DM (Chapter 17)

All dental professionals should be familiar with the ADA's Statement on

Effectiveness and Safety of Tooth Whitening Products.

A strong oxidizing agent, breaks down into water and oxygen. Oxygen reacts with the pigments in both extrinsic and intrinsic stains, producing the bleaching effect.

Hydrogen peroxide

Carbamide peroxide is applied to the teeth how?

In either liquid or gel in strengths varying from 10% to 20%.

When whitening a nonvital tooth sodium perborate mixed with 35% hydrogen peroxide is placed in the canal. What is is sealed with and how long should it remain?

It is packed with a cotton pellet and sealed with zinc phosphate or IRM. Can remain in the canal for 3 to 7 days at a time.

Hydrogen peroxide is applied to the teeth in what form?

Liquid or gel in strengths varying from 5% to 35%

Internally whitening a nonvital tooth can weaken the bond between tooth surface and esthetic restorations therefore resorations must be done no sooner than 7 days after bleaching. T/F

True

Hydrogen peroxide in 6%, 10%, and 15% concentrations are also available from

Ultradent in the Opalescence product, Go.

How can tooth sensitivity be improved from whitening?

apply neutral sodium fluoride or potassium nitrate in trays for 30 minutes twice daily.

With the weak bond postbleaching, esthetic restorations must be placed

at least 7 days after the whitening procedure, preferably after 2 weeks.

Research has shown that bond strength of materials is weakest immediately after

bleaching

An extrinsic stain occurs on the surface of the tooth. Causes of extrinsic staining include foods and drinks, such as

coffee and tea, and tobacco, both smoked and smokeless.

With laser whitening in addition to activating the whitening agent, the argon laser interacts directly with what?

dark stains to neutralize them, but it becomes less effective in directly neutralizing stains as the tooth whitens.

Walking bleach can increase free radical formation in the root canal of a nonvital tooth and lead to

external resorption.

Trayless whitening systems use

flexible, adhesive, polyethylene strops that are coated with a whitening agent.

A nonvital tooth

gives no response to temperature change or electrical stimulus. The pulp in this tooth is no longer living, hence the term "nonvital.

Common abrasives include

hydrated silica, precipitated calcium carbonate, and dicalcium phosphate dihydrate

Laser whitening must be used with caution because the laser is the only one that can increase

intrapulpal temperature and cause dental pulp necrosis.

Nonvital walking bleach

is a second method of lightening endodontically treated teeth.

Laser whitening utilizes a

laser beam, either argon or carbon dioxide, that is applied to the teeth to activate the whitening agent.

What is the most rapid whitening technique that is currently available?

laser whitening

Sodium perborate is the active ingredient in

many household fabric bleaches, which are designated as being safe for colors.

When the whitening treatment is done at home by the patient, it is frequently called

nightguard vital whitening because the whitening agent is applied to the teeth inside a custom tray resembling a nightguard appliance.

Sodium perborate is another weak oxidizing agent. It is sometimes used together with hydrogen peroxide to whiten

nonvital teeth.

Laser whitening is usually completed in how many appointments?

one

The professionally applied, in-office whitening technique is often referred to as

power whitening.

Hydrogen peroxide can penetrate enamel and dentin and may produce

reversible pulpitis

The pulp cavity within a nonvital tooth may contain necrotic pulp, no pulp, or an inert material placed when an endodontic procedure known as a

root canal.

Reversible pulpitis

temporary inflammation of the pulp tissue

An intrinsic stain occurs within

tooth structures (enamel or dentin).

The decomposition of hydrogen peroxide releases free radicals of oxygen that react with pigments in both extrinsic and intrinsic stains producing the

whitening effect.

A vital tooth

(a tooth with living pulp tissue) can be whitened in the dental office by the dental team or at home by the patient.

Posteruptive stain Some intrinsic stain occurs after the tooth erupts. Causes for this type of stain include the following:

- amalgam restorations - caries - endodontic treatment

Among the peroxides are

- hydrogen peroxide - calcium peroxide - sodium percarbonate

Preeruptive stain Other intrinsic stains occur before tooth eruption, when the teeth are in the formative or calcification stage. These stains include the following:

- tetracycline stain - fluorosis >1ppm - dentinogenesis imperfecta and amelogenesis imperfecta

Depending on the concentrations, the trays remain in place 30 to 60 minutes for those with ___% hydrogen peroxide

10

Whitestrips Supreme are professional whiten strips from Proctor and Gamble containing the highest concentration of peroxide. The hydrogen peroxide concentration is

14%

Depending on the concentrations, the trays remain in place for 15 to 20 minutes for those with ___% hydrogen peroxide.

15

Carbamide peroxide gel in strengths from 10% to 22% is dispensed by the patient into custom-made resin trays. The trays are worn during the day for multiple treatment sessions of how long?

2 hours or some choose to sleep with them

A 10% carbamide peroxide solution is equivalent to ____% hydrogen peroxide

3

How are crest whitestrips used?

3-7% hydrogen peroxide gel applied to facial surface of the anterior teeth twice daily for 30 minutes

A 15% carbamide peroxide solution is equivalent to ____% hydrogen peroxide

5

Depending on the concentrations, the trays remain in place 60 to 90 minutes for those with __% hydrogen peroxide

6

Brushing with a potassium nitrate-containing dentifrice before and after bleaching is advised. During power bleaching, a patient must be anesthetized. a. The first statement is true; the second statement is false. b. The first statement is false; the second statement is true. c. Both statements are true. d. Both statements are false.

A

The term "nonvital" may be used to describe a tooth that has: a. Been treated with a root canal procedure b. A necrotic pulp c. No pulp tissue in the pulp cavity d. All of the above

A

Which of the following variables is not a factor in the success of a vital tooth whitening treatment? a. Number of teeth to be treated b. Strength of the whitening agent c. Type and intensity of discoloration or stain d. Length of exposure of the tooth to the whitening agent

A

Which of the following esthetic tooth treatments requires no removal of tooth structure? a. Nonvital tooth whitening b. Vital tooth whitening c. Facial veneer d. Porcelain-bonded-to-metal crown

B

Which of the following statements is NOT true regarding tooth sensitivity from vital tooth whitening? a. It is a common side effect b. It is not reversible c. It can be treated by topical application of potassium nitrate d. It may be caused by a tray that is too rigid

B

Dental professionals should be aware that a statement on safety and effectiveness of whitening products is available through the: a. Whitening product manufacturers b. SDS c. ADA d. ADHA

C

Which of the following statements is the most accurate? a. Hydrogen peroxide is more stable than carbamide peroxide b. Carbamide peroxide is used in the nonvital tooth whitening technique known as a walking bleach c. Hydrogen peroxide decomposes into water and free radicals of oxygen d. Carbamide peroxide is most often applied to teeth as a gel at a 35% concentration

C

Carbamide peroxide chemical makeup

CH6N2O3

A weaker oxidizing agent, breaks down into hydrogen peroxide and urea.

Carbamide peroxide

All of the following are contraindications to lightactivated bleaching procedures EXCEPT: a. Use of photosensitive drugs b. History of melanoma c. Undergoing radiation therapy or chemotherapy d. Previous use of nightguard bleaching system

D

An aqueous cleaning technology used in prewhitening and touch-up whitening is dispensed in a: a. Gel b. Liquid c. Strip d. Swab

D

Teeth with a moderate degree of_____are the most difficult to successfully whiten. a. Extrinsic food and beverage stain b. Yellow intrinsic discoloration c. Extrinsic tobacco stain d. Tetracycline stain

D

When should a bleached tooth be restored with a composite restoration? a. Immediately b. 1 to 2 days c. 3 to 4 days d. 1 to 2 weeks

D

Which of the following is the most common esthetic procedure in dentistry? a. Facial veneer b. All-porcelain crown c. Porcelain-bonded-to-metal crown d. Tooth whitening

D