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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 for discoloration

5

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
  • 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 &lips

MUST place dam and wedges IP between every tooth

  • dry dam - has earloops
  • caulking agent (oraseal)

Sodium bicarbonate guard (behind teeth)

  • and have more available
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5
Q

HCl-pumice microabrasion method

A
  • 18% HCl acid pumice slurry in slowly rotating rubber cup for 5secs press hard on labial surfaces
  • wash direct into aspirator after every 5secs application
  • remove dam
  • FV
    Profluorid etc not Duraphat
  • 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 polsih at the end ?

A

SEM (systematic evidence map) evidence shows a compacted, relatively prismless layer of surface Enamel
this changes the optical properties of Enamel 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

Example of proprietary kit for microabrasion

A

Opalustre (ultradent)

  • 6.6% HCl

Prema kit

  • 10% HCl
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16
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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17
Q

HCl-pumice microabrasion disadvantages

A
  • removes E -sensitivity
  • HCl compounds caustic
  • requires PPE for pt, dentist and nurse
  • prediction of tx outcome is difficult
  • must be done in surgery
  • cannot be delegated
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18
Q

post op instruction for microabrasion

A
  • teeth dehydrated after procedure
  • porous
  • 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
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19
Q

reviewing HCl-pumice microabrasion

A
  • review in 4-6wks and take post-op photos
    (when fully rehydrated)
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20
Q

bleaching regulations

A
  • EU directive 2012
    can whiten >18yo with up to 6% H2O2
  • GDC 2014
    “products containing/releasing 0.1-6% H2O2 cannot be used on U18yo except where such use is intended wholly for the purpose of txing/preventing disease” -
    ( incs discolouration due to hypomineralisation, fluorosis, trauma etc)
21
Q

options for bleaching

A

external vital bleaching

  • chair side ‘power’ bleaching
  • at home nightguard

internal non-vital bleaching

  • inside outside
  • walking bleach
22
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

23
Q

vital chair side bleaching conc

A

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

24
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

25
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
26
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

27
Q

what does 10% carbamide peroxide gel break down into?

A
  • 3% H2O2 and 7% urea
    then catalases and peroxidases
  • water, ammonia, CO2
28
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’

29
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)
30
Q

2 method of non-vital bleaching

A
  • walking bleach
  • inside-out method
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
  • clean with ultrasonic 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% Carbamide peroxide gel

  • access cavity of tooth open
  • do not necessarily need GI lining
  • 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
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

Tooth mousse - main ingredient and function?

A
  • Recaldent CPP-ACP (casein phosphopeptide-amorphous Ca phosphate)
  • milk derived protein
  • Promote remineralisation
  • 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

brand for resin infiltration

A

ICON

45
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

46
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
47
Q

insufficient enamel reduction consequence

A
  • over contouring
  • increases plaque retention and
  • stagnation (salivary flow) at the gingival margin, esp in those with poor OH
48
Q

bond strength of comp in enamel reduction

A

Significantly increased after partial removal of buccal E

49
Q

composite veneers

A

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

paeds (7 decks)

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