Dental Staining and its Removal GN PDF

So! Now I've got your a1en3on! 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...

So! Now I've got your a1en3on! 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 Forma3ve 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: DeFne the methods by which stain adheres to the tooth structure DeFne and discuss potenGal causaGve factors for Intrinsic and Extrinsic stains Describe how you would remove Extrinsic stain and reduce Intrinsic stain 6 Staining does not affect teeth or gingiva directly Rougher surface area than smooth enamel so it is considered as plaque retentive factor - secondary local factor Staining can also be covering calculus Not all dental stains are the same! tooth or restoration. Within hard or soI deposit Within tooth structure Directly to tooth.  Correct iden3Kca3on, aids the determina3on of ae3ology and removal or preven3on techniques  ClassiKca3on Extrinsic : originates from outside Intrinsic : Originates from internal source source Extrinsic Staining  -Can be > removed. Extrinsic Stains Extrinsic stains are deFned as stains located on the outer surface of the tooth structure and caused by topical or extrinsic agents These stains can be removed  to knew need do not. info · Process ↳ just for  know ! need to do not Again - , Just Infor N2 – type dental stain (direct dental stain) – The chromogen changes colour aRer 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 reacGon 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 dysfuncGon > No natural cleansing - Poor oral hygiene Microscopic pits and Fssures Certain bacteria Y Causes more staining  Black coffee/tea Red wine Curries/food Smoking Causa3ve Agents of Extrinsic Stain Corsodyl Chromogenic staining And there’s more!  Why should we remove stains? Thick and rough stains can become a nidus for plaque retenGon 4 Area where thick plaque can form AestheGc beneFt to the paGent ↳ Biggest concern for patient If poor oral hygiene is the most common cause of stain what does this tell us about our paGent? 1. Disclose and show patient 2. Power driving and hand scalers and polish 3. Show patient oral hygiene methods to prevent stain returning Almost always associated with presence of plaque Yellow Stain Occur at any age Evident when oral hygiene is poor Most common - labial surface lower anteriors Easily removed by good oral hygiene COMMON, thick plaque causing gingival inflammation Dull yellow stain where plaque is retained Common to all ages Indicator of poor oral hygiene  Chromogenic bacteria - name due to composition - well known to cause staining on teeth (yellow, green, orange and black stains) Can change colour after chemical reaction. Bacteria usually found in upper respiratory tract but can migrate to oral cavity where they can colonise tooth or pelicle and stain the tooth. Stains can reform once removed unless oral hygiene improves. Some adult teeth can be affected BUT mostly children Green Stain Yellowish green to Dark green Caused by Chromogenic bacteria and fungi Organisms grow only in light Primarily e\ect children but also some adults Often found embedded in plaque deposits Can be seen in any age but most common in children Difficult to remove due to underlying area of decalcification - can be seen once staining is removed. Take great care when removing staining as could cause further damage to tooth surface Polish is best approach to start with to see what is underneath staining. Tobacco - most common - varies in colour depending on quantity, frequency of smoker, roughness of enamel and oral hygiene Most common lingual, palatal and pits/fissures - pellicle is stained by tar producing tenacious deposit - can become intrinsic overtime. Removal can be time consuming and smelly - power driving scalers followed by polish. (Air polish may be required and pumice) Smoking cessation advice Brown Stain Corsodyl/chlorhexidine - stains badly and not needed for most patients. Can look similar to tobacco but more widely spread and heavy stained Can be evident on dorsum of tongue also Doesn’t smell - may have greyish tongue Difficult to remove, also stains composite Power driven scalers, polish, pumice or air polish. Light brown to dark brown stains Can become intrinsic - Part of tooth structure Tea/coffee/red wine - brown stain, generalised, most common palatally Stain depending on use, oral hygiene and depths of fissures Can be easily removed if light or can also be heavy and difficult to remove Epitex may be used for interdental staining  Orange Stain Chromogenic Bacteria Less common than green staining Buccal surfaces of anterior teeth Rare Discolouration from food, medicines and Chromogenic bacteria Usually found in patients with poor oral hygiene Oral hygiene instruction required. Black Stain Brown pigment from smokeless tobacco, paan & betel nut Combination of tobacco, herbs and flavourings > - Increased by high plaque levels Produces heavy thick red/brown to black stain Extremely difficult to remove Longer appointments needed Carcinogenic - increases risk of cancer  Can become this severe! Betel nut stain Metallic Stain From metal or factory dust exposure Metal from vitamins oral iron tablets May become intrinsic Not very common Can be seen in iron supplement users (high dose) If happens for too long, can become intrinsic overtime Greenish, blue or grey in colour Black Line Stain Black or very dark brown stain, can be conGnuous or interrupted Line formation > - Follows contour of the tooth ↳ Usually adjacent to gingival margin Not plaque related - can be evident in patients with poor oral hygiene Can be difficult to remove May be caused by May be demineralisation underneath stain Not common chromogenic bacteria 25 Intrinsic Stain 26  Intrinsic Stains Intrinsic stains are deFned 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 More systemic into the tooth structure When extrinsic becomes intrinsic  Restora3ve procedures Causa3ve agents Defect during development Extrinsic becomes intrinsic  Causa3ve agents Development Endogenous - Excessive Fluoride Tetracycline Restora3ve procedures T Exogenous EndodonGcs Amalgam migraGon Extrinsic can become intrinsic over 3me ↳ Exogenous Grey Pulpless tooth T Often due to nerve death Yellowish brown to slate grey Release of billiverdin  Pink Due to trauma Created by haemorrhage into pulp chamber DecalciKca3on Post Orthodon3c Treatment Stainless but tooth colour has changed - unable to remove 33 DecalciKca3on 34 Restora3ve/Metallic Grey black colour Metal Ion from amalgam migrate into the tooth structure Composite materials discolour with age Disturbances in Tooth Development 36  Pre Erup3on Disturbances Localised Enamel Hypoplasia Systemic Enamel Hypoplasia Amelogenesis Tetracycline Stain Imperfecta 37  Dental Fluorosis Hypo mineralisaGon results from an intake of more than 2ppm Enamel alteraGons are a results of damage to ameloblasts during formaGon  Den3nogenesis Imperfecta OdontoblasGc disturbance DenGne 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  Polish (Brush and pumice may be required) Power driven scalers (check for demineralisation under stain with probe) Airflow That’s how we do it! Oral hygiene advice and education (twice daily, 2mins, interdental cleaning) Whitening can be offered to patients. 45 Extrinsic Stain Removal Good Oral Hygiene Polishing Debridement/PMPR Power Driven Scaler/Air Polishing Epitex Bleaching/Whitening 46 This is how you might feel aIerwards! Can be hard work Ensure you have enough time to complete - be realistic Be honest to patient and explain unable to complete all stain removal if not enough time avaliable - never be forced and feel rushed! 47 This is how your pa3ent feels aIerwards! 48 Intrinsic Stain Removal Vital Bleaching Not usually within dental therapist remit CosmeGc DenGstry/Veneers Micro abrasion Non vital bleaching Composite Resin RestoraGons 49 Some Techniques Available 50 So To Finalise. Why Do We Need To Remove Stain? Stain is unsightly Stain is rough and therefore plaque retenGve 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 A1en3on 53