Tx Of Intrinsic Discolouration Of Anterior Permanent Teeth In Children And Adolescents Flashcards
Give some overarching treatments for tooth discolouration
Enamel microabrasion
Bleaching
- vital
- non vital
Resin infiltration
Composite veneers
- direct
- indirect
What pre-op records are needed for discoloured teeth?
Clinical photos
Shade
Sensibility testing
Diagram of defect
Radiographs if indicated
How is the HCL pumice technique done?
PPE worn and patient with glasses and bib
Place rubber dam and apply petroleum jelly to gingiva
Place sodium bicarbonate guard
Place HCL pumice slurry into small rubber cup and clean tooth for 5 seconds,
maximum 10 x 5 second applications
Wash directly into aspirator
Apply fluoride varnish - profluorid
Polish with sandpaper disc as affects opalescence of enamel to reduce discoloured appearance
Advantages of microabrasion?
Easy to do
Conservative
Inexpensive
Minimal subsequent maintenance
Removes yellow, brown, white and multi coloured staining
Permanent results
Can be done before or after bleaching
Disadvantages of microabrasion?
Removes enamel
Requires protective apparatus for patient, dentist and nurse
Prediction of outcome is difficult
Cannot be delegated and must be done in dental surgery
Any post op instructions after microabrasion?
Warn pt to avoid highly coloured food and drinks for 24 hours
Review 4-6 weeks and taker post op radiographs
When is use of 0.1-6% hydrogen peroxide allowed in those under 18?
When it is for the purpose of preventing or treating disease
Such as tooth discolouration for hypomineralisation, trauma, fluorosis etc
What bleaching options are there?
External Vital bleaching
- chair side
- night guards at home
Non-vital / internal non vital bleaching
- inside out
- walking bleach
How is night guard vital Bleaching done?
Timescale?
10% carbamide peroxide gel placed into whitening tray and placed into mouth overnight
Pt to
- brush thoroughly
- apply little gel to tray
- seat in mouth and remove excess
- rinse gently and dont swallow
- wear overnight or for at least 2 hours
- remove tray and brush and rinse with cold water
3-6 weeks
Advantages of non vital bleaching?
Tooth conserving
Original tooth morphology
No irritation of gingival tissues
No lab input for ‘walking bleach’
What is an ideal tooth for non-vital bleaching?
- Adequate root filling
- no clinical or radiological disease
- anterior tooth with no large restorations, especially labial
- no intrinsic amalgam discolouration
- no fluorosis or tetracycline discolouration
What is the process of ‘walking out’ non vital bleaching?
How long for?
When stop?
Any regression?
Access cavity cut and root filling removed to just below gingival margin using round bur or ultrasonic
Bleaching agent placed on cotton wool and placed within cavity
Dry cotton wool placed to cover
Sealed with GIC/RMGIC
Renew bleach every 2 weeks
If no change after 3-4 renewals then stop
6-10 changes in total
50% regression at 2-6 years
What is combination ’inside out’ bleaching?
Access cavity of tooth left open
Custom mouth guard made with windows for teeth not needing bleaching
Bleaching 10% carbamide peroxide applied to Back of tooth and the tray
Gel changed every 2 hours except for overnight
Worn all the time unless eating or cleaning
How should restoration of the pulp chamber occur after non vital bleaching?
What if regression occurs?
Non setting CaOH paste for 2 weeks, then seal with GIC
Either
- white GP and composite resin to facilitate re-bleaching
Or
- incrementally cured composite
- no re-bleaching but stronger tooth
Regression = veneer or crown prep
Possible Complications with non vital bleaching?
External cervical resorption
Spillage of bleaching agents
Failure to bleach
Over bleach
Brittleness of crown
