from acute inflammation experienced

33
Q

How does bleach cause tooth sensitivity

A

 Due to passage of hydrogen peroxide through intact enamel and dentine, reaching the pulp

34
Q

What is non vital bleaching

A

internal bleaching

35
Q

What are the advantages of internal bleaching

A

o Simple
o Tooth conserving
o Original tooth morphology
o Gingival tissues not irritated by restoration
o Adolescent gingival level not a restorative consideration
o No lab assistance (only for walking bleach method)

36
Q

What should we consider when deeming if a tooth is suitable for non vital bleaching

A

o Requires adequate root filling with no clinical/radiological disease
o Anterior teeth without large restorations
o Not intrinsic staining from amalgam
o Not fluorosis or tetracycline discolouration

37
Q

What are the 2 non vital bleaching methods

A

walking bleach
inside out (combination)

38
Q

What is the walking bleach technique

non vital bleaching

A

The oxidising process is allowed to proceed gradually over days

39
Q

What is the technique for the walking bleach technique

A
  • remove root filling 1-2mm below CEJ
  • seal root filling with GIC
  • place etch to open dentinal tubules for penetration
  • sodium perborate placed in pulp chamber
  • review patient every 3-4 days for replacement of bleach
  • calcium hydroxide dressing placed in pulp chamber for 2 weeks in the interim post bleaching
  • final definitive restoraiton placed
40
Q

When should you stop replacing the bleach

for walking bleach technique

A

after 3/4 time if no change
up to 6-10 times if change seen

41
Q

What is the inside out technique

A

access cavity created
10% carbamide peroxide gel used

42
Q

Describe the technique for the inside out technique (combination)

A
  • Access cavity created
  • Access cleaned with ultrasonic
  • 10% carbamide peroxide gel placed within access
  • Appropriate part of bleaching tray covering outside of tooth filled with the gel and fitted into mouth
  • Should be changed every 2 hours and kept in overnight
  • Remove tray when eating and clean out access
43
Q

What should the definitive restoration be

post nonvital bleaching

A

 White GP and composite resin placed to facilitate rebleaching
 OR
 Incrementally cured composite which does not leave room for rebleaching but allows for a stronger tooth
 OR
 Veneer or crown prep if regression

44
Q

What are the complications of non vital bleaching

A
  • external cervical resorption
  • spillage of bleaching agents
  • failure to beach
  • overbleach
  • brittleness of tooth crown
    *
45
Q

How do we try and prevent external crevical resorption

A

prevent leakage of bleach to surrounding periodontium/external root surface by ensuring sealing material reaches ACJ (walking bleach technique)
calcium hydroxide placement post-bleaching to reverser acidity + prevent bacterial penetration

46
Q

What is resin infiltration’s brand name

A

ICON

47
Q

What is resin infiltration

A

o The surface layer is eroded, lesions are desiccated and a low viscosity resin infiltrant is applied
o The resin penetrates the lesion by capillary forces
o Infiltrated lesions lose their discoloured appearance and look similar to sound enamel

48
Q

What should you consider when deciding if a veneer requires enamel preparation

A

 Aesthetic
 Relative tooth position (instanding or outstanding)
 Masking dark stain
 Age
 Psyche
 Plaque removal

BDS4 Paediatrics (4 decks)

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