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1 Tooth Whitening DA 122 Dental Materials

1 Tooth Whitening DA 122 Dental Materials. 2 Tooth-whitening

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Page 1: 1 Tooth Whitening DA 122 Dental Materials. 2 Tooth-whitening

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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