Post on 28-Dec-2015
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Tooth Whitening
DA 122 Dental Materials
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Tooth-whitening
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Background/History
• Also called “Bleaching”• Process discovered during WWI– Soldiers developed “trench mouth” from poor
diets– Military dentists had them clean with carbamide
perioxide solution to improve periodontal conditions
– Noticed side effect: tooth color lightened– 1920’s dentists tried various combinations of
perioxide solutions to light people’s teeth, for both cosmetic and therapeutic uses
• Today: over 90% of dental offices offer some sort of whitening service
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World War I
Mobile dental clinic
Mobile equipment
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Reasons for Bleaching Teeth: Staining• Intrinsic Staining:
– within the tooth• due to chemicals ingested during tooth development• Example:
– Tetracycline staining– Fluoride staining
• Dental decay, trauma (injury), endodontic treatment• Aging• Genetic predisposition
• Extrinsic Staining– From outside the body
• Chromogenic foods:– Coffee, tea, cola, red wine (blueberries, soy sauce, balsamic vinegar,
tomato sauce)
• Tobacco products• Poor oral hygiene
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Intrinsic Staining
Tetracycline Staining: blue-grey or brown shading
Fluorosis: chalky-white to brown stains
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Extrinsic Staining
Chromogenic foods Tobacco Stains
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Types of Bleaching Treatments
• In-Office Non-vital
• In-Office Vital
• Home-Bleaching Treatment
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In-office Non-vital
• Tooth has had endodontic treatment and has darkened
• Involves a single tooth• “walking bleach”• Sodium hydroxide
paste placed into pulp chamber; left in for a period of time; may involve 2 or more visits
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In-Office Vital
• Usually involves all teeth– Can be single tooth or
single arch
• “power bleaching”(Zoom)
• Sodium hydroxide paste placed on tooth surface and activated with a heat/curing lamp (sometimes)
• Must use dental dam to protect gingiva
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Home Bleaching Treatment
• Custom tray is made for patient
• Dentist dispenses gel for in-home use. Carbamide peroxide most common bleach used.
• Patient does self-treatment at home with gel in custom tray
• Patient may purchase tooth-whitening kits over-the-counter; results vary
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Side-Effects of Tooth-whitening
• 1. thermal sensitivity– Teeth become sensitive to hot and cold
• 2. gingival irritation– Localized irritation to gingival tissues– Gingiva appears white or reddened, as if burned
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Patient Evaluation for Tooth-whitening• Evaluation by dentist BEFORE
treatment is necessary• Patient must have good oral health,
especially gingival health• Check medical history for
– Allergies– TMJ disorders– Pregnancy or lactating
(contraindicated)
• Dental radiographs and examination
• Dentist must evaluate condition of teeth, to determine if tooth-whitening is indicated: cause and degree of stains, vital/nonvital, presence of restorations or poor oral hygiene
Patient with gag reflex not good candidate
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Pre-Treatment Visit
• Take Intra-oral photos “before” shots
• Select and record shade:– Beginning shade– Goal shade (about 3-5 shades lighter)– Dentist and patient should agree on reasonable
shade goal
• Take alginate impressions of arch or arches to be treated
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Pre-Treatment Visit
Intraoral PhotographSelect and Record Shade
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Fabrication of Custom Bleaching Tray• 1.Pour alginate impression without a base• 2.Trim model to horse-shoe shape• 3.Label model with
– Patient full name– Date that impression was taken– Doctor’s name– BLEACH TRAY
• 4.Trace gingival margins on model, with pencil or permanent marker
• 5.Lightly spray model with silicone lubricant to prevent tray material from sticking to model during vacuformer process
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Tray Fabrication
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Making the tray (steps continued)• Armamentarium:
– Vacuformer– Plastic tray material (.020, .035,
.040)– Prepared model– Lab scissors– Heated knife or surgical scissors
• 6.Follow vacuformer directions• 7.Let tray cool completely
before removing from model– 8.cut away excess tray material– Cut along gingival area (leaving
2mm beyond CEJ) with knife or scissors
• 9. Check for roughness along edges, try onto model
• 10.Disinfect tray before delivering to patient
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Delivery of Custom Bleach Tray to Patient
• Try-in tray in patient’s mouth– Check for fit and patient
comfort
• Review home-instructions with patient – Verbally– Give written copy
• Demonstrate loading the tray with the gel (avoid overfilling)
• Reappoint for follow-up visits
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Patient care follow-up
• Patient should be checked for progress every 1-2 weeks
• Check for thermal sensitivity and gingival irritation, also
• When patient has reached the goal shade:– Take and record shade– Take intra-oral photos– Make plans for maintenance and possible touch-
ups– Give instructions for maintenance
• To avoid relapse, caution patient about: – Chromogenic foods and beverages– Smoking