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Tooth Whitening DA 122 Dental Materials.

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Presentation on theme: "Tooth Whitening DA 122 Dental Materials."— Presentation transcript:

1 Tooth Whitening DA 122 Dental Materials

2 Tooth-whitening

3 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

4 World War I Mobile dental clinic Mobile equipment

5 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

6 Intrinsic Staining Tetracycline Staining: Fluorosis:
blue-grey or brown shading Fluorosis: chalky-white to brown stains

7 Extrinsic Staining Chromogenic foods Tobacco Stains

8 Types of Bleaching Treatments
In-Office Non-vital In-Office Vital Home-Bleaching Treatment

9 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

10 In-Office Vital Usually involves all teeth “power bleaching”(Zoom)
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

11 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

12 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

13 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

14 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

15 Pre-Treatment Visit Intraoral Photograph Select and Record Shade

16 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

17 Tray Fabrication

18 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

19 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

20 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

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