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Tooth color is based on
thickness of enamel layer
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Reasons teeth stain over time
- Diet
- Caries
- Restorative Materials
- Pulpal Necrosis and Treatment
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What is the course of treatment for a discolored tooth
- 1.Determine the cause of discoloration
- 2.Assess the extent of staining
- 3.Decide on a restoration vs. whitening procedure or combination of both
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Intrinsic stain is ______ the tooth structure
within
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Intrinsic stain can be ____ or _____
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What are some examples of Posteruptive stain
amalgam staining, caries, endodontic treatment
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Explain the process of Tetracycline staining
Tetracycline (an antibiotic) binds with Calcium ions in the hydroxyapatite crystals of dentin and enamel and becomes part of the lattice work of teeth and bones
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What is fluorosis
Levels of fluoride above 1ppm during tooth formation
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Describe mild fluorosis
White spots
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Describe Severe fluorosis
Brown spots (Colorado Brown Stain) and pitting
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Dentinogenesis imperfecta
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What are the properties of Hydrogen Peroxide
- H2O2 - Strong oxidizing agent
- Free radical reacts w/staining pigments to neutralize and remove them
- Used in 5-35% concentrations
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Hydrogen Peroxide can penetrate through to dentinal tubules and cause
reversible pulpitis
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Weaker oxidizing agent that breaks down into hydrogen peroxide
Carbamide Peroxide
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What are the properties of Carbamide Peroxide
- Used in 10-35% concentrations (equal to 3-5% hydrogen peroxide)
- Mixed w/ Carbopol a thickening agent that keeps whitener on teeth longer
- Used in custom trays at home
- Used in whitening strips
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_________is a weak oxidizing agent that is mixed with ________ and used on ______
- Sodium Perborate
- Hydrogen peroxide
- non-vital teeth
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What are some properties of Sodium Perborate
- Safer and easier to handle than using highly concentrated hydrogen peroxide solution alone
- Placed into the pulp chamber area and sealed in with a temporary filling for 3 to 7 days
- Has been linked to root resorption
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Power bleaching is done with a
high conc. of hydrogen peroxide (15% – 35%).
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Explain laser whitening
- is power bleaching where an Argon or CO2 laser is used to activate the bleach
- Quickest method to whiten
- Quickest way to fry a pulp
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At home whitening techniques containing hydrogen peroxide vary from
2% to 10% for 30 minutes per day
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At home whitening techniques containing carbamide peroxide gel vary from
10% to 35% carbamide peroxide and the tray is worn for 30 minutes up to overnight, depending on the strength of the gel
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Crest white strips contain
hydrogen peroxide gel applied to the facial surfaces of the anterior teeth
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With whitening pastes the effect is achieved primarily through the _______ of extrinsic stain by abrasive particles such as ______
- mechanical removal
- hydrated silica, precipitated calcium carbonate, and dicalcium phosphate dihydrate
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Whitening paste contain a peroxide agent such as _______ that also contributes to the _______
- calcium peroxide and sodium percarbonate
- whitening effect
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What are the two biggest problems of whitening
- Tooth (Cold) Sensitivity
- Gingival or other mucosal irritation
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What two things can be added to the tray during whitening to reduce sensitivity
neutral sodium fluoride or potassium nitrate
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What are some contraindications for Whitening
- Anterior restorations – inform the patient!Enamel is cracked or hypoplastic
- Carious lesions
- Cervical abrasions or tooth sensitivity.
- Any light sensitivities (melanoma, cancer therapy, photosensitive drugs) – do not use light activated systems.
- No non-vital bleach in extensively restored teeth – it weakens them further
- Amalgam stains in dentinal tubules must not undergo nonvital bleaching since the product will not whiten those areas
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