Paeds=Treatment of discoloured teeth

Question 1

List the treatment options for discolouration of teeth.

Answer 1

• Micro-abrasion
• Bleaching
• Composite bonding
• resin infiltration
• Veneers
• Do nothing.

Question 2

What is microabrasion?

Answer 2

Removal of the surface layer of opaque enamel

Question 3

Discuss the diadvantages of microabrasion?

Answer 3

• Removes enamel:
  
  • Sensitivity
  • Teeth can become more sensitive to staining
• HCL acid is caustic so we need to protect dentist and patient.
• Difficult to predict treatment outcome
  
  • Teeth can appear more yellow (normal crown colour revealed underneath)

Question 4

Discuss the advantages of microabrasion?

Answer 4

• Easy
• conservative
• Inexpensive
• Teeth need minimal subsequent maintenance
• Fast acting
• Removes yellow-brown, white and multicoloured stains.
• Permanent results.

Question 5

List the steps for microabrasion?

Answer 5

1. Clean with pumice and water
2. Soft tissue protection (petroleum jelly and a rubber dam)
3. Gingival protection (sodium bicarbonate guard)
4. Microabrasion- HCL pumice with slow handpeice and rubber cup for 5s
5. Application of white fluoride varnish
6. Polish with sandpaper disc
7. Polish with toothpaste

Question 6

Why is white fluoride varnish applied to the tooth after microabrasion?

Answer 6

To remineralise

To help with sensitivity.

Question 7

What do we tell the patient after microabrasion treatment?

Answer 7

Avoid highly coloured food and drinks for at least 24hours.

Question 8

What is the maximum number of microabrasion cycles to undertake?

Answer 8

2

Question 9

In what situations can we bleach under 18s?

Answer 9

For use in treatment of diseases e.g. trauma/fluorosis/hypomineralisation

Question 10

Compare the chemicals used for chairside bleaching and at home bleaching?

Answer 10

Chairside- Hydrogen peroxide 15-38% (equivalent to 75% carbamide peroxide)

At home bleaching- 10% carbamide peroxide.

Question 11

What advice do we give the patient recieving a night guard for whitening?

Answer 11

Wear it at night (or for at least 2 hours a day)

Brush your teeth and floss before placing the mouthguard in.

Apply a little gel to the tray, set over teeth and press down.

Remove excess.

Clean with a brush and cold water.

You may need a bit of sensitive toothpaste.

Question 12

How does tooth whitening affect the treatment plan of restorations?

Answer 12

You need to wait until after tooth whitening to complete any restorations (we need to match the restorations to the already whitened teeth)

Question 13

Why can patients experience tooth sensitivity after tooth whitening?

Answer 13

The hydrogen peroxide easily passes through intact enamel and dentine to the pulp.

Question 14

How do we treat sensitivity from tooth whitening

Answer 14

Tooth mouse.

It contains an amorphosus calcium phosphate milk derived protein. (Be careful with milk allergies)

Applied for 2 weeks post bleaching.

Advised application for 4 weeks post microabrasion.

Question 15

How do we prevent gingival irritation from tooth whitening?

Answer 15

The impression tray is made to not be over the gingivae

Question 16

How does bleaching treat patients with amelogenesis imperfecta ?

Answer 16

By making the rest of the tooth whiter to disguise the white marks of the amelogenesis imperfecta.

Question 17

List suitable teeth for treatment by non vital bleaching?

Answer 17

Previously root canaled teeth.

Anterior teeth without large restorations.

Question 18

List unsuitable teeth for treatment by non- vital bleaching?

Answer 18

• Teeth with intrinsic discolouration due to amalgam.
• Fluorosis discolouration
• Tetracycline discolouration

Question 19

Describe the walking bleach technique:

Answer 19

Bleaching agent is sealed in to the tooth then a temporary restoration placed.

The patient comes back in for next appointment to have the bleach changed.

Question 20

Describe the inside out bleaching technique

Answer 20

The access cavity of the tooth being bleached is left open.

Carbamide peroxide is applied to the cavity and tray.

This mouthguard is worn at all times apart from when eating.

The gel is changed every 2 hours except at night.

Pt must keep the cavity clean.

Question 21

Why do we place non setting calcium hydrogen for 2 weeks after inside out bleaching before the final restoration?

Answer 21

To prevent any external cervical resorption.

Question 22

List some complications of Bleaching?

Answer 22

• External cervical resorption
• Spillage of bleaching agents
• Failure to bleach
• Overbleaching
• Brittleness of tooth crown.

Question 23

How do we prevent external cervical resorption?

Answer 23

By placing a layer of cement over the GP (so the bleaching agent cannot get to the external surface of the root)

Question 24

What is resin infiltration?

Answer 24

Infiltration of enamel lesions with low viscosity light curing resins.

Question 25

How does resin infiltration work ?

Answer 25

The surface layer is eroded, lesions dehydrated and then a resin infiltrant is applied. The resin penetrates the lesion (driven by capillary forces). This causes the infiltrated lesions to lose their discoloured appearance and look like sound enamel.

Question 26

Describe the process of resin infiltration?

Answer 26

1. Rinse and clean the teeth
2. Rub in etch and leave for 2 minutes
3. Rinse off etch.
4. Apply icon Dry (and leave it for 30s)
5. Check if lesion has been accessed (are the white spots masked?)
   Repeat steps until white spots are marked.
6. Apply icon infiltrant & leave for 3 minutes
7. Remove excess
8. Light cure for 40s
9. 2^nd layer of infiltrate & leave to act for 1 minute.
10. Blow off excess.
11. Light cure for 40s
12. Polish.