Vital Bleaching

Question 1

How long does it take tetracycline stains to whiten?

Answer 1

3-6 months or longer

Question 2

How long does it take blue/gray stains to whiten?

Answer 2

2-6 weeks (twice as long as yellow/brown)

Question 3

How long does it take nicotine stains to whiten?

Answer 3

1-3 months

Question 4

How long does it take yellow/brown stains to whiten?

Answer 4

1-3 weeks

Question 5

This can cause yellow to dark brown staining, and can cross the placental barrier (avoid during pregnancy)

Answer 5

Tetracycline (look at photo)

Question 6

This can cause blue-gray appearance of teeth, palate, or anterior mucosa

Answer 6

Minocycline Hydrochloride

Question 7

This can cause gray brown discoloration

This can cause yellow discoloration

Answer 7

Chlortetracyline

Oxytetracycline

Question 8

What is the main ingredient of vital bleaching?

Answer 8

Carbamide Peroxide

Question 9

What is carbamide peroxide made of?

Answer 9

Hydrogen Peroxide + Urea

Question 10

Roughly how much of CP converts to HP?

Answer 10

1/3

Question 11

How long is HP active for?

Answer 11

30-60 mins (used less because of it)

Question 12

How long is CP active for?

It releases 50% in the first ___ hours but continues to release for ___ hours longer

Answer 12

2-10 hours (used more because active longer than HP)

2 hours, 6 hours

Question 13

What is the only ADA approved formula for vital bleaching?

Why is it good?

Downside?

Answer 13

10% carbamide peroxide

Lower concentration = less sensitivity

Takes longer to whiten well

Question 14

How does CP work?

How does HP work?

Answer 14

Diffuses through enamel and dentin, breaks down into HP and urea

HP oxidizes organic pigments in tooth structures by breaking them down into small constituents that reflect less light

Question 15

If composite restorations are planned, should you whiten before or after the restoration is placed?

Why?

Answer 15

Whiten before, restorations don’t lighten

Question 16

How long should you wait after bleaching before placing composite

Why?

Answer 16

Two weeks

Residual peroxide may affect bond strengths

Question 17

What is a big disadvantage of OTC whitening kits?

Answer 17

No dental examination prior to bleaching

Question 18

Opalescence go has 10% HP, how much is this in CP

Answer 18

30%

Question 19

Why is dentist supervision preferred for whitening?

More viscous, potent gels
Better fitting trays
And management of these primary adverse effects

Answer 19

***Adverse effects are generally tooth sensitivity and gingival irritation.

Question 20

What percent of patients experience sensitivity during in office bleaching?

Answer 20

100%

Question 21

When making a custom tray, how far should the resin be from the gingival margin?

How long should the blockout be cured?

Answer 21

1mm

20-40 seconds

Question 22

When heating the tray material, how far should it sag?

Answer 22

1-2 inches

Question 23

When trimming the tray fabrication with scissors, scallop interproximally (can be scalloped or non scalloped, with or without reservoir).

Trimming 0.5mm beyond the CEJ has what effect?

Trimming 0.5 mm below the CEJ has what effect?

Answer 23

Beyond - increased retention

Below - decreased gingival irritation

Question 24

What type of tray is most comfortable for the patient?

Answer 24

Non-scalloped and without reservoir

Provides a better seal against gingiva - less leakage and material required

Question 25

Why does HP (like in opalescence go) cause tooth sensitivity?

What is another reason it occurs?

Answer 25

low molecular weight, can easily diffuse through enamel and dentin

Dehydration

Question 26

What should immediately be used when there is sensitivity?

Then what modifications to the bleaching should be made

Answer 26

3% potassium nitrate desensitizing gel

Lower concentration and/or frequency

Question 27

How does opaluster work?

What is it useful for?

Answer 27

enamel microabrasion, followed by fluoride treatment

Isolated shallow brown/white discolorations

Question 28

Macroabrasion is done via what mechanism?

Answer 28

Finishing burs and polishing removes localized white spots