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bds4 paediatric dentistry > Treatment of Intrinsic Discolouration in Permanent Anterior Teeth > Flashcards

Treatment of Intrinsic Discolouration in Permanent Anterior Teeth Flashcards

1
Q

What options are available for treatment of intrinsic discolouration in permanent anterior teeth?

A
  • enamel micro abrasion
  • bleaching
    • vital
      • surgery
      • home
    • non-vital
      • inside/outside technique
      • walking bleach
  • resin infiltration technique
    • ICON
  • localised composite restoration
  • veneers
    • composite
      • direct
      • indirect
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2
Q

For what types of discolouration must pre-op records be recorded and why?

A
  • all types of discolouration
    • standardisation of recording
  • show success of treatment
    • patient might not notice clinically
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3
Q

What pre-op records should be taken for discoloured teeth?

A
  • clinical photos
  • shade
    • of defect
    • of background
  • sensibility test
    • compare before and after
    • can be increased
      • bleaching
      • microabrasion
    • can be decreased
      • composite
      • resin infiltration
  • diagram of defect
  • radiographs if clinically indicated
    • must know periapical status
    • check root status
      hypoplastic/hypomineralised teeth)
  • patient assessment
    • VAS
      • visual analogue scale
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4
Q

What materials are used for enamel microabrasion?

A
  • 18% hydrochloric acid
  • pumice
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5
Q

Before starting microabrasion, what safety measures must be carried out?

A
  • PPE must be worn at all times
  • patient must wear goggles and a bib
    • 18% HCl used
      • holes in clothes
      • eye injury
      • skin and lip burns
  • clean teeth with pumice and water
    • remove plaque, pellicle, food debris
  • petroleum jelly applied to gingiva and lips
    • burns heal quickly
    • poor aesthetics
      • very white colour
  • rubber dam placed
    • caulking agent around gingival margins
      • oroseal
  • sodium bicarbonate guard placed
    • sodium bicarbonate mixed with water
    • placed on dam behind teeth
    • if HCl is dropped it is neutralised
  • sodium bicarbonate available
    • apply on rinsing
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6
Q

Describe the process of micro abrasion

A
  • dam and wedjets placed
    • edges of dam must be inverted
  • HCl and pumice slurry applied
    • slowly rotating rubber cup
    • mixture pressed into tooth
      • medium-firm pressure
  • 10 x 5 or 5 x 10 second applications
    • for each tooth
    • wash directly into aspirator each time
  • polish teeth
    • finest soflex disc
  • fluoride varnish application
    • Profluorid
      • not Duraphat due to yellow colour
  • final polish with toothpaste
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7
Q

After microabrasion, what is the purpose of polishing with a fine so flex disc?

A
  • produces a compacted, relatively prismless layer of surface enamel
    • altered optical properties
    • intrinsic discolouration less perceptible
  • results in a shiny appearance
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8
Q

Is microabrasion more effective at targeting the white or the brown spots of fluorosis?

A

brown

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9
Q

When might microabrasion be used?

A
  • decalcification after ortho
  • fluorosis
  • lesions caused by trauma to primary teeth
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10
Q

How many microns of enamel are removed by one session of microabrasion?

A

100 microns

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11
Q

What kits are available for microabrasion and what variations exist?

A
  • Opalustre/Ultradent
    • 6.6% HCl
    • silicon carbide particles
    • bristled rubber cups
  • Prema Kit
    • 10% HCl
    • fine grit silicon carbide
  • neither are as fast as 18% HCl
    • safer as reduced acid strength
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12
Q

What are the advantages of microabrasion?

A
  • easily performed
  • conservative
  • inexpensice
  • teeth need minimal post-op maintenance
  • fast-acting/results in one session
  • removes yellow-brown and white stains
  • effective
  • results are permanent
  • can use before or after bleaching
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13
Q

What are the disadvantages of micro abrasion?

A
  • removes enamel
  • HCl acid compounds are caustic
  • protective apparatus required
  • prediction of treatment outcome is difficult
  • must be done in the dental surgery
  • cannot be delegated
  • sensitive for patients with sensitivity
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14
Q

How is micro abrasion reviewed?

A
  • review 4-6 weeks after micro abrasion
    • take post-op photographs
    • sensibility tests
    • VAS
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15
Q

What post-operative instructions must be given to a patient after microabrasion?

A
  • teeth are dehydrated after procedure
    • increased porosity
    • will take up whatever is consumed
  • do not eat highly coloured food or drink
    • 24 hours post op
    • if would stain a white t-shirt, avoid
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16
Q

What is the GDC guidance on bleaching of permanent teeth in children?

A

‘products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for the purpose of treating or preventing disease’

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17
Q

What are the different types of bleaching available for permanent teeth in children?

A
  • vital bleaching (external)
    • chairside
      • power bleaching
    • at home
      • night guard vital bleaching
  • non-vital bleaching (internal)
    • inside outside technique
    • walking bleach technique
18
Q

What material is used for chair side bleaching and who is it suitable for?

A
  • unstable, rapid reacting hydrogen peroxide
    • 15-38% hydrogen peroxide
      • equivalent to 75% carbamide peroxide
  • too strong for children
  • realistically too strong for adults
19
Q

What material is used for home bleaching systems in night guards?

A
  • 10% carbamide peroxide
20
Q

What modifications can be made to nightguards for vital bleaching?

A
  • reservoirs for bleach on desired teeth
  • windows cut where bleaching not required
21
Q

At what stage can at home vital bleaching be started?

A
  • once all of the teeth are fully erupted
    • upper canine last anterior to erupt
      • 11-12 years
  • avoids a colour discrepancy
    • unerupted would remain unbleached
22
Q

What instructions must be given to a patient surrounding at home vital bleaching?

A
  • brush teeth thoroughly
  • apply gel to the tray
  • set over the teeth and press down
  • remove excess
  • rinse gently, do not swallow
  • wear overnight or minimum 2 hours
  • brush tray and rinse with cold water
  • store correctly so pets do not eat
23
Q

How long should at home vital bleaching be carried out to manage discolouration?

A
  • 3-6 weeks
    • continue until colour acceptable
  • can alternate nights
    • one night gel
    • one night sensitive toothpaste
24
Q

Describe the breakdown of carbamide peroxide

A

10% carbamide peroxide –>

3% hydrogen peroxide, 7% urea –>

(catalases and peroxidases)

water, ammonia and carbon dioxide

25
Q

What are the advantages of non-vital bleaching?

A
  • simple
  • tooth conserving
  • original tooth morphology maintained
  • gingival tissues not irritated by restoration
  • adolescent gingival level not considered
  • no lab assistance required
26
Q

What factors must be considered for tooth selection for non-vital bleaching?

A
  • adequate root filling
    • no clinical disease
    • no radiological disease
  • anterior teeth without large restorations
    • restorations do not bleach
    • warn patient it will look worse initially
    • can replace restoration
  • not amalgam intrinsic discolouration
    • not commonly seen now
  • not fluorosis or tetracycline discolouration
27
Q

Describe the process of preparing a tooth for non-vital bleaching

A
  • remove GP to below gingival margin
    • avoids dark line at gingival level
      • s-shaped dentinal tubules
  • clean cavity with ultrasonic tip
  • apply bleaching agent on cotton wool
  • cover with dry cotton wool
  • seal with glass ionomer cement
28
Q

What is the walking bleach technique and what is the regression rate?

A
  • bleach renewed at each appointment
    • no more than 2 weeks in between
      • bleach fully dissociated
      • no further effect
  • 6-10 changes in total
    • if no change after 3-4, should stop
  • 50% regression at 2-6 years
29
Q

What is inside outside bleaching technique?

A
  • access cavity of tooth left open
    • do not need GI lining
  • customer mouthguard made
    • windows where bleaching not required
  • patient applies pleach to tooth and tray
  • patient keeps access cavity clean
    • replacing gel
    • removal of food debris
  • 10% carbamide peroxide
    • changed very 2 hours
    • except during the night
  • worn all the time
    • except eating and cleaning
30
Q

How should a pulp chamber be restored after non-vital bleaching?

A
  • non-setting calcium hydroxide paste
    • 2 weeks
    • sealed in with GIC
  • white GP and composite resin
    • can re-bleach if required
  • incrementally cured composite
    • cannot re-bleach
    • tooth stronger
    • veneer or crown in case of regression
31
Q

What are the potential complications of non-vital bleaching?

A
  • external cervical resorption
    • most common in traumatised teeth
    • not common
  • spillage of bleaching agents
  • failure to bleach
  • over bleach
  • brittleness of tooth crown
32
Q

How can external cervical resorption be prevented after non-vital bleaching?

A
  • layer of cement over GP
    • prevents bleaching agent escaping
      • external surface of root
    • can prevent adequate bleaching
      • cervical region
  • non setting calcium hydroxide for 2 weeks
    • reverses acidity in periodontal ligament
      • if bleach escaped
    • final restoration can then be placed
33
Q

What are the possible effects of bleaching on soft tissue?

A
  • short term exposure
    • minor ulceration/irritation
    • plaque reduction
    • aids wound healing
  • long term exposure
    • delayed wound healing (?)
    • periodontal harm (?)
    • mutagenic potential (?)
34
Q

What is tooth mousse?

A
  • CPP-ACP
    • casein phosphopeptide amorphous calcium phosphate
      • mild derived protein
      • cannot use in case of dairy allergy
    • Recaldent (brand)
35
Q

How can tooth mouse be used as an adjunct to microabrasion and bleaching?

A
  • evidence is not great
    • can be used to reduce sensitivity
    • not great for improving aesthetics
  • suggested use from manufacturer
    • after bleaching
      • 2 weeks at home application
    • after micro abrasion
      • 4 weeks at home application
36
Q

What is resin infiltration and how can it be used?

A
  • infiltration of enamel lesions with low-viscosity light curing resins
  • surface layer eroded
    • lesions desiccated
    • resin infiltrant applied
      • penetrates lesions
      • driven by capillary forces
  • discoloured appearance lost
    • similar appearance to sound enamel
    • refractive index moved from 1.32-1.46
    • enamel refractive index is 1.62
37
Q

What is the refractive index of enamel?

A

1.62

38
Q

Can bleaching and resin infiltration be used in combination?

A

yes, however bleaching must be carried out first as bleach will not enter the enamel prisms if filled with resin

39
Q

What factors must be considered for veneers in paediatric patients?

A
  • aesthetics
  • relative tooth position
  • masking dark stains
  • age
  • psyche
  • plaque removal
40
Q

How must enamel reduction for veneers be considered for veneers in paediatric patients?

A
  • overcontouring
    • increased plaque retention
    • stagnation at gingival margin
      • especially with existing poor OH
  • bond strength
    • significantly increased
      • partial buccal enamel removal

bds4 paediatric dentistry (11 decks)

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