Week 1 PP Flashcards
(30 cards)
What is Vital Bleaching
Non-invasive method of lightening stained or discolored teeth (at home or in dental office)
Make the teeth a brighter colour
3 Primary Indications for Vital Bleaching
- Extrinsic Stains (coffee, tea, etc)
- Aging
- Intrinsic Stains (inside)
What are Extrinsic Stains?
Appear on the surface of teeth as a result of coffee, tea, red wine, or tobacco
How aging affects colour of teeth
Over time through routine wear and tear, enamel wears down and becomes more transparent allowing the yellow dentin below to show through
Form eeryday wear and tear - eating, acidic food, etc
What is Intrinsic Staining?
Staining due to trauma, medications (Tetracycline) or fluoride ingestion during tooth formation
the hardest stains to remove - if they can be removed at all
Fluorosis stains will be super bright white after bleaching but after a few days it will fade
The success of vital and non-vital whitening depends on:
-Cause and type of discoloration/stain
-Degree or intensity of discoloration - how many levels do we half to jump
-Time teeth will be exposed to bleaching (whitening) agent - single time as well as duration (how many weeks)
-Bleaching (whitening) product and technique used
-Presence of restorations in the tooth - restorations will NOT change colour
Patients must be made aware that the results are not guaranteed and are not permanent. Most whitening systems last 3-5 years - then a touch up may be required
Composition of Whitening Products
Tooth whitening products are made from peroxide based ingredients. These products work deep within the enamel to remove staining and discolouration. Peroxide based products allow oxygen to enter the enamel and dentin, thereby whitening the discolored substances
Oxygen particles enter the enamel/dentin - breakdowns and removes the stains
2 Main Peroxide Ingredients
Hydrogen Peroxide
Carbamide Peroxide
What is Hydrogen Peroxide?
Strong oxidizing agent - penetrates enamel and dentin
May produce reversible pulpitis - sensitivity
Liquid or gel - 5% to 35% (percentage determines how long you can leave it on your teeth saftely)
What is Carbamide Peroxide?
-Breaks down to form hydrogen peroxide in the mouth
-Weaker oxidizing agent - more stable
-Gel - 10% to 30% (but 15% is recommended)
-Gel contains a thickening agent that increases adhesion and maximizes exposure
*better for sensitive teeth
3 Main Options of Teeth Whitening
- in office
- at home (DDS supplied)
- over the counter
In Office Whitening
Also referred to as “Laser Bleaching”. This technique uses light energy to speed the process of bleaching - 1 appointment method
-The procedure is most often completed within 30min to 1hr
-Teeth become up to 5 shades lighter
-Complete isolation of teeth is required - can use a “liquid” dental dam to protect the gum tissue from any bleaching product getting on it
-Higher concentration whitening agent is applied (25-38% hyrogen peroxide)
-Halogen (or other light source) is used which speeds up the process
*can cause sensitivity - advise patient of this
At Home Whitening
Patient is supervised by the DDS throughout the process
-Patients see results in approx 2 weeks
-Ususally results in 6 shades of lightening
-Custom fit tray is fabricated for the patient
-Peroxide-based gel is supplied in syringes for the patient to take home
-Trays are most commonly used 2x day for 2 weeks or overnight for 1-2 weeks - depends on the strength/percentage of product given to patient
At Home Whitening - 3 appointment steps
1st apt - Consult/Upper & Lower Alginate impressions (custom whitening trays will be fabricated)
2nd apt - Impression tray insertion (try in mouth to make sure they fit), pre-bleaching photos taken, their current shade is taken and written in chart, homecare instructions provided
3rd apt - Follow-up appointment to check progress (take current shade now), photos (including tissue or teeth sensitivy), ensure tissues are not being burned from whitening products, decide if they are completed or are going to continue to achieve a ligther shade
Patient Bleaching Instructions (at home) ** KNOW THIS FOR WHITENING TRAY EVAL**
-brush and floss before tray placement
-place gel in trays (pea sized amounts); less material is better than more
-seat the tray in mouth
-remove excess bleach with finger & tissue once trays are seated intraorally
-do not eat or drink when wearing the tray
-wear the tray for the recommend time (depends on type of bleach - higher % worn for shorter period of time, lower % may be worn over night)
-discontinue using the tray if adverse effects occur
-discuss adverse effects or other problems ith the DDS
Patient Bleaching Post Op Instructions (at home) - KNOW THIS FOR WHITENING EVAL**
-After removal, rinse trays with cold water as hot water can distort tray fit
-Rinse mouth with warm water, try not to swallow gel
-Using a sensitive toothpaste can help if there is mild post-op sensitivty
-Store trays in container, keep away from pets and heat
Smile Line and Whitening Assessment
-Do you have fixed prosthetics? (They will NOT change colour)
-Do you have removeable prosthodontic dentures?
-Do you have fluorisis like appearance? (makes it really white at first, but will fade)
-Do you have decalcification? (should be cautious when there is)
-Do you have tetracycline stains present? (can’t be whitened as much)
-Do you have restorative fillings? (cannot be whitened)
-Are you pregnant or nursing?
-Do you have recession?
-Do you have sensitivity present?
-Dental hygiene completed within 6 months?
-Are there genetic ameloggenesi imperfect or dentinogenisis present?
-Are you an ideal candidate for whitening?
OTC Whitening
A variety of OTC products are available. These prodcuts are safe, reliable, and effective. These products do not achieve dramatic changes achieved through dentist supervised products.
3 Most Common Tyes of OTC Whitening
- Brush on whitening
- Whitening strips
- Trays with bleaching gels
Brush on Whitening Products
Peroxide gel that is brushed on the facial surface of the teeth. Whitens teeth through oxidation, however, this is the least effective type of whitening as saliva flow inhibits the effectiveness. Also, if not used properly it can cause blotches on the teeth.
Whitening Strips
Thin flexible strips coated in adhesive hydrogen peroxide gel. Strip is applied like a bandage to the facial anterior teeth. Visible results are seen in 7-10 days.
*can miss interproximal
Trays with Bleaching Gel
Trays are very similar to what patients recieve in the dental office. Most commonly a tray is molded to the mouth by softening in boiling water. The tray is then filled with a peroxide gel and placed in the mouth for approx 30 mins.
the bleach typically isnt as strong because it is hard not to get on the gums (it is inevitable)
RDA Role in Tooth Whitening
-Assist in recording the medical and dental history
-Shade selection
-Take intra-oral photos before (with the selected shade) and after the whitening procedure
-Take and pour prelim impressions for the custom whitening trays
-Fabricate and trim the tray
-Provide post-op instructions
-assist in weekly/biweekly clinic visits
Abuse of Whitening Prodcuts can come from..
- not following directions
- Overusing products to achieve whiter teeth
