whitening Flashcards
extrinsic stains
Stains on the external surface of teeth
▶ Poor oral hygiene, eating habits, chromogenic microorganisms, tobacco
▶ Usually, can be removed with prophylaxis
intrinsic stains
Deeper internal stains or enamel defects
▶ Advancing age, metabolic drug staining, trauma, endodontic therapy (tooth dehydration, effects of restorative materials)
▶ More complex to treat and usually requires dental professional to treat
tetracyline
▶ Most commonly long-term use of minocycline
▶ Dark blue-gray stains more difficult to treat than mild
yellow-orange discolorations
▶ Can require up to 6 months of consistent use of vital
bleaching products
Treatment Considerations
➢ what must precede a bleaching
treatment?
➢ Treat what prior to whitening and address what in the esthetic zone with?
➢ It’s possible to place esthetic restorations prior to whitening in a lighter shade, but the patient need to be aware these may?
➢ Existing restorations in the esthetic zone will most likely need to?
➢ A diagnosis to ensure dental health must precede a bleaching
treatment.
➢ Treat caries in the non-esthetic zone prior to whitening and
address failed restorations and/or areas of caries in the esthetic
zone with temporary restorations.
➢ It’s possible to place esthetic restorations prior to whitening in
a lighter shade, but the patient need to be aware these may
need to be replaced following whitening if the color match is
unacceptable.
➢ Existing restorations in the esthetic zone will most likely need
to be replaced, and patient needs to be informed
exposed roots with whitening
Exposed root surfaces may experience sensitivity, and if large
areas are exposed, or if restorations are inadequate, patients
may develop mild to moderately severe pain
calc and extrinsic stains with whitening
Remove calculus and extrinsic stains. If tissue is traumatized, wait one to two weeks before beginning bleaching treatment to minimize possible gingival sensitivity.
whitening and preexisting restorations
Whitening does not alter shade of restorations; wait two
weeks following the bleaching procedure before matching and
placing resin-bonded restorations. Color stabilization requires
time and residue peroxide ions may interfere with bond strengths. This is important before placing definitive tooth- colored restorations
teeth with amalgam and whitening
Teeth with large amalgam restorations may appear darker than other bleached teeth because the internal restoration
becomes more visible through the bleached enamel. The patient should be made aware that this may require a more extensive esthetic restoration following bleaching
Tooth Whitening Mechanism
▶ Enamel composition
▶ Dentin composition
▶ Hydrogen peroxide role?
▶ Colgate Optic White: rxn?
Tooth Whitening Mechanism
▶ Enamel: A semi-translucent, prismatic, primarily inorganic
▶ Dentin: A yellow opaque, tubular, primarily organic
▶ Hydrogen peroxide migrates through the enamel and breaks
down organic pigment molecules in the enamel and dentin
(primarily dentin)
▶ Colgate Optic White: Electrochemical reaction to increase pH making the conducting gel more effective, faster, and less sensitive
Colgate Optic White Professional In-office light charge
at least 4 hrs before tx
in office whitiening payement
Pt must pay in advance in order to get the kit from the dispensary to charge prior to the
appointment. Dispensary personnel can charge it, or the student can charge it.
starting shade confirmation
take it and confirm with pt
Colgate Optic White Professional In-office technique
retractor/dry?
Click pen until? on each tooth? The serum does not have to be perfectly even but avoid the? If some gets on the tissue?
Allow serum to dry ? secs; teeth will look shiny.
Remove cheek retractor and place LED device. It will beep once at ? minutes then twice at ?
minutes and turn off.
Remove device, place cheek retractor and use ? to remove dried serum. Apply to ? teeth at a time, then remove serum with?
Re-apply whitening serum and repeat this process ? more times for a total of ? cycles.
Take final shade and compare to?
Place cheek retractor and dry teeth with 2 x 2 gauze.
Click pen several times until you see a drop of serum, then paint a thin coat on each tooth. The
serum does not have to be perfectly even but avoid the gingival tissue. If some gets on the tissue,
wipe away with gauze, cotton roll or swab.
Allow serum to dry 10-15 secs; teeth will look shiny.
Remove cheek retractor and place LED device. It will beep once at 5 minutes then twice at 10
minutes and turn off.
Remove device, place cheek retractor and use Ethanol pen to remove dried serum. Apply to 2-3
teeth at a time, then remove serum with gauze, cotton roll or swab. (Gauze seems to work best)
Re-apply whitening serum and repeat this process 2 more times for a total of 3 cycles.
Take final shade and compare to starting shade
Colgate Optic White At-home kit contains
6% hydrogen peroxide
Colgate Optic White At-home kit
6% Hydrogen Peroxide serum
Available for purchase? how?
Similar pen with whitening serum that is a ? concentration for
home use.
Patient dries teeth with?
Paint serum on?
Insert LED device for ? minutes.
Leave dry serum on teeth ?.
Brush off dry serum in the?
Colgate Optic White At-home kit
6% Hydrogen Peroxide serum
Available for purchase; patient pays for the kit and student picks it up
at the dispensary.
Similar pen with whitening serum that is a lower concentration for
home use.
Patient dries teeth with tissue or gauze.
Paint serum on upper and lower teeth.
Insert LED device for 10 minutes.
Leave dry serum on teeth overnight.
Brush off dry serum in the morning.
UMKC Codes and Fees
External bleaching- In Office Kit (Both Arches) Colgate OW
External bleaching-Take home kit (2 arches) Colgate OW
External bleaching-Take home kit (2 Arches) Opalesence
Internal bleaching-per tooth (add’l fee for restoration)
Unspecified-add’l bleaching material Colgate or Opalesence
9972 External bleaching- In Office Kit (Both Arches) Colgate OW $193
9975 External bleaching-Take home kit (2 arches) Colgate OW $150
9975A External bleaching-Take home kit (2 Arches) Opalesence $150
9974 Internal bleaching-per tooth (add’l fee for restoration)** $87**
9999A Unspecified-add’l bleaching material Colgate or Opalesence $46
Dentist Supervised Nightguard Vital Bleaching:
▶ Active Ingredient is?
▶ Patients notice whitening effect after how long?
▶ Rebound shade?
▶ Bonding delay?
▶ For sensitivity, have patients use?
▶ Active Ingredient is 10%-22% Carbamide Peroxide or 3%-6% Hydrogen Peroxide
▶ Patients notice whitening effect after 4-5 days with a two-week regimen
▶ Rebound of ½ shade should be expected
▶ Bonding should be delayed for 2 weeks: residual peroxide ions could interfere with bond strength and shade needs to stabilize to final shade
▶ For sensitivity, have patients use Potassium Nitrate or Stannous Fluoride; either as toothpaste or a gel within the whitening trays
Hydrogen Peroxide vs Carbamide Peroxide
Carbamide peroxide contains?
Therefore, 30% carbamide peroxide contains? 10% carbamide peroxide would contain?
Patients are sometimes confused why?
what whitens the teeth?
Carbamide peroxide contains hydrogen peroxide and urea with the amount of hydrogen peroxide at a 3:1 ratio.
Therefore, 30% carbamide peroxide contains 10% hydrogen peroxide whereas a 10% carbamide peroxide would contain 3.33% hydrogen peroxide
Patients are sometimes confused why something 10% is the same strength as something 30%- be prepared to explain the difference.
It is the hydrogen peroxide that is whitening the teeth
Value-oriented shade guide
Value is the most important component in shade selection because it is the lightness to darkness of a hue
A shade guide oriented in this way is helpful in evaluating whitening results
from pre-treatment to post-treatment shades
Non-Vital Bleaching
Discoloration can be from bleeding into dentin from trauma, residual pulp
tissue left after RCT, or staining from restorative materials
setting rules for the game of non-vital bleaching:
Do NOT promise?
Don’t guarantee?
Be sure PATIENT EXPECTATIONS are?
Agree upon?
DOCUMENT?
Pt. will forget?
Result may not meet?
Patients often forget the original
agreement in?
Do NOT promise anything you can’t deliver.
Don’t guarantee RESULTS.
Be sure PATIENT EXPECTATIONS are REASONABLE regarding the proposed procedure.
Agree upon the fee & the NUMBER of visits to be involved in this TRIAL bleaching attempt.
DOCUMENT the starting place with shade guides and photos. Obtain photos and shade of the end result.
Pt. will forget how bad it was to start with.
Result may not meet their expectations.
Patients often forget the original agreement in the heat of expected payment
It is legal and ethical to display
your results in similar situations
in a professional manner.
risks of non-vital bleaching
May not achieve full bleaching of the tooth-results not guaranteed
Existing composites may need to be replaced
Chance of leakage of bleaching agents into root canal causing irritation/pain
benefits of non-vital bleaching
Whiter/matching tooth
Lower cost than crown or veneer
most important factors to Internal bleaching technique
MOST IMPORTANT:
- Make sure you have a Successful RCT in place
- Make sure you have a Substantial SEAL over GP with vitrebond
