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PresRes 3 > Whitening > Flashcards

Whitening Flashcards

1
Q

History of Tooth Whitening

A
  1. 1980s: innovation
  2. 1990s: emerging
  3. 2000s: commodity (look younger, improve self-confidence, smile more)
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2
Q

Stains/Discolorations

A
  1. important to identify causes of stain prior to initiating tx
  2. certain stain types are more response to “bleaching”
  3. two categories: extrinsic and intrinsic
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3
Q

Extrinsic stain

A
  1. occur after tooth eruption
  2. caused by tobacco, food, drink, metals, alloys
  3. caused by chromogens accumulating on external surface of tooth (incorporated into dental pellicle)
  4. most can be removed via routine prophylaxis
  5. darken over time, become more difficult to remove when left unaddressed
  6. HIGHLY RESPONSIVE to whitening
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4
Q

Intrinsic Stains

A
  1. can occur during development/throughout life
  2. “internal” stains
  3. CAN’T be removed via prophy
  4. can be reduced
    * *YELLOW stain: high typical responses
    * *BLUE-GRAY stain: slow and low typical responses
    * *BROWN stain: moderate typical responses
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5
Q

What causes intrinsic stains?

A
  1. age: enamel thinning, dentinal thickening, secondary dentin formation
  2. genetics/systemic conditions/developmental disorders: amelogenesis imperfecta, dentinogenesis imperfecta
  3. antibiotics: tetracycline
  4. fluoride: >1-2 ppm
  5. trauma
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6
Q

Inactive Ingredients of Whitening

A
  1. thickening agents
  2. carrier
  3. surfactant/detergent
  4. preservatives
  5. flavoring
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7
Q

Thickening agents

A
  1. increase viscosity
  2. increases oxygen-releasing time=increased activity (4X)
  3. polyacrylic acid polymer (carboxypolymethylene=Carbopol)
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8
Q

Carrier

A
  1. maintains moisture

2. glycerine and/or propylene glycol

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9
Q

Surfactant/detergent

A
  1. increases effectiveness by acting as surface-wetting agent
  2. prevent reattachment of chromogens
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10
Q

Preservatives

A
  1. prevent bacterial growth

2. sodium benzoate or propylparaben

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11
Q

Flavoring

A
  1. increase patient acceptance

2. flavors/sweeteners

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12
Q

Active ingredients of whitening

A
  1. carbadmide peroxide

OR

  1. hydrogen peroxide
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13
Q

Carbamide Peroxide

A

hydrogen peroxide and urea

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14
Q

Hydrogen Peroxide

A

absorbed into enamel and dentin

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15
Q

Comparing hydrogen peroxide to carbamide peroxide

A

10% carbamide=3% hydrogen peroxide

35% carbamide=12% hydrogen peroxide

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16
Q

How is carbamide peroxide different from hydrogen peroxide?

A
  1. hydrogen peroxide=very unstable

2. hydrogen peroxide penetrates the tooth more quickly than carbamide peroxide

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17
Q

How does whitening work?

A
  1. basic mechanism is same for both active ingredients
  2. tooth is semi-permeable membrane
  3. peroxide penetrates to the pulp in 5 to 15 minutes
    * *bleach passes from incisal edge to apex of tooth
  4. color change is same at pulp as at dentin-enamel junction
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18
Q

How does whitening work?

Ex: hydrogen peroxide

A
  1. H2O2 is unstable and reactive
  2. H2O2 breaks down in water
  3. oxygen free radicals look for something to attach to
  4. most easily attacked are double carbon bonds that are the source of most stains
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19
Q

How it works: oxidation-reduction reaction

A
  1. O2 molecules enters the enamel and dentinal tubules
  2. attracted to double bonds of stain molecules
  3. double bonds are broken down into single bonds (alters internal colors)
  4. changes molecules to become translucent
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20
Q

The organic colors are mostly __

A
  1. aldehydes

2. esters

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21
Q

After oxidation, the molecules change into __

A
  1. carboxylates

2. hydroxyls

22
Q

Lightening effect

A

chromagens are oxidized during whitening

23
Q

Chroma/value/hue changes

A

ONLY chroma and value change

24
Q

Strength of whitening gel/contact time is the most important

A
  1. MORE time the bleaching solution is in contact with teeth=faster the teeth will bleach
  2. strength of whitening gel is less important
25
Q

Double carbon bonds absorb/reflect light

A

absorb light

26
Q

Single carbon bonds absorb/reflect light

A

reflect light

27
Q

Bleaching endpoint

A
  1. point at which a patient’s teeth won’t lighten any further
  2. continued bleaching at this point does no more good
28
Q

Vital Tooth Whitening

A
  1. in office (power bleaching)
  2. dentist supervised
  3. over-the-counter
  4. power whitening centers (malls)
29
Q

Non-vital Tooth Whitening

A
  1. walking/modified walking bleach technique
    * *sodium perborate and H2O
    * *in pulp chamber, sealed and repeated at intervals
  2. non-vital in office “power bleaching”
    * *hydrogen peroxides
    * *in pulp chamber, re-assessed at two weeks
30
Q

Whitening toothpaste

A
  1. higher amounts of abrasives and/or detergent
  2. some products have higher hydrogen peroxide or carbamide peroxide
  3. can expect a change of 1-2 shades
31
Q

OTC Whitening Strips

A
  1. deliver a thin layer of peroxide gel
  2. have varying instructions
  3. results can usually be seen before end of tx cycle
  4. can expect a change of 1-2 shades
32
Q

OTC Whitening Gels

A
  1. peroxide-based gel brushed directly onto labial/facial surfaces
  2. have varying instructions
  3. can expect a change of 1-2 shades
33
Q

OTC Whitening Rinses

A
  1. contain oxygen sources
  2. can expect a change of 1-2 shades
    3 . results typically take longer-up to 3 months
34
Q

Does light activation offer any benefits?

A

NO

  1. amount of whitening
  2. persistence of results
  3. avoidance of sensitivity
35
Q

Effects on soft tissues

A

highly concentrated hydrogen peroxides (office settings)

  1. soft tissue burning
  2. gingiva turn white, brown
  3. reversible, no long term effects

USE a rubber dam!!

36
Q

Systemic effects

A
  1. GI upset
  2. burning sensation of palate, throat
  3. safety at low concentrations when used as directed
  4. OTC > concern than in-office solutions
37
Q

Effects on Tooth Structure (aggressive bleaching)

A
  1. reduced stability of resins, GI, sealants, ceramic crowns
  2. changes surface integrity and microstructure of enamel
  3. increases susceptibility to demineralize
38
Q

Effects on Tooth Structure (normal bleaching)

A

safe

39
Q

Sensitivity

A
  1. passage of H2O2 through enamel and dentin to pulp
  2. young patients have large pulp horns
  3. exposed root surfaces
    4 abfraction lesions, erosion, wear lesions
  4. over wearing of tray
  5. improper fit of tray
  6. dehydration (goes away after rehydration)
    8 higher concentration, higher likelihood of sensitivity
  7. no long term effects
40
Q

Tx Options for Sensitivity

A
  1. ibuprofen
  2. alternate whitening days
  3. potassium nitrate-prevents re-polarization of the nerve
  4. neutral fluoride-occludes dentinal tubules
41
Q

Pros of Custom Trays

A
  1. less expensive
  2. great for touch-ups
  3. less sensitivity
  4. positive results (happier patients)
42
Q

Cons of Custom Trays

A
  1. takes longer

2. patient compliance

43
Q

Pros of In-Office Solutions

A
  1. faster
  2. quick results
  3. good jumpstart
44
Q

Cons of In-Office Solutions

A
  1. more expensive
  2. potential for increased sensitivity
  3. follow-up tray for best results
45
Q

Home Tx Options

A
  1. patient time commitment requirement
  2. light-activated systems were never designed to be better than take-home systems (just faster, more convenient)
  3. combining light-activated systems with take home products for touch up whitening can extend benefits
46
Q

Yellow/brown stain requires __ weeks to remove

A

1 to 3 weeks

47
Q

Blue/grey stain requires __ weeks to remove

A

6+ weeks

48
Q

Tetracycline stain requires __ to remove

A

months (if possible)

49
Q

Contraindications for whitening

A
  1. active decay
  2. multiple fractured teeth
  3. multiple anterior restorations
  4. pregnant women
50
Q

What should be done before whitening?

A
  1. prophy
  2. help pt select best tx option
  3. inform pt what to expet
  4. keep records
  5. chart patient’s shade before and after tx
  6. one arch at a time

PresRes 3 (6 decks)

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