Discoloration

Question 1

pre-op records

Answer 1

clinical photos
shade of tooth/defect
sensibility testing
diagram of defect
pt assessment e.g. VAS

Question 2

tx options

Answer 2

do nothing
enamel microabrasion
bleaching: vital/non-vital SPECIALIST FOR CHILDREN
resin infil (ICON)
composite restoration
veneers- direct/indirect

Question 3

what is microabrasion

Answer 3

removal of the surface layer of opaque enamel

Question 4

advantages of MA

Answer 4

easy, conservative, inexpensive, minimal maintenance
can be done before or after bleaching

Question 5

disadvantages of MA

Answer 5

removes enamel> sensitivity, more susceptible to staining
18% HCL is CAUSTIC
PPE
prediction of outcome is diffcult

Question 6

microabrasion clinical technique

Answer 6

1. PPE
2. clean teeth with pumice and water, removes plaque/pellicle
3. soft tissue protection, petroleum jelly
   4.rubber dam
4. sodium bicarb guard
5. HCL pumice slurry application max 10 5s applications
6. polish with finest sandpaper disc
7. FV application- profluorid

Question 7

MA key points

Answer 7

max 10x 5 s applications
no metal instruments, use wooden stick to apply
100 micron enamel loss

Question 8

MA post op instructions

Answer 8

warn pt to avoid highly coloured food/ drinks 2 weeks
review 4/6 weeks, post op photos
2nd cycle only if first worked

Question 9

Nightguard vital bleaching

Answer 9

10% carbamide peroxide gel
tray design- windows in teeth to not be bleached
e.g. caries hypomineralistaion veneers crowns
sensitive toothpaste may be required

Question 10

pt technique for nightguard vital bleaching

Answer 10

brush teeth
apply gel to tray
set over teeth push down
remove excess
rinse gently do not swallow
wear overnight
remove, clean tray

Question 11

non-vital bleaching advantages

Answer 11

simple
tooth conserving
no gingival irritation

Question 12

non-vital bleaching indications

Answer 12

adequate root filling- no disease
anterior teeth without large restorations
not amalgam/fluorosis/tetracycline discolouration

Question 13

non-vital bleaching complications

Answer 13

external cervical resorption
spillage of bleaching agents
failure to bleach
over bleach
brittleness of tooth crown

Question 14

what are the two non-vital techniques

Answer 14

inside out
walking

Question 15

first 5 steps of both techniques

Answer 15

1. GP removed to below CEJ
2. clean with ultrasonic
3. layer of RMGIC over GP
4. bleaching agent on cotton pledget
5. cover with dry pledget

Question 16

inside-out technique

Answer 16

6. access left open
7. custom made tray
8. pt applies 10% carbamide peroxide to back of tooth/ tray

Worn all the time except eating/cleaning
gel changed every 2 hours

Question 17

walking technique

Answer 17

6. seal with GIC
7. renew bleach ideally no more than 2 weeks between appts
   if no change after 3-4 STOP
8. 6-10 changes

Question 18

restoration of pulp chamber after NVB

Answer 18

after NVB non-setting CaOH for 2 weeks, seal GIC
1: White GP+ composite: facility to rebleach
2: composite: no re-bleaching but stronger teeth