bleaching
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| bleaching | conservative trtmt for the esthetic improvement of dicolored or stained teeth since no tooth structure is sacrificed or cut
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| factors in the success of bleaching | cause of stain, degree of stain, bleaching agent used and strength, length of exposure, bleaching technique, vitality of tooth, cracks/restorations in tooth
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| contraindications of bleaching | teeth stained by caries, pulpal necrosis, endo, sensitive dentin, allergies, pregnant/lactating, children, heavy smokers, excessive drinkers
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| nonvital teeth | necrotic pulp darkens with time
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| vital teeth | natural shading or darkening from aging
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| stain | extrinsic-surface vs. intrinsic-inside tooth structure
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| dentinogenisis imperfecta and amelogenisis imperfecta | bleaching will not help
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| tetracycline and fluorisis | difficult to bleach
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| primary bleaching agents | hydrogen peroxide, carbamide peroixide CH6N2O3, sodium perborate
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| hydrogen peroxide H2O2 | may cause temp pulpitis, liquid or gel form, 5%-35%
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| carbamide peroxide (CH6N2O2) | weaker oxidizing agent and more stable than H2O2, liquid or gel, 10-15%, decomposes into N2O2-10% carbamide is equivalent to 3% hydrogen peroxide
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| sodium perborate | used w/ H2O2 for non-vital teeth...root canal-done from inside
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| non-vital bleaching technique | cotton ball saturated w/ 35% H2O2 insertedd into pulp chamber, heated instrument is applied to cotton ball to accelerate the release of oxygen, when desired bleacing occurs, pulp chamber is filled w/ permanent filling material
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| vital teeth bleaching technique | prof applied in office, patient applied at home, prof supervised, OTC at home-not recommended often ineffective and lack professional supervision
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| professionally applied in office | 30-35% H2O2, isolate teeth, peroxide is painted on teeth, activated w/ a heat source, also laser bleaching being used now-argon or carbon dioxide lasers
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| Patient applied professionally supervised | 2%,5%,10% gels dispensed into custom-made resin trays-worn 30 minutes per day
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| Patient applied professionally supervised-carbamide peroxide | 10%, 15% custom made trays-wear during the day for multiple sessions or while sleeping
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| 3 apt series. 1st apt | med hx, informed consent, IO exam, prophy, IO pics w/ shade guide, full arch impressions
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| 2nd apt | test fit trays, patient instructions, side effects-tooth sensitivity...soft tissue irritation, written instructions, FU apt in 4-6 wks
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| 3rd apt | exam-additional bleaching if needed, usually 2-4 wks at most, IO pic-compared to before pic
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