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paeds > tx of intrinsic discolouration in permanent incisors > Flashcards

tx of intrinsic discolouration in permanent incisors Flashcards

1
Q

tx options

A 
enamel microabrasion
bleaching
resin infiltration (ICON)
localised composite Rxs
veneers - composite
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2
Q

pre-op records for all discoloured teeth

A

standardisation - so can monitor during tx
clinical photos
shade
sensibility testing, check for sensitivity
diagram of defect
radiographs if clinically indicated
pt assessment e.g. VAS - Visual Analogue Scale - see how pt feels before and after tx

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3
Q

indications for HCl-pumice microabrasion

A

trauma to primary incisors
fluorosis
decalcification after fixed ortho

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4
Q

pre-tx preparation for HCl-pumice microabrasion

A 
PPE - pt must be wearing glasses and bib
clean teeth with pumice and H2O
petroleum jelly to gingivae
MUST place dam and widgets IP between every tooth
 - dry dam - has earloops
Na bicarb guard (behind teeth)
 - and have more available
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5
Q

HCl-pumice microabrasion method

A

18% HCl pumice slurry in slowly rotating rubber cup for 5secs. press hard on labial surfaces
- max 10 x 5secs applications
wash direct into aspirator after every 5secs application
remove dam
FV
- Profluorid etc not Duraphat (colophony yellow - teeth more porous so may take up stain)
polish with finest sandpaper disc
final polish with toothpaste

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6
Q

HCl-pumice microabrasion conc

A

18% HCl pumice slurry

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7
Q

max HCl-pumice microabrasion application

A

10 x 5secs

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8
Q

why shouldn’t you use Duraphat after HCl-pumice microabrasion?

A

colophony is yellow - teeth are more porous so may take up stain

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9
Q

HCl-pumice microabrasion - why sandpaper discs?

A

SEM evidence shows a compacted, relatively prismless layer of surface E
this changes the optical properties of E so areas of intrinsic discolouration become less perceptible

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10
Q

dental txs and enamel loss - prophy with toothpaste

A

5-10um

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11
Q

dental txs and enamel loss - prophy with pumice

A

5-50um

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12
Q

dental txs and enamel loss - ortho bracket bonding/debonding

A

5-50um

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13
Q

dental txs and enamel loss - acid etch

A

10um

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14
Q

dental txs and enamel loss - 10 x 5secs HCl pumice microabrasion

A

100um

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15
Q

Opalustre/Ultradent

A

purple syringes
6/6% HCl and silicon carbide particles in a water soluble paste (do for longer)
specialised rubber cups with bristles

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16
Q

Prema kit

A

10% HCl, fine grit silicon carbide particles in H2O soluble paste

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17
Q

using proprietary kits for microabrasion

A

still isolate teeth
FMIs
most can be used >1 on teeth but must be vigilant re E thickness (yellow dentine shine through)
about 25-75um per tx?

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18
Q

advantages of HCl-pumice microabrasion

A 
easy
conservative
cheap
minimal maintenance
fast-acting
effective
permanent results
can use before/after bleaching
removes yellow-brown, white and multicoloured stains
 - best on brown stains
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19
Q

HCl-pumice microabrasion disadvantages

A 
removes E
HCl compounds caustic
requires PPE for pt, dentist and nurse
prediction of tx outcome is difficult
must be done in surgery
cannot be delegated
20
Q

reviewing HCl-pumice microabrasion and post-op instructions

A

teeth dehydrated after procedure
warn pt to avoid highly coloured food and drinks for at least 24hrs
- will take up stains easily - avoid anything that will stain a white t shirt - tomato based, curry, cola, squash etc

review in 4-6wks and take post-op photos
- when fully rehydrated

21
Q

bleaching EU directive 2012

A

can whiten >18s with up to 6% H2O2
“products containing/releasing 0.1-6% H2O2 cannot be used on U18s except where such use is intended wholly for the purpose of txing/preventing disease” - GDC 2014
- incs discolouration due to hypomineralisation, fluorosis, trauma etc

22
Q

options for bleaching

A 
external vital bleaching
 - chair side 'power' bleaching
 - at home nightguard
internal non-vital bleaching
 - inside outside
 - walking bleach
23
Q

what to warn pt about future when doing bleaching?

A

effects of bleaching aren’t permanent

as get older may have to pay in future

24
Q

vital chair side bleaching

A

unstable, rapidly reacting H2O2 usually 15-38%
(about 75% carbamide peroxide)
increased risk to STs and eyes

25
Q

nightguard vital bleaching gel and tray design

A

10% carbamide peroxide gel

cut windows in customised tray over any teeth you don’t want to bleach

26
Q

nightguard vital bleaching pt instructions

A 
brush teeth thoroughly
apply a little gel to tray
set over teeth and press down
remove excess
rinse gently, don't swallow
wear overnight (or for at least 2hrs)
remove, brush tray and rinse cold water
27
Q

timescale of vital nightguard bleaching

A

about 3-6 weeks
keep going until acceptable colour (as long as not too many side effects)
can be used as an adjunct to microabrasion

28
Q

what does 10% carbamide peroxide gel break down into?

A

3% H2O2 and 7% urea

then catalases and peroxidases - water, ammonia, CO2

29
Q

advantages of non-vital bleaching

A 
simple
tooth conserving
original tooth morphology
gingival tissues not irritated by Rx
adolescent gingival level not a Rx consideration
no lab assistance for 'walking bleach'
30
Q

non-vital bleaching tooth selection

A

adequate root filling
- no clinical/radiological disease
anterior teeth without large Rxs
- may need to replace composites after bleaching e.g. trauma
not amalgam intrinsic discolouration
not fluorosis or tetracycline discolouration (vital cases)

31
Q

walking bleach

A

oxidising process allowed to proceed over days. seal inside tooth
remove root filling to below gingival margin
- adult bur - miniature head
- US tip
bleaching agent on cotton wool
cover with dry cotton wool
seal GIC/IRM
renew bleach
- ideally no more than 2 weeks between its appts as oxidation process will have finished
if no change after 3-4 renewals stop
6-10 changes total

32
Q

walking bleach regression

A

50% 2-6yrs

33
Q

combination inside out bleaching in office aspect

A

10% gel, inside tooth and in tray, can seal in if cooperation is an issue
access cavity of tooth open
do not necessarily need GI lining - block dentinal tubules you are trying to bleach
custom made mouthguard (cut windows in guard of the teeth you don’t want to bleach)

34
Q

combination inside out bleaching home aspect

A

pt applies bleaching agent to back of tooth and tray
pt keeps access cavity clean - replacing gel removes food debris etc
wear all the time except eating and cleaning
gel changed about every 2 hours except overnight
- paeds - morn, break, lunch, after school, after dinner, bed

35
Q

non-vital bleaching restoration of pulp chamber

A 
nsCaOH paste for 2wks, seal in with GIC
then:
1 - white GP and composite resin
  - facility to rebleach
OR
2 - incrementally cured composite
   - no internal rebleaching but stronger tooth
   - veneer or crown prep if regression
36
Q

potential complications of non-vital bleaching

A 
ECR - rare, more likely if prev trauma
spillage of bleaching agents
failure to bleach
over bleach
brittleness of tooth crown
37
Q

preventing ECR

A

layer of cement over GP

nsCaOH in tooth for 2 weeks before final restoration

38
Q

preventing ECR - layer of cement over GP

A

prevents bleaching agent from getting to external surface of root (not for inside-out technique)
can prevent adequate bleaching of cervical area

39
Q

preventing ECR - nsCaOH in tooth for 2 weeks before final restoration

A

reverses any acidity in PDL that might have occurred if had got to external surface of root

40
Q

bleaching - effects on ST

A 
concern?
short-term exposure 
- minor ulceration/irritation
- plaque reduction
- aids wound healing
long-term exposure (theoretical)?
- delayed wound healing
- PD harm 
- mutagenic potential
41
Q

what is tooth mousse and what can it be used for?

A

recaldent CPP-ACP (casein phosphopeptide-amorphous Ca phosphate) milk derived protein
as an adjunct to microabrasion and bleaching
evidence not great

42
Q

suggested use of tooth mousse from manufacturer as an adjunct to bleaching and microabrasion

A

after bleaching - 2wks home application
poorly demarcated hypo mineralised lesions, mild/mod fluorosis - after microabrasion and for 4wks home application (pea sized at night before bed)

43
Q

what is resin infiltration?

A

infiltration of E lesions with low viscosity light-curing resins
surface layer is eroded, lesions desiccated (dried with ethanol), and apply resin infiltrant
resin penetrates lesion driven by capillary forces
infiltrated lesions lose their discoloured appearance and look similar to sound E

44
Q

resin infiltration method

A

clean teeth and rinse
apply and rub in etch gel (Icon Etch). 2mins working time
rinse and apply Icon Dry. 30s
visual inspection - insufficient result/lesion not accessible
repeat until good masking of white spots, lesion accessible
apply separation sheets
Icon Infiltrant. 3mins
remove excess - blow
light cure 40s
2nd infiltration to compensate for polymerisation shrinkage
polish

45
Q

to reduce/not to reduce enamel for veneers?

A 
aesthetics
relative tooth position e.g. instanding incisor would be good to build it out a bit
masking dark stain
age (v young teeth large pulp)
psyche
plaque removal
46
Q

enamel reduction - studies

A 
over contouring (if you don't remove E) increases plaque retention and stagnation at the gingival margin, esp in those with poor OH
bond strength is significantly increased after partial removal of buccal E
47
Q

composite veneers

A

direct - freehand/putty guide
indirect e.g. BellGlass
- often for amelogenesis imperfecta

paeds (7 decks)

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