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BDS4 Paeds > Txt of Intrinsic Discolouration in perm anterior teeth > Flashcards

Txt of Intrinsic Discolouration in perm anterior teeth Flashcards

1
Q

What are the different txt options available for Intrinsic discolouration?

A
  • Enamel microabrasion
  • Bleaching (Vital or Non Vital)
  • Resin infiltration technique (ICON)
  • Localised composite restoration
  • Veneers (composite either Direct or Indirect)
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2
Q

What Pre-op records should be utilised for all discoloured teeth?

A
  • Use for standardisation of recording of aesthetic procedures
  • Clinical photos
  • Shade (take shade of defect and background of tooth)
  • Sensibility testing, check for sensitivity
  • Diagram of defect
  • Radiographs if clinically indicated
  • Patient assessment e.g VAS etc

Level 5 use the SHADE sheet

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3
Q

Who first introduced Enamel colour modification by controlled hydrochloric acid pumice microabrasion technique?

A
  • Croll and Cavanaugh
  • 1986
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4
Q

What is the step by step HCL pumice technique for enamel discolouration?

A
  • Hand hygiene
  • PPE
  • Pt don glasses and bib
  • Clean teeth with pumice and water (removes the pellicle , any plaque etc)
  • Petroleum jelly to gingivae
  • Rubber dam placed ! Can also use oroseal or opaldam to conceal gingiva so don’t give chemical burn
  • Place sodium bicarbonate guard placed behind the teeth to neutralise any drop of HCL
  • Have more sodium bicarbonate available
  • Make HCL pumice slurry and rub in with either using a wooden spatula or a slowly rotating rubber cup for 5 sec
  • Max 10 x 5sec applications
  • Wash direct into aspirator after every 5 sec application
  • Fluoride varnish application (not Duraphat)
  • Polish with finest sandpaper disc (flexdiscs light blue)
  • Final polish with toothpaste
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5
Q

What percentage of HCL is used in microabrasion?
What are risks of HCL?

A
  • 18% HCL
  • Corrosive so can burn eyes, mucosa, clothes etcc
  • Always place rubber dam
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6
Q

Why do you use Sandpaper discs in microabrasion cases?

A
  • SEM (scanning electron microscope) 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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7
Q

How many microns are you removing from enamel when using prophy with toothpaste?

A
  • 5-10microns
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8
Q

How many microns are you removing from enamel when using prophy with pumice?

A

5-50microns

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9
Q

How many microns are you removing from enamel when using ortho bracket bonding/debonding?

A

5-50microns

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10
Q

How many microns are you removing from enamel when using acid etching?

A

10 microns

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11
Q

How many microns are you removing from enamel when using 10 x 5 secs HCL pumice microabrasion?

A

100 microns

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12
Q

Give some advantages of Microabrasion with HCL?

A
  • Easily performed
  • Conservative
  • Inexpensive
  • Teeth need minimal subsequent maintainence
  • Fast acting
  • Removes yellow-brown, white an multi-coloured stains
  • Effective
  • Results are permanent
  • Can use before or after bleaching
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13
Q

What are some disadvantages of microabrasion using HCL?

A
  • Removes enamel
  • HCl acid compounds are caustic
  • Requires protective apparatus for patient, dentist and dental nurse
  • Prediction of treatment outcome is difficult
  • Must be done in dental surgery
  • Cannot be delegated (you must complete)
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14
Q

Prorietary kits

A

***slide 17

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15
Q

What warnings must you give a pt after doing microabrasion? When should you review a pt?

A
  • Teeth are dehydrated after procedure therefore outcome does not occur immediately
  • Warn pt to avoid highly coloured food and drinks for at least 24hrs (more if they can) include tomato based foods , currys etc
  • Review pt 4-6weeks after microabrasion and take post op photographs
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16
Q

What are the bleaching options for pts?

A

Vital bleaching (external vital bleaching
- Chairside power bleaching
- Night guard vital bleaching at home

Non vital bleaching
- Inside outside technqiue
- Walking bleach techniue

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17
Q

Are the effects of dental bleaching permanent?

A
  • No not permanent
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18
Q

Why would you not peform chairside vital bleaching for a adolescent?

A
  • Unstable
  • Rapidly reacting hydrogen peroxde usually 15-38% which is equivalent to 75% carbamide peroxide
  • Greater risk to soft tissue and eyes
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19
Q

When utilising nightguard vital bleaching what is the percentage of carbamide peroxide gel?

A
  • 10% carbamide peroxide gel
20
Q

What do you need to consider when utilising nightguard vital bleaching?

A
  • Need to be aware of what teeth you want to bleach and what teeth are fully erupted or PE erupted
  • Cut windows in customised tray over any teeth you don’t want to bleach
21
Q

What instructions should you give to pts when utilising nightguard vital bleaching?

A
  • Brush teeth thouroughly
  • Apply a little gel to tray
  • Set over teeth and press down
  • Remove excess
  • Rinse gently, do not swallow
  • Wear overnight (or for at least 2 hours)
  • Remove brush try with brush and rinse with cold water
22
Q

What is the timescale for nightguard vital bleaching?

A
  • 3-6weeks
  • keep going until acceptable colour
23
Q

What does 10% carbamide peroxide break down into?

A
  • 3% hydrogen peroxide
  • 7% urea
    breaks down to
  • Water
  • Ammonia
  • CO2
    as it catalases and peroxidases
24
Q

What are some 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 laboratory assistance for ‘walking bleach’

25
Q

If you are going to utilise non vital bleaching you have to select a tooth that is going to work. What are the indications for non vital bleaching?

A
  • Adequate root filling
    no clinical disease
    no radiological disease
  • Anterior teeth without large restorations
  • Not amalgam intrinsic discolouration
  • Not fluorosis or tetracycline discolouration
26
Q

What are the two methods of Non Vital bleaching?

A
  • Walking bleach where the oxidising process is allowed to proceed gradually over days
  • inside out method with 10% carbamide peroxide gel
27
Q

What is the method of Non vital Walking Bleach?

A
  • Ensure enough root filing is removed to below gingival margin
  • Bleaching agent 10% carbamide peroxide on cotton wool placed into access cavity
  • Cover with dry cotton wool
  • seal with GIC / IRM
28
Q

What is the regression rate of Non vital Walking bleach applications?

A
  • 50% at 2-6yrs
29
Q

When should you stop with the Non vital walking bleach applications?

A
  • If there is no change after 3-4 renewals stop
  • 6-10 changes total
30
Q

With Non vital walking bleach how often should you renew bleach? Why?

A
  • No more than 2 weeks between appointments
  • 10% carbamide peroxide breaks down to 3%hydrogen peroxide and 7% urea
  • catalases and peroxidases break the hydrogen peroxide and urea down to ammonia, water and CO2
    **
31
Q

What is the method of Non vital inside out bleaching?

A
  • 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!)
  • Patient applied bleaching agent to back of tooth and tray
  • Patient keeps access cavity clean, replacing gel removes food debris etc
    10% Carbamide peroxide is bleaching agent of choice
  • Worn all the time except eating and cleaning
  • Gel changed every 2 hours or so except during the night
  • Non setting CaOH paste for 2 weeks , seal in with GIC
  • Then either place white GP and comp resin Or incrementally cured comp
  • Can also do veneer or crown prep if regression
32
Q

What is the advantage to sealing Tooth with white GP and comp resin after Inside out non vital bleaching?

A
  • Can re bleach if needed
33
Q

What is an advantage of using cured composite to restore tooth after Non vital inside out bleaching?

A
  • Can’t re bleach but stronger tooth
34
Q

What are some potential complications of Non vital bleaching?

A
  • External cervical resorption
  • Spillage of bleaching agents
  • Failure to bleach
  • Over bleach
  • Brittleness of tooth crown
35
Q

What is a method to Preventing external cervical resorption in Non vital bleaching?

A
  • Can use layer of GIC cement over GP which prevents bleaching agent from getting to external surface of root and can prevent adequate bleaching of cervical area
  • Can use non setting calcium hydroxide in tooth 2 weeks before final restoration as reverse any acidity in PL that might have occurred if above had happened
36
Q

What effects are there on the soft tissue for Non vital bleaching?

A

Short term exposure
- Minor ulceration/irritation
- Plaque reduction
- Aids wound healing

Unsure of long term exposure but could give delayed wound healing, periodontal harm and mutagenic potential

37
Q

What is a brand of tooth mousse and what can it be used in adjunct with?

A
  • Recaldent CPP-ACP (Casein phosphopeptide - amorphous calcium phosphate) milk derive protein
  • Evidence not great but can used as adjunct to microabrasion and bleaching
38
Q

What is the suggested use of Recaldent ?

A
  • After bleaching can use for 2 weeks home application
  • Use for poorly demarcated hypomieralised lesions, Mild/mod fluorosis after microabrasion and for 4 weeks home application
  • Both applications use pea size at night before bed
39
Q

What does the GDC say about Non-vital bleaching?

A
  • can be used on pts if used for the purpose of treating or preventing disease
40
Q

What are the risks the pt must consent to before Non- vital bleaching txt can occur?

A
  • Gum sensitivity/irritation.
  • As composite restorations (white fillings) cannot be whitened these must be removed and replaced following tooth whitening, if present.
  • The tooth/teeth must be left hollow with no dressing in place. This leaves the tooth more vulnerable to breaking during this treatment and there is a risk of the tooth fracturing. We advise to avoid high contact sports and chewy/tearing foods on the tooth/teeth being treated.
  • This treatment may not give a satisfactory aesthetic result and further treatment may be required.
  • Not suitable if the patient has the following conditions:
    o Acatalasaemia (deficiency of catalase saliva enzyme) – rare 0.2%
    o Glucose-6-phosphate dehydrogenase (G6PD) deficiency – disorder of erythrocytes (blood cells) – rare 0.1%
  • Not suitable if patient is pregnant or breastfeeding
41
Q

What should the pt expect or avoid in Non vital bleaching txt?

A
  • Avoid over bleaching and hard to correct as tooth is too white
  • Avoid high colourant food and drink during txt and for 2 weeks after as it will stain teeth. I.e. anything that could stain a white shirt, baked beans, coca cola curry, tomato based sauce
  • Avoid hard foods or foods that need tearing or chewing
  • Avoid contact sports
42
Q

What advice should you tell a pt during Non Vital bleaching txt?

A
  • In order for bleaching gel to reach dark areas of tooth the dentist will remove any dressing and fillings and make the tooth hollow
  • Use a specially ocnstucted tray, dentist will check this can be inserted and removed well
  • Place bleaching gel in 2 places , into tray in area of tooth being treated (half a kernal of sweetcorn per tooth) and into hollow itself. the dentist will show you how to do this
  • Change the bleaching gel every 2 hours if possible. However it is safe to leave the tray in for
    longer as the bleach stops working after 2 hours.
  • Do not eat or drink while the tray is in the mouth. It is best to place the tray with bleaching gel
    after breakfast and then replace the bleaching gel after any other meals or snacks.
  • Stop tooth whitening when the tooth shade looks the same colour as the teeth on either
    side and you are happy with the shade. (Usually after 3 – 4 days). Otherwise over bleaching
    occurs.
  • Stop tooth whitening 48 hours (2 days) before the next dental appointment, so that the
    dentist can place the final white filling. If the tooth is not the correct colour by this time
    contact the dentist as you will need a new appointment.
  • Usually only 1 tooth is being treated and 1 tube of bleaching gel is more than enough. If you
    are using the gel more quickly this may suggest that you are using too much. If any bleaching
    gel spreads onto the surrounding gum please remove this with a tissue.
  • Please store the bleaching gel in the fridge
43
Q

How does Resin infiltration work to correct discoloured teeth?

A
  • Infiltration of enamel lesions with low viscosity light curing resins
  • surface layer is eroded, lesions desiccated and a resin infiltrant is applied.
  • Resin penetrates lesion driven by capillary forces
  • Infiltrated lesions lose their discoloured appearance and look similar to sound enamel.
44
Q

Describe the technique of Resin infiltration

A
  • Rubber dam
  • Rinsing and cleaning of teeth
  • Application if Icon Etch
  • Rub in the etching gel with microbrush
  • Allow to act for 2 mins
  • Rinse etch gel
  • Apply Icon dry
  • Let its act for 30secs
  • Assess teeth, if insufficient result then repeat steps again until good masking of discolouration occurs
  • Or can place separation sheets
  • Apply Icon infiltration and it let it act for 3 mins
  • Removal of excess material
  • Light cure 40 secs
  • Do second infiltration to compensate for polymerisation shrinkage
  • Let act for 1min then blow off excess
  • Light cure 40 secs
  • Polish
45
Q

When placing veneers you need to assess whether you need to reduce or not reduce enamel. What factors do you need to consider when thinking of this option?

A
  • Aesthetics
  • Relative tooth position
  • Masking dark stain
  • Age
  • Psyche
  • Plaque removal
46
Q
A

BDS4 Paeds (1 decks)

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