Dental Staining and its Removal PDF

So! Now I've got your attention! 1 GDC learning Outcomes 1.1 1.7.8 1.1.1 1.9.1 1.1.8 1.10.2 1.2.1 1.10.3 1.2.2 1.10.4 1.2.4 1.10....

So! Now I've got your attention! 1 GDC learning Outcomes 1.1 1.7.8 1.1.1 1.9.1 1.1.8 1.10.2 1.2.1 1.10.3 1.2.2 1.10.4 1.2.4 1.10.5 1.5.3 1.10.6 1.5.5 5.2 1.7.3 1.7.7 2 Formative Assessment Please complete the work book. 3  Dental Staining and Its Removal Julie Watson Here’s One I Made Earlier! 5 Learning Outcomes By the end of this session, you will be able to: Define the methods by which stain adheres to the tooth structure Define and discuss potential causative factors for Intrinsic and Extrinsic stains Describe how you would remove Extrinsic stain and reduce Intrinsic stain 6  Not all dental stains are the same! Within hard or soft deposit Within tooth structure Directly  Correct identification, aids the determination of aetiology and removal or prevention techniques  Classification Extrinsic : originates from outside Intrinsic : Originates from internal source source Extrinsic Staining Extrinsic Stains Extrinsic stains are defined as stains located on the outer surface of the tooth structure and caused by topical or extrinsic agents These stains can be removed Process  N2 – type dental stain (direct dental stain) – The chromogen changes colour after binding to the tooth. E.g. food that has aged. N3 – type dental stain (indirect dental stain) - The colourless material or pre chromogen binds to the tooth and under goes a chemical reaction to cause a stain, e.g. browning of foods that are high in carbohydrates and sugars, cooking oils, baked products and fruit. 13 Predisposing Factors Enamel defects Salivary dysfunction Poor oral hygiene Microscopic pits and fissures Certain bacteria Causative Agents of Extrinsic Stain And there’s more!  Why should we remove stains? Thick and rough stains can become a nidus for plaque retention Aesthetic benefit to the patient If poor oral hygiene is the most common cause of stain what does this tell us about our patient? Yellow Stain Dull yellow stain where plaque is retained Common to all ages Indicator of poor oral hygiene Green Stain Yellowish green to Dark green Caused by Chromogenic bacteria and fungi Organisms grow only in light Primarily effect children but also some adults Brown Stain Light brown to dark brown stains Can become intrinsic Orange Stain Chromogenic Bacteria Less common than green staining Buccal surfaces of anterior teeth Black Stain Brown pigment from smokeless tobacco, paan & betel nut Increased by high plaque levels  Can become this severe! Metallic Stain From metal or factory dust exposure Metal from vitamins oral iron tablets May become intrinsic Black Line Stain Black or very dark brown stain, can be continuous or interrupted Follows contour of the tooth May be caused by chromogenic bacteria 25 Intrinsic Stain 26  Intrinsic Stains Intrinsic stains are defined as stains located within the tooth structure and caused by internal or intrinsic agents These stains cannot be removed  Intrinsic Stain Exogenous Endogenous Originates from a source Originates from within the outside of the tooth but tooth structure has become incorporated into the tooth structure  Restorative procedures Causative agents Defect during development Extrinsic becomes intrinsic  Causative agents Development Excessive Fluoride Tetracycline Restorative procedures Endodontics Amalgam migration Extrinsic can become intrinsic over time Grey Pulpless tooth Yellowish brown to slate grey Release of billiverdin  Pink Created by haemorrhage into pulp chamber Decalcification Post Orthodontic Treatment 33 Decalcification 34 Restorative/Metallic Grey black colour Metal Ion from amalgam migrate into the tooth structure Composite materials discolour with age Disturbances in Tooth Development 36  Pre Eruption Disturbances Localised Enamel Hypoplasia Systemic Enamel Hypoplasia Amelogenesis Tetracycline Stain Imperfecta 37  Dental Fluorosis Hypo mineralisation results from an intake of more than 2ppm Enamel alterations are a results of damage to ameloblasts during formation  Dentinogenesis Imperfecta Odontoblastic disturbance Dentine is opalescent Teeth can appear translucent to bluish grey to brown So How Do We Remove These stains? 40 That’s how they do it! 41 And More! 42 And More! 43 Even More! 44 That’s how we do it! 45 Extrinsic Stain Removal Good Oral Hygiene Polishing Debridement/PMPR Power Driven Scaler/Air Polishing Bleaching/Whitening 46 This is how you might feel afterwards! 47 This is how your patient feels afterwards! 48 Intrinsic Stain Removal Vital Bleaching Cosmetic Dentistry/Veneers Micro abrasion Non vital bleaching Composite Resin Restorations 49 Some Techniques Available 50 So To Finalise. Why Do We Need To Remove Stain? Stain is unsightly Stain is rough and therefore plaque retentive Stain may be covering calculus 51 Further Reading Treatment of Intrinsic discolouration in permanent anterior teeth in children and adolescents. By Alyson Wray and Richard Welbury. Slideshare.net/reemabdulrazack/intrinsic-and extrinsic- discolouration https://www.youtube.com/watch?v=PEw948xvT_Y https://www.youtube.com/watch?v=C4ISsxbiAxw 52 Thank You For Your Attention 53