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BDS4 Paediatrics > Tx of Intrinsic Discolouration Permanent Anterior Teeth > Flashcards

Tx of Intrinsic Discolouration Permanent Anterior Teeth Flashcards

1
Q

What pre-op records do you need for all discolured teeth?

A

Clinical photos
Shade
Sensibility testing, check for sensitivity
Diagram of defect
Radiographs if clinically indicated
Patient assessment e.g VAS etc

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2
Q

What sheet is used on level 5 for discolouration of teeth?

A

The SHADE sheet

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3
Q

What are the different tx option for discoloured teeth?

A

-Enamel microabrasion
-localised composite restoration
-bleaching (vital or non-vital)
-resin infiltration (ICON)
-veneers (direct or indirect)
-do nothing

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4
Q

Difference between vital and non-vital bleaching?

A

-vital (sugery or at home)
-non vital (inside outside technique or walking bleach technique)

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5
Q

What is microabrasion?

A

The removal of the surface layer of opaque enamel

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6
Q

What are the advantages of microabrasion?

A

-Easily performed
-Conservative
-Inexpensive
-Teeth need minimal subsequent maintenance
-Fast acting
-Removes yellow-brown, white and multi-coloured stains
-Effective
-Results are permanent
-Can use before or after bleaching

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7
Q

What are the disadvanatges of microabrasion?

A

-Removes enamel (Sensitivity, Teeth may become more susceptible to staining)
-HCl acid compounds are caustic
-Requires protective apparatus for patient, dentist and dental nurse
-Prediction of treatment outcome is difficult, (teeth may appear more “yellow” as the normal colour of crown revealed under white opacity)
-Must be done in dental surgery
-Cannot be delegated

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8
Q

Why might teeth appear more yellow after microabrasion?

A

-the enamel is more white than dentine so might get shine through of dentine making it appear more yellow
-also the white flecks are what are removed to get a uniform colour sometimes

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9
Q

What is the clinical technique for microabrasion?

A

-clean teeth with pumice and water,
-petroleum jelly on soft tissues to protect
-rubber dam
-sodium bicarbonate guard
-HCL pumice slurry in slowly rotating rubber cup on each tooth for 5secs
-wash teeth directly into aspirator
-review colour and shape then possible repeat for 5 secs again until happy
-FL varnish application
-polish with finest sandpaper disc
-polish with toothpaste

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10
Q

What is the max no of application of HCL on the pumice per tooth?

A

10x5sec applications

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11
Q

What Fl- varnish is used post tx for microabrasion? Why?

A

Proflourid etc NOT duraphat

Duraphat is yellow and may stain teeth

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12
Q

Why is fl- varnish applied after microabrasion?

A

To help w/ sensitivity and remineralisation

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13
Q

Why is a sandpaper disc used at the end of microabrasion?

A

Using sandpaper disc leaves a compacted relatively prismless layer or surface enamel. This changes the optical properties of the enamel so that areas of intrinsic
discolouration become less perceptible.

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14
Q

Microabrasion can be used in conjunction with what else?

A

Composite

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15
Q

How much enamel is lost with microabrasion? How does this compae with etching?

A

-100micron (if do 10x5secs HCL pumice)
-10micron for acid etch

Is not a lot but can be significant in some peoplek

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16
Q

What percent of HCL is used?

A

Different depending on what kit is used

Opalustre = 6.5%
Prema Kit = 10%

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17
Q

What instructions would you give pts post microabrasion and why?

A

-to avoid highly coloured foos and drinks for at least 24hrs (up to a week) as teeth are dehydrated after procedure and may stain teeth

-anything that would stain a white tshirt

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18
Q

When would you review microabrasion and what would you do at this appt?

A

-review 4-6wks after and take post-op pics

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19
Q

Can you offer more microabrasion? When w ould you and what is the max no. of treatments?

A

-yes - if it has worked
-if it hasn’t worked first time then it is unlikely to work

max = 2 treatments

20
Q

Can you bleach teeth in pts under 18?

A

Yes - some controversy but yes

21
Q

What are the bleaching options for discoloured teeth>

A

Vital bleaching (external vital bleaching):
-Chairside- ‘power bleaching’
-Night guard vital bleaching- ‘at home’

Non- vital (dead tooth) bleaching (internal non-vital bleaching):
-‘inside outside’ technique
-‘walking bleach’ technique

22
Q

Describe how chairside bleaching works/what is used?

A

Uses unstable, rapidly reacting hydrogen peroxide usually 15-38% (equivalent to 75% carbamide peroxide).

Note: Greater risk to soft tissues and eyes.

23
Q

What is used for home nighttime bleaching?

A

Nightguard vital bleaching (NGVB) with 10% carbamide peroxide e.g opalescence, Philips Zoom, PolaNight
Vary in strength

24
Q

How can you get trays for bleaching teeth but only targeting certain teeth? (what modification)

A

Have windows cut out of customised trays over any teeth you don’t want to bleach

25
Q

What instructions would you give to pt if doing at home bleaching?

A

Brush teeth thouroughly
Apply a little gel to tray
Set over teeth and press down
Remove excess
Rinse gently, do not swallow
Wear overnight (or for at least 2 hours)
Remove brush try with brush and rinse with cold water
Sensitive toothpaste may be required
Timescale approx 3-6 weeks, keep going until acceptable colour

26
Q

Side effects of tooth whitening?

A

-sensitivity
-gingival irriation

27
Q

Side effects of tooth whitening?

A

-sensitivity
-gingival irritation

28
Q

Why does tooth whitening cause sensitivity?

A

Sensitivity is related to the easy passage of hydrogen peroxide through intact enamel and dentin (reaching the pulp in five to 15 minutes) and to the bleaching tray, which causes sensitivity in 20% of patients

29
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
-No laboratory assistance for ‘walking bleach’

30
Q

Selection criteria for non-vital tooth bleaching?

A

Adequate root filling
no clinical disease
no radiological disease
Anterior teeth without large restorations
Not amalgam intrinsic discolouration
Not fluorosis or tetracycline discolouration

31
Q

Difference between walking bleach vs inside out method?

A

walking bleach = oxidising process allowed to proceed gradually over days

inside out - 10% carbamide peroxide gel, can seal in if co-op an issue

32
Q

Describe the clinical technique for non-vital bleaching.

A

-remove GP to below the CEJ
-clean with ultrasonic
-bleaching agent on a cotton pledget
-cover with dry cotton pledget
-seal with GIC/RMGI

33
Q

For the walking bleach technique, how often do you renew bleach and how long for?

A

-renew bleach ideally no more than 2wks between appointments
-if not changes after 3-4 renewals then stop
-6-10 changes in total

34
Q

Regression rate for walking bleach non-vital bleaching technique?

A

50% at 2-6yrs

35
Q

Describe the inside out bleaching technique.

A

-Access cavity of tooth open
-Do not necessarily need GI lining
-Custom made mouthguard (cut windows in guard of the teeth you don’t want to bleach!)
-Patient applied bleaching agent to back of tooth and tray
-Patient keeps access cavity clean, replacing gel removes food debris etc
-10% Carbamide peroxide is bleaching agent of choice
-Worn all the time except eating and cleaning
-Gel changed every 2 hours or so except during the night

36
Q

How do you restore the pulp chamber after non-vital bleaching?

A

Non setting calcium hydroxide paste for 2 weeks, seal in with GIC. Then:
Either: White GP and composite resin – facility to re-bleach
Or: Incrementally cured composite –no re-bleaching but stronger tooth.

Veneer or crown prep if regression

37
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

38
Q

What can be done to help prevent external cervical resorption?

A

of cement over GP
Prevents bleaching agent from getting to
external surface of root (not for inside-out technique)
Can prevent adequate bleaching of cervical area

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

39
Q

What are the effects of a short term exposure and long term exposure of bleach on the soft tissues?

A

short term:
-minor ulceration/irritation
-plaque reduction
-aids wound healing

long-term:
-delayed wound healing
-periodontal harm
-mutagenic potential

40
Q

What is tooth mousse made from?

A

(casein phosphopeptide – amorphous calcium phosphate) milk derived protein

41
Q

What is tooth mousse used for?

A

sensitivity

42
Q

What is the suggested use of tooth mousse after bleaching and microabrasion?

A

-2 weeks after bleaching (home application)
-microabrasion - 4 weeks home application

43
Q

What is resin infiltration?

A

infiltration of enamel lesions with low-viscosity light-curing resins

44
Q

How is resin infiltration carried out/how does it work?

A

Surface layer is eroded, lesions desiccated and a resin infiltrant is applied.
Resin penetrates lesion driven by capillary forces
Infiltrated lesions lose their discoloured appearance and look similar to sound enamel.

45
Q

When considering veneers, what do you need to think about when considering whether or not to reduce enamel?

A

Aesthetics
Relative tooth position
Masking dark stain
Age
Psyche
Plaque removal

BDS4 Paediatrics (2 decks)

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