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Flashcards in teeth WHITENING-Elgendy Deck (19)
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1

Bleaching Rationale

  • tooth discoloration due to intrinsice or extrinsic stains
    • intrinsic stains
      • aging
      • excessive fluoride intake
      • dental caires
      • restorations
    • extrinsic stains
      • poor oral hygiene
      • chromatogenic foods
      • tobacco use
  • Cause of staining needs to be assessed to predict which bleaching will work better
    • yellow staining responds well to bleaching
    • blue-grey stain-difficult

2

MOA: Hydrogen Peroxide vs Carbamide Peroxide

  • Hydrogen Peroxide gel
    • concentration varies: 3-40%
    • releases all peroxide in first hour
    • produces more sensitivty than carbamide peroxide
  • Carbamide peroxide gell
    • concentration: 10-22%
    • 10%=orginal standard for at home bleaching
    • penetrates enamel and dentin to pulp in 5-15 mins
    • dissociates into urea and hydrogen peroxide
      • urea-elevates the pH 
        • stablizes hydrogen peroxide
    • More stable molecule
      • longer shelf life
      • more predictable
    • releases 50% of its peroxde in first 2-4 hours
      • remainder released next 2-6 hours

3

Types of bleaching

  • Vital bleaching
    • in-office bleaching
    • at-home bleaching
    • OTC bleaching
  • Non-vital bleaching
    • internal bleaching
    • external bleaching
    • walking bleaching

4

In-Office bleaching

  • 35% hydrogen peroxide
  • applied directly on teeth
  • may use light or heat to enhance peroxide release
  • rapid and acceptable results
  • tissue injury may occur

5

At-home bleaching

  • 10% carbimide in custom fit tray
  • safe and excellent results
  • less expensive than in-office
  • requires longer periods of tx than in-office

6

Internal Bleaching

  • 30% hydrogen peroxide
  • applied to pulp chamber
  • heat applied for 30 mins
  • solution rinsed from pulp

7

Walking Bleaching

  • Mixture of:
    • hydrogen peroxide
    • sodium perborate
  • make a paste
  • sealed in the pulp chamber for several days

8

Non-vital power bleaching (internal)

  • Hydrogen peroxide (30-35%) placed inn pulp chamber
    • activated by light or heat
    • gel removed
    • tooth dried
  • Walking bleach technique used between visits for 2 weeks
  • Best technique bc of strong interaction b/w hydrogen peroxide and heat

9

Inside/outside bleaching

  • combo of:
    • internal bleaching
    • home bleaching

10

Sodium perborate mixed with:

3-30% hydrogen peroxide vs distilled water

  • No significant difference
  • sodium perborate-Distilled water mixture took longer
  • Shade stability is same 

11

Non-vital: Preliminary treatment

  • determine cause of tooth discoloration
  • take pre-treatment and post-treatment radiographs
    • check quality of root filling
  • root filling should be reduced 1-2mm below CEJ
  • Clean cavity surface from debris and remnant of endo material

12

non-vital tooth bleaching

  • base required
    • prevent radicular penetration of bleaching agents
  • bleaching agent should be changed every 3-7 days
  • successful bleaching apparent after 2-4 visits
  • Use resin composites with lighter shades
  • Negative influence of adhesion reduced by:
    • beveling the cavity before acid etching
    • pretreatment of enamel w/dehydrating agents (Alcohol)
  • To dissolve peroxide remnants
    • cavity cleaned w/sodium hypochlorite

13

Teeth Whitening: Indications vs Contraindications

  • Indications:
    • dissatisfied w/tooth color
    • matching teeth w/lighter indirect restoration
    • whitening single discolored tooth
  • Contraindications:
    • Superficial stains
    • Hypersensitive teeth
    • carious teeth
    • cracked teeth
    • large pulp chambers
    • severe enamel loss

14

What percent of patients experience sensitivity during or after bleaching treatment?

25-70%

15

Tooth Sensitivity Management

  • Passive Treatment
  • Active Treatment
    • apply medicine using same bleaching tray
      • fluoride
      • potassium nitrate 
        • "numbness"
  • Passive treatment
    • shorten duration of treatment 
    • stop treatment for day or more 
    • allows recovery

16

Treatment of patients with maximum sensitivity

  • Do not start bleaching after prophy
  • Brush with potassium nitrate toothpaste for 2 weeks before starting
  • wear empty tray 1 or 2 nights to become familiar
  • wear tray w/potassium nitrate toothpaste for 1 or 2 nights
  • Begin bleaching initially with shorter daytime period 
    • use 10% carbamide peroxide w/potassium nitrate and fluoride in produce
  • Contineu brushing w/desensitizing toothpaste 
  • avoid acidic rinks which remove smear layer
    • colar, fruite juices

17

Alternatives to bleaching

  • Microbrasion
  • Macrobrasion
  • Veneers (Direct or indirect)
  • Crowns

18

Microabrasion

19

Local causes for intrinsic discoloration

  • pulp necrosis
  • intrapulpal hemorrhage
  • pulp tissue remnant after endo
  • endo materials
  • coronola filling material
  • root resorption
  • aging