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Flashcards in Discolouration of teeth Deck (33)
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1

Aetiology of discolouration

Extrinsic/intrinsic
System/local
Enamel/dentine
Congenital/acquired

2

Extrinsic factors causing tooth discolouration

Food/drink
Smoking
Poor OH
Drugs

3

Intrinsic factors causing discolouration of enamel
a) local
b) systemic

a) trauma, idopathic, caries
b) amelogenesis inperfecta, flourosis, systemic illness, idiopathic

4

Intrinsic factors causing discolouration of dentine
a) local
b) systemic

a) necrotic pulp, metal ions, root canal filling materials, caries,
b) dentinogesis imperfecta, tetracycline, bilirubin

5

Amelogenesis imperfecta manifestations?

Normal shape
Brown markings
Opaque

6

Treatment of discoloured anterior teeth

Enamel micro abrasion
Tooth whitening
Veneers (composite/porcelain)
Crowns

7

Indications for micorabrasion?

White/brown intrinsic blemishes in outer layer of enamel
Turner teeth (hypoplasia)
Flurosis
Idiopathic speckling
Post-ortho demin
Prior to veneers

8

Microabrasion contraindications

Non-vital teeth or tetracycline staining (within the dentine)

9

Microabrasion technique

Clean teeth
Rubber dam
Seal dam
Sodium bicarbonate and water paste on rubber dam around teeth

Etchant for 15 secs and wash off
Repeat up to 10x
Fluoride gel on teeth to mineralise
Polish with toothpaste

10

HOw can vital tooth whitening be characterised?

Over the counter - toothpaste
In-surgery - heat and light - 15% carbamide peroxide gel
Tray-based - 15% carbamide peroxide gel over night

11

Problems with over the counter teeth whitening?

Self-diagnosis - may be careis

12

Indications of vital whitenign?

Severe extrinsic stain
Age related discolouration
Calcified pulp
Fluorosis
Mild tetracylcine

13

Contraindications for vital whitening?

Large pulp
During ortho
Hypersensitive teeth
Severe enamel loss
Extensive restoration
Pregnancy/breast feeding

14

How does teeth whitening work?

Oxidation

15

Consequence of whitening?

If you do it too long - enamel breakdown

16

Materials used for in-surgery tooth whitening?

Rubber dam
Phosphoric acid (etch)
Hydrogen peroxide

17

Tray-based whitening materials?

Carbamide peroxide gel 10% = 3% hydrogen peroxide

18

Effects of whitening on teeth?

Mild sensitivity to temperature changes
Cellular pulp changes
Dameg to enamel
PH of solution
Bond strength to composite

19

Saftey concerns of tray whitening?

JE may be permeable to carbamide peroxide - exposure to lots of cells

20

Why should <18 years not use vital whitening?

Larger pulp chambers
Little secondary dentine
Poorer plaque control (?)
Increased potential for pulpal hyperaemia
Heat should not be used

21

What is the maximum hydrogen peroxide dose prescribed by dentist for whitneing?

<6%

22

Advantages of non-vital tooth whitening

Simple
Tooth conserving
Original morphology
Gingival tissues
Adolescents
No lab assistance

23

Materials/methods of non-vital whitening?

Thermo-catalytic --> heat source, light or probe release oxygen from bleaching agent

Walking bleach --> oxidising process allowed to proceed gradually over days - seal carbamide peroxide gel in for a week repeatedly

Inside/outside bleach --> bleach tray and open access cavity

24

Indications for non-vital whitenign?

Adequate obturation (remove GP to gingival margin)
No radiological disease
No lareg restorations
Not staining caused by restorative materials (amalgam not reversible)
Fluorosis/tetracylines not appropriate

25

Describe walking bleach technique

Access cavity and pulp chamber restorations removed - GP to gingival margin
Freshen dentine inside pulp chamber, etch chamber
carbamide peroxide gel into cavity, cotton wool placed over
Seal with GIC
Return in a week

26

Complications of non-vital whitening?

External cervical resorption
Spillage
Failure to whiten
Over whitening
Brittleness of tooth crown

27

Describe inside/outside non-vital whitening technique

Access pulp chamber
squirt carbamide peroxide gel inside
Place beaching tray on and squirt into bleaching tray (inside and outside the tooth)

28

Indications for inside/outside NV whitenign?

Single root filled tooth
No signs of pathology
Impressions
Adequate OHI and able to clean tray

29

Arguments for enamel reduction in primary teeth for veneer prep?

Decreases likelihood of over contouring
Better bond strength to composite

30

Arguments against enamel reduction in primary teeth for veneer prep?

Young patient have large pulp chambers and unstable soft tissue