Preventives and Whitening PDF

PREVENTIVES Copyright © 2019 Wolters Kluwer · All Rights Reserved Preventive Dental Materials Tooth Paste Mouth Washes Fluorides Sealants Mouth guards Copyright © 2019 Wolters Kluwer · All Rights Reserved Custom Fluoride Trays Used to create a custom fluoride t...

PREVENTIVES Copyright © 2019 Wolters Kluwer · All Rights Reserved Preventive Dental Materials Tooth Paste Mouth Washes Fluorides Sealants Mouth guards Copyright © 2019 Wolters Kluwer · All Rights Reserved Custom Fluoride Trays Used to create a custom fluoride tray for home-care fluoride treatments. 3 Copyright © 2019 Wolters Kluwer · All Rights Reserved 4 Indications for usage 1. Rampant enamel or root caries at any age 2. Xerostomia 3. Exposure to radiation and/or chemotherapy therapy 4. Root surface by hypersensitivity Copyright © 2019 Wolters Kluwer · All Rights Reserved  Chapter 25 Pit and Fissure Sealants Introduction I. Purpose and Indications II. Contraindications III. Procedure IV. Self-Etching and Fluoride-Releasing Sealants Copyright © 2019 Wolters Kluwer · All Rights Reserved I. Purpose and Indications “I” Shaped Fissure Reproduced with permission from Gwinnett AJ. The bonding of sealants to enamel. J Am Soc Prevent Dent. 1973;3:21. Reproduced with permission from Gwinnett AJ. The bonding of sealants to enamel. J Am Soc Prevent Dent. 1973;3:21. Copyright © 2019 Wolters Kluwer · All Rights Reserved Copyright © 2019 Wolters Kluwer · All Rights Reserved  An increased risk for caries  Incipient caries within the enamel in pit and fissure areas  Existing pit and fissures anatomically susceptible to decay Copyright © 2019 Wolters Kluwer · All Rights Reserved II. Contraindications Caries Surfaces with well-coalesced pits and fissures Copyright © 2019 Wolters Kluwer · All Rights Reserved Armamentarium for Placing Sealants Copyright © 2019 Wolters Kluwer · All Rights Reserved III. Procedure A. Surface preparation B. Isolation C. Dry the tooth or teeth thoroughly D. Apply etchant E. Rinse thoroughly F. Dry the tooth or teeth again G. Evaluate the etched surface Copyright © 2019 Wolters Kluwer · All Rights Reserved III. Procedure (cont.) H. Apply a primer from a dentinal bonding system (optional) I. Apply the sealant to the tooth surface J. Polymerize the sealant K. Occlusal adjustment L. Evaluate the sealant M. Evaluate the sealant placement procedure N. Follow-up evaluation Copyright © 2019 Wolters Kluwer · All Rights Reserved B. Isolation Garmer Cotton Roll Holders Copyright © 2019 Wolters Kluwer · All Rights Reserved B. Isolation (cont.) Cotton Triangles Copyright © 2019 Wolters Kluwer · All Rights Reserved D. Etchant Courtesy of 3M Dental Products Division. Copyright © 2019 Wolters Kluwer · All Rights Reserved Apply Etchant, Rinse, and Thoroughly Dry Copyright © 2019 Wolters Kluwer · All Rights Reserved G. Evaluate Appearance for Proper Etching Copyright © 2019 Wolters Kluwer · All Rights Reserved I. Sealant Application Copyright © 2019 Wolters Kluwer · All Rights Reserved J. Polymerize the Sealant Light-activated sealants Chemically activated sealants K. Occlusal Adjustment Generally unnecessary for unfilled sealant materials Copyright © 2019 Wolters Kluwer · All Rights Reserved Types of Sealants Light Activated Chemical Cure or Self Cure Copyright © 2019 Wolters Kluwer · All Rights Reserved Light-Activated Sealants Copyright © 2019 Wolters Kluwer · All Rights Reserved Copyright © 2019 Wolters Kluwer · All Rights Reserved Pit and Fissure Sealants—Evaluate Copyright © 2019 Wolters Kluwer · All Rights Reserved IV. Self-Etching and Fluoride-Releasing Sealants A. Self-Etching Sealants B. Fluoride-Releasing Sealants Copyright © 2019 Wolters Kluwer · All Rights Reserved 26 Fuji Triage (Self-Cure) This product is in the Glass Ionomer family and what does that mean? First you pumice the tooth surface Then rinse Depress the actuator button on capsule Triturate in the high speed mixer for 10 seconds Load the capsule into the applicator Copyright © 2019 Wolters Kluwer · All Rights Reserved Copyright © 2019 Wolters Kluwer · All Rights Reserved Copyright © 2019 Wolters Kluwer · All Rights Reserved Copyright © 2019 Wolters Kluwer · All Rights Reserved Copyright © 2019 Wolters Kluwer · All Rights Reserved  Chapter 18 Oral Appliances Introduction I. Types of Oral Appliances II. Materials Used in Fabrication III. Fabrication of an Oral Appliance IV. Maintenance of an Oral Appliance Copyright © 2019 Wolters Kluwer · All Rights Reserved The Purpose for Oral Appliances Copyright © 2019 Wolters Kluwer · All Rights Reserved I. Types of Oral Appliances A. Athletic mouthguards B. Fluoride custom trays C. Orthodontic appliances (tooth positioners) D. Nightguards E. Space maintainers F. OSA/snoring appliances G. Whitening trays H. Acrylic and bis-acryl (TRIAD) appliances Copyright © 2019 Wolters Kluwer · All Rights Reserved A. Athletic Mouthguards 1. Advantages 2. Popularity 3. Wide application 4. Encouraging the use of mouthguards 5. Types Copyright © 2019 Wolters Kluwer · All Rights Reserved 5. Athletic Mouthguard Types a) Stock b) Mouth formed c) Custom made Copyright © 2019 Wolters Kluwer · All Rights Reserved American Dental Association Recommended Activities for Use of Athletic Mouthguards Copyright © 2019 Wolters Kluwer · All Rights Reserved A. Athletic Mouthguards Courtesy of Dental Arts Lab, Inc. Courtesy of Great Lakes Orthodontics, Ltd. Copyright © 2019 Wolters Kluwer · All Rights Reserved Ideal Mouthguard Properties Copyright © 2019 Wolters Kluwer · All Rights Reserved B. Fluoride Custom Trays 1. Qualifying conditions 2. Compatible gels 3. Increasing awareness 4. Other uses Courtesy of Dental Arts Lab, Inc. Copyright © 2019 Wolters Kluwer · All Rights Reserved C. Orthodontic Appliances Copyright © 2019 Wolters Kluwer · All Rights Reserved D. Nightguards Courtesy of Dr. James Foor, Morgantown, WV. Copyright © 2019 Wolters Kluwer · All Rights Reserved 43 Night Guards Used to help prevent bruxism To protect anterior restorations Can be made in office or sent out to lab Many different styles Copyright © 2019 Wolters Kluwer · All Rights Reserved 44 Copyright © 2019 Wolters Kluwer · All Rights Reserved E. Space Maintainers Copyright © 2019 Wolters Kluwer · All Rights Reserved F. OSA/Snoring Appliances Courtesy of Great Lakes Orthodontics, Ltd. Copyright © 2019 Wolters Kluwer · All Rights Reserved G. Bleaching Trays Copyright © 2019 Wolters Kluwer · All Rights Reserved H. Acrylic and Bis-Acrylic (TRIAD) Appliances Copyright © 2019 Wolters Kluwer · All Rights Reserved II. Materials Used in Fabrication A. Definition Thermoplastic Thermoset B. Types – Polyethylene C. Properties – Each material has a specific major polymer component Copyright © 2019 Wolters Kluwer · All Rights Reserved Thermoplastic Materials Courtesy of Buffalo Manufacturing Co., Inc. Copyright © 2019 Wolters Kluwer · All Rights Reserved Use of Thermoplastics Copyright © 2019 Wolters Kluwer · All Rights Reserved III. Fabrication of an Oral Appliance Copyright © 2019 Wolters Kluwer · All Rights Reserved III. Fabrication of an Oral Appliance (cont.) Copyright © 2019 Wolters Kluwer · All Rights Reserved IV. Maintenance of an Oral Appliance Daily brushing and rinsing Soft-bristled, wet toothbrush Soak in a professional cleaner for specific appliances Do not clean “boil and bite” appliances in hot water Useful life minimum is 2 years with proper maintenance Copyright © 2019 Wolters Kluwer · All Rights Reserved Whitening or Bleaching CLASSIFICATION OF TOOTH DISCOLORATION  Extrinsic discoloration  Intrinsic discoloration Copyright © 2019 Wolters Kluwer · All Rights Reserved ETIOLOGY OF DISCOLORATION Extrinsic Discoloration:  Stains that lie on/attach to the tooth surface or in the acquired pellicle, or  The incorporation of extrinsic stain within the tooth substance following dental development. It occurs in enamel defects and in the porous surface of exposed dentin Copyright © 2019 Wolters Kluwer · All Rights Reserved ETIOLOGY OF DISCOLORATION Extrinsic Discoloration: E.g. Smoking / chewing tobacco Plaque, chromogenic Beverages (tea, coffee, red wine, bacteria cola) Mouthwashes Foods (curry, cooking oils and fried foods, foods with colorings, (chlorhexidine) berries, beetroot) Antibiotics (erythromycin, amoxicillin-clavulanic acid) Iron supplements Copyright © 2019 Wolters Kluwer · All Rights Reserved ETIOLOGY OF DISCOLORATION Intrinsic Discoloration:  Intrinsic discoloration occurs following a change to the structural composition or thickness of the dental hard tissues. Copyright © 2019 Wolters Kluwer · All Rights Reserved  ETIOLOGY OF DISCOLORATION Intrinsic Discoloration: Pre-eruptive: Post-eruptive: Disease: Trauma (e.g. pulpal Hematological diseases hemorrhagic products) Liver diseases Primary and secondary Diseases of enamel and dentine (e.g. caries Amelogenesis/ Dentinogenesis imperfecta) Tooth wear Medication: Dental restorative materials Tetracycline, other antibiotic s Ageing Fluorosis stains (excess F) Chemicals Enamel hypoplasia (trauma or Antibiotics infection) Minocycline/Tetracycline (used to treat acne) Copyright © 2019 Wolters Kluwer · All Rights Reserved To bleach or not to bleach? Copyright © 2019 Wolters Kluwer · All Rights Reserved GENERAL INDICATIONS  Generalised staining  Ageing  Extrinsic stain - Smoking and dietary stains (tea/coffee etc)  Fluorosis  Tetracycline staining (? in combination with restorative techniques)  Traumatic pulpal changes  White spots  Brown spots (not as good response) Copyright © 2019 Wolters Kluwer · All Rights Reserved CONTRAINDICATIONS  Patients with high/unrealistic expectations  Decay and active peri-apical pathology (must be resolved first)  Pregnancy/Breastfeeding  Sensitivity/cracks/exposed dentin  Existing crowns / large restorations (anteriorly)  Elderly patients with visible recession and yellow roots (roots don’t whiten as readily as crowns)  If patients cannot afford changing existing restorations post-whitening Copyright © 2019 Wolters Kluwer · All Rights Reserved Contraindications continued Diagnosed with melanoma Undergoing radiation or chemotherapy Taking photosensitive drugs Copyright © 2019 Wolters Kluwer · All Rights Reserved  Effects on Soft tissues Cervical resorption Pulp Hardness of teeth Tooth colored restorations Adhesive bond strength -changes composition of enamel and dentin, therefore defer definitive adhesive restorations until 2 weeks (at least 10 days) after bleaching completed Copyright © 2019 Wolters Kluwer · All Rights Reserved Whitening Definition “any treatment procedure or method a dental professional might prescribe to whiten the color and brighten your teeth” 10-20% carbamide peroxide, hydrogen peroxide 5-35% Copyright © 2019 Wolters Kluwer · All Rights Reserved BLEACHING TECHNIQUES  Vital bleaching : Home use of 10 %, 15%, 20% carbamide peroxide in a dental tray “In office bleaching” (15-35% hydrogen peroxide) carried out in single visit (photo initiation) plus additional home use of carbamide peroxide 10% to “top up”  Non-vital bleaching : (AKA Walking bleaching) The ‘Inside/Outside’ method using 35 % hydrogen peroxide, and sodium perborate Copyright © 2019 Wolters Kluwer · All Rights Reserved PATIENT INFORMATION (Home Bleaching ) 1. Brush teeth and floss as normal before each use. 2. Advise the patient to remove the tip from the syringe containing the whitening gel and to extrude a little (~1mm) of the gel into the deeper and front parts of the tray. (No more than ½ a syringe). Place gel in the tray on the cheek and the tongue side of the back teeth. 3. Seat the tray over the teeth and press down firmly. 4. A finger, a tissue, or a soft toothbrush should be used to remove excess gel that will flow beyond the edge of the tray. Copyright © 2019 Wolters Kluwer · All Rights Reserved PATIENT INFORMATION Copyright © 2019 Wolters Kluwer · All Rights Reserved PATIENT INFORMATION 5. Rinse gently and do not swallow. The tray is usually worn whilst sleeping or a minimum of 2 hours. 6. In the morning, remove the tray and brush the residual gel from the teeth. Rinse out the tray and brush it. Store it in a safe container.  The patient should not eat, drink or smoke while bleaching trays in mouth.  10% CP should not be exposed to heat (decomposes), sunlight or extreme cold. Store in a fridge and keep away from reach of children. Copyright © 2019 Wolters Kluwer · All Rights Reserved More Patient Information Advise the patient that it will probably take about 2-6 weeks to achieve satisfactory result Nicotine stain 1-3 months Tetracycline stain 2-6 months, sometimes 12 Further restorations may be required Copyright © 2019 Wolters Kluwer · All Rights Reserved POST WHITENING INSTRUCTIONS  The Next 24 – 48 hours are important in enhancing & maximizing whitening results.  Avoid substances which may stain teeth  Such as: Red wine, coca cola, coffee, tea  Sensitivity: Copyright © 2019 Wolters Kluwer · All Rights Reserved SENSITIVITY Cause: Passage of hydrogen peroxide through enamel and dentin to the pulp Manipulation of teeth 55% to 75% of patients experience sensitivity Copyright © 2019 Wolters Kluwer · All Rights Reserved SENSITIVITY At risk patients:  Large pulp chambers  Exposed root surfaces  Abfraction, attrition, erosion, abrasion lesions  Over wearing of trays  Improper fit of trays  High concentrations of bleaching agent  No long-term effects in the literature Copyright © 2019 Wolters Kluwer · All Rights Reserved  TREATMENT OF SENSITIVITY Decrease wearing time/concentration Desensitizing toothpaste –Potassium nitrate works on the nerve of the tooth 10 - 30 mins in a tray –Neutral Sodium Fluoride occludes the dentinal tubules ( 4-6 weeks) Relief gel, Tooth mousse –Amorphous Calcium Phosphate Copyright © 2019 Wolters Kluwer · All Rights Reserved Making an At Home Whitening Tray Take alginate impressions of arches to be whitened Technician to cast up and block-out the labial aspects of the teeth to be bleached using reservoirs- recommended (lab technicians add flowable composite onto labial aspects of teeth) Make a thin vacuum-formed soft tray from a thermoplastic material Check this carefully on the model to ensure there are no sharp areas of the tray that might irritate the gingival margins. Copyright © 2019 Wolters Kluwer · All Rights Reserved TRAY DESIGN Copyright © 2019 Wolters Kluwer · All Rights Reserved TRAY DESIGN Copyright © 2019 Wolters Kluwer · All Rights Reserved In Office Whitening Review medical history for contraindications Complete radiographs, and exam Prophylaxis Impressions Isolate teeth Apply peroxide and light Review post op instructions Copyright © 2019 Wolters Kluwer · All Rights Reserved Copyright © 2019 Wolters Kluwer · All Rights Reserved 81 Copyright © 2019 Wolters Kluwer · All Rights Reserved 82 Copyright © 2019 Wolters Kluwer · All Rights Reserved 83 Copyright © 2019 Wolters Kluwer · All Rights Reserved 84 Copyright © 2019 Wolters Kluwer · All Rights Reserved 85 Copyright © 2019 Wolters Kluwer · All Rights Reserved 87 Sealants Lab Copyright © 2019 Wolters Kluwer · All Rights Reserved