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paediatrics > Intrinsic Discolouration > Flashcards

Intrinsic Discolouration Flashcards

1
Q

What are the treatment options for a discoloured anterior tooth?

A

Microabrasian
Vital bleaching
Non-vital bleeding
Resin infiltration (ICON)
Localised composite restorations
Veneers

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2
Q

What pre-op records are required for discoloured teeth prior to treatment?

A

Clinical photos
Shade of the defect and shade of the background of the tooth
Sensibility testing- check for sensitivity
Diagram of defect
Radiographs if clinically indicated
Patient assessment- Visual analogue scale

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3
Q

Why is it important to check the sensitivity levels of teeth?

A

Microabrasion and bleaching may make the teeth more sensitive

Composite veneers may make the tooth less sensitive

Important to know the baseline

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4
Q

What is micro abrasion?

A

Utilises 18% HCL with pumice and water to abrade the surface of the defect off the tooth.

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5
Q

What is micro abrasion good at treating?

A

Works best with brown lesions- fluorosis, trauma to primary incisors, white spot lesions from ortho treatment.

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6
Q

Describe the procedure of micro abrasion?

A

Don PPE
Give patient glasses and bibs
Apply dental dam
Clean teeth with pumice and water
Place oraseal or opal dam around the gingival margins to protect these
Place sodium bicarbonate guard on the dam behind the teeth
HCL pumic slurry in slowly rotating rubber cup over the defect for 5 seconds
- maximum 10x 5 second applications.
Wash directly into the aspirator every 5 second application.
Apply fluoride varnish- profluorid.
Polish with sandpaper disc.
Final polish with toothpaste.

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7
Q

Why do you use Profluorid varnish and not duraphat for micro-abrasion?

A

Microabrasion makes your teeth very porous and durapjat is yellow- so you want to use a whiter varnish.

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8
Q

Why use sandpaper discs to polish following micro abrasion?

A

Improves the result of the procedure if you use sand paper discs.

It changes the optical properties of the enamel so that areas of intrinsic discolouration become less perceptible.

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9
Q

How much tooth tissue is lost due to micro abrasion?

A

100 microns.

Roughly 5-10 microns is lost when using trophy and toothpaste.

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10
Q

What post-op instructions are given to patients and parents after micro abrasion?

A

Teeth are dehydrated after procedure so do not eat highly coloured food and drinks for at least 24 hours.
- anything that would stain a white t shirt- do not eat or drink.

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11
Q

When should patients be reviewed after micro abrasion?

A

4-6 weeks- take post-op photographs, sensibility tests and visual analogue scale.

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12
Q

What are the advantages of micro abrasion?

A

Easily performed

Conservative

Inexpensive

Teeth need minimal subsequent maintenance

Fast acting

Removes yellow0brown, white and multi-coloured stains

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

Requires protective apparatus for patient, dentist and dental nurse

Prediction of treatment outcome is difficult

Must be done in dental surgery

Cannot be delegated- i.e. to therapist.

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14
Q

Can bleaching be done 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 is intended wholly for the purpose of treating or preventing disease.

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15
Q

What are the options for bleaching?

A

Vital external bleaching- chair side or night guard vital bleaching.

Non-vital bleaching- inside outside technique or walking bleach technique.

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16
Q

Why is chairside bleaching not recommended in children?

A

Unstable, rapidly reacting hydrogen peroxide (too strong for paeds patients)- equates to 75% carbide peroxide.
- risk to soft tissues and eyes.

Nightguard vital bleaching with 10% carbamide peroxide gel.

17
Q

What equipment do you need for night guard vital bleaching?

A

Bleaching tray- take impressions for his and block out areas that you don’t want to bleach.

10% carbamide peroxide gel.

18
Q

What instructions would you give to patients for Nightguard vital bleaching?

A

Brush teeth thoroughly

Apply about half a kernel of sweetcorn per tooth onto the tray

Set over the teeth and press down

Remove excess gel with a tissue

Rinse gently, do not swallow

Wear overnight or for at least 2 hours.

Remove tray and rinse with cold water.

19
Q

How often should you review a patient who is using a night guard vital bleaching kit?

A

See them initially after 2 weeks- might take 3-6 weeks to see effect.

20
Q

What does carbamide peroxide degrade to?

A

10% carbamide peroxide degrades to 3% hydrogen peroxide and 7% urea.

Catalases and peroxides degrades these to water, ammonia and carbon dioxide.

21
Q

When is non-vital bleaching done?

A

When the tooth is non-vital.

22
Q

What are the advantages of non-vital bleaching?

A

Simple
Tooth conserving
Original tooth morphology
Gingival tissues not irritated by restoration
Adolescent gingival level not a restorative consideration

23
Q

When deciding whether to carry out non-vital bleaching, what would you check in a tooth?

A

Adequate root filling- within 1-2mm of radiographic apex, well condensed, no ledges or voids, well tapered.
- No clinical or radiographic signs of disease.

Anterior teeth without large restorations
- If they do have restoration, you will need to warn them that it will look worse before it looks better.
- Either need to take the restoration off, bleach it and then replace the restoration or bleach it with the restoration and then replace it.

Not amalgam intrinsic discolouration

Not fluorosis or tetracycline discolouration.

24
Q

What are the two methods for non-vital bleaching?

A

Walking bleach- bleach placed inside the tooth and seal it up, oxidising process allowed to proceed gradually over days.

Inside out method- uses a tray, bleach into the tray and place it in mouth. Remove part of the root filling and leave it open.

25
Q

Describe the procedure of non-vital “walking bleach” technique?

A

Don PPE
Give patient protective equipment
Apply dental dam with oraseal or opal dam.
Access cavity to expose GP
Use ultrasonic tip to remove GP to below the gingival margin.
Place a cotton wool pledget soaked in 10% carbamide peroxide into cavity.
Cover with dry cotton wool pledget
Restore with temp GIC.

26
Q

How often does the carbamide peroxide cotton wool pledget need to be replaced in the walking bleach technique?

A

No more than 2 weeks in between appointments.
- If no change after 3-4 weeks then stop.

6-10 changes total.

27
Q

Why is it advised to not allow more than 2 weeks between bleaching changes for the walking bleach technique?

A

Catalases and peroxides will convert the hydrogen peroxide to water, ammonia and carbon dioxide.

The bleach will denature and tooth onset being bleached anymore.

28
Q

Describe the procedure for inside out non-vital bleaching?

A

Access cavity to open tooth

Custom made mouthguard- cut windows in guard of the teeth you don’t want to bleach

Patient applied bleaching agent (10% carbamide peroxide gel) to back of tooth and tray

Patient keeps access cavity clean, removes food debris.

Worn all the time except eating and cleaning.

Change the gel every 2 hours, except for during the night.

29
Q

How will the pulp chamber be restored?

A

Non setting calcium hydroxide paste for 2 weeks- seal in with GIC.

Either-
- White GP and composite resin (allows re-bleaching to be done)
- Incrementally fired composite- no re-bleaching but stronger tooth.

30
Q

What are the potential complications of non-vital bleaching?

A

External cervical resorption
Spillage of bleaching agents
Failure to bleach
Over bleach
Brittleness of tooth crown

31
Q

How can you help prevent external cervical resorption?

A

Layer of cement over GP
- prevents bleaching agent from getting to external surface of root (not for inside out technique)
- but can prevent adequate bleaching of cervical area.

Non-setting calcium hydroxide in tooth for 2 weeks before final restoration
- reverses acidity in PL that might have occurred if above had happened.

32
Q

What can be given to patients as an adjunct to micro abrasion and bleaching?

A

Tooth mousse- CP-ACP milk derived protein.
- cannot be given to someone with a milk allergy.

After bleaching
- 2 weeks home application

After microabrasion
- 4 weeks home application.

33
Q

What is resin infiltration?

A

Infiltration of enamel lesions with low-viscosity light curing resins. by capillary action.

34
Q

Describe the procedure of Resin infiltration with ICON.

A

Apply dental dam
Clean the tooth
Apply etch and rub it on the tooth for 2 minutes- erodes the surface.
Rinse the etch off
Apply ICON dry for 30 seconds
- Observe and see if the white spots are removed with the ICON dry.
Plastic strips between the teeth
Apply ICON resin to the teeth and then remove excess with cotton wool rolls- leave for 3 mins.
Light cure.

Resin penetrates the lesion driven by capillary forces.

35
Q

What other options are there for intrinsic discolouration?

A

Veneers- direct with composite or indirect with BellGlass.

Probably the option in tetracycline staining.

36
Q

What must you warn patients of prior to bleaching?

A

Won’t last forever
Won’t bleach restorations
Might not work at all
May cause sensitivity
Problems with bonding to teeth after bleaching.
Gingival irritation

paediatrics (13 decks)

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