Chap 13 HIGH YIELD

What causes intrapulpal hemorrhage and pulpal necrosis tooth discoloration?

Trauma causing bleeding within the pulp chamber and breakdown products like iron sulfides staining dentin

What is the management for tooth discoloration caused by intrapulpal hemorrhage and pulpal necrosis?

Internal bleaching is usually successful

What causes calcitic metamorphosis tooth discoloration?

Post-trauma deposition of hard tissue within the pulp chamber leading to yellowish, dull discoloration

What is the management for calcitic metamorphosis tooth discoloration?

External bleaching first; if unsuccessful, consider veneers or RCT and internal bleaching

What causes aging-related tooth discoloration?

Thinning enamel and increased dentin deposition causing teeth to appear yellow or gray

What is the management for aging-related tooth discoloration?

External bleaching

What causes dental fluorosis?

Excessive fluoride intake during enamel formation leading to hypomineralization and discoloration

What is the management for mild dental fluorosis?

Microabrasion using hydrochloric acid plus pumice

What is the management for moderate dental fluorosis?

External bleaching

What is the management for severe dental fluorosis?

Veneers or crowns

What causes tetracycline staining?

Antibiotic binds to calcium during tooth development, causing intrinsic discoloration

What is the management for mild tetracycline staining?

External bleaching

What is the management for severe tetracycline staining?

Internal bleaching or veneers/crowns

What causes enamel hypocalcification?

Defective mineralization leading to opaque or chalky enamel

What are the management options for enamel hypocalcification?

Microabrasion, resin infiltration, or external bleaching

What causes enamel hypoplasia?

Defective enamel formation leading to thin or pitted enamel surfaces

What is the management for enamel hypoplasia?

Restorative treatments like composite resin, veneers, or crowns

What systemic conditions cause blood dyscrasias-related intrinsic tooth staining?

Erythroblastosis fetalis, porphyria, hyperbilirubinemia, thalassemia, and sickle cell anemia

What is the management for tooth discoloration due to blood dyscrasias?

Restorative treatments

Is bleaching effective for blood dyscrasias staining?

Bleaching is often ineffective

What causes iatrogenic tooth discoloration?

Discoloration from dental materials like amalgam or sealers, or procedures

What is the management for iatrogenic tooth discoloration?

Replace offending materials; internal bleaching, veneers, or crowns if necessary

What causes endodontic material-related tooth discoloration?

Residual pulp tissue or materials like sealers post-treatment

What is the management for endodontic material-related tooth discoloration?

Internal bleaching; ensure complete removal of materials from pulp chamber

What is the concentration range of hydrogen peroxide used for in-office bleaching?

30 to 35 percent

What is the primary use of 30 to 35 percent hydrogen peroxide?

In-office bleaching

What are the advantages of hydrogen peroxide for bleaching?

Rapid action; effective for intrinsic and extrinsic stains

What are the risks of hydrogen peroxide bleaching?

Potential for soft tissue burns, sensitivity, and risk of cervical root resorption with heat activation

What are the clinical application requirements for high-concentration hydrogen peroxide?

Requires careful isolation; not recommended for at-home use due to high concentration

What concentration range of carbamide peroxide is used for at-home external bleaching?

10 to 40 percent

What are the advantages of carbamide peroxide?

Slower release of hydrogen peroxide, lower sensitivity, and suitable for night use

What are the disadvantages or risks of carbamide peroxide?

Less potent than hydrogen peroxide and longer treatment duration

How is carbamide peroxide commonly applied?

Commonly used in custom trays

What is the equivalent concentration of hydrogen peroxide for a 10 percent carbamide peroxide solution?

3.5 percent hydrogen peroxide

How should carbamide peroxide concentrations above 10 percent be used?

Under dental supervision

What effect does heat activation have on hydrogen peroxide bleaching?

Enhances bleaching efficacy but increases the risk of root resorption

What protective measures must always be used during in-office bleaching?

Protective measures such as rubber dams to protect soft tissues

What ongoing patient monitoring is required during bleaching?

Monitor patients for sensitivity and adjust treatment protocols accordingly

What are the indications for internal nonvital bleaching?

Intrinsic discolorations originating from within the pulp chamber such as necrosis, blood degradation products, dentin discoloration like tetracycline, and intrinsic stains not responsive to external bleaching

What are the contraindications for internal bleaching?

Superficial enamel-based discoloration, defective enamel formation like amelogenesis imperfecta, severely compromised dentin structure, active caries, and discolored proximal composite restorations unless planned for replacement post-bleaching

What is the preferred technique for internal nonvital bleaching?

Walking Bleach technique

Does the walking bleach technique involve heat application?

No heat application

What agents are placed into the cleaned pulp chamber in the walking bleach technique?

Sodium perborate plus water or hydrogen peroxide less than or equal to 10 percent

What materials are used to temporarily seal the access cavity in the walking bleach technique?

IRM or Cavit

When should a tooth undergoing the walking bleach technique be re-evaluated?

After 1 to 2 weeks

How many times can the walking bleach procedure be repeated?

Can be repeated 2 to 3 times

Why is the thermocatalytic technique no longer recommended?

Involves placing 30 to 35 percent hydrogen peroxide into pulp chamber and applying heat, resulting in an increased risk of external cervical root resorption

What form and mixture is sodium perborate used in for internal bleaching?

Powder mixed with water

Why is sodium perborate the preferred agent for nonvital internal bleaching?

Safe, slow release of peroxide

What are the causes of external root resorption during internal bleaching?

High hydrogen peroxide concentration greater than 30 percent combined with heat, or bleaching in inadequately obturated canals

What is the management for mild external root resorption from bleaching?

Surgical access, curettage, and restore with MTA or GIC

What is the management for severe external root resorption from bleaching?

May need extraction

What causes chemical burns during internal bleaching?

Contact of 30 percent hydrogen peroxide with soft tissues

How are chemical burns managed or prevented during bleaching?

Use rubber dam, protect tissues, use safer agents like sodium perborate

What causes coronal fracture following internal bleaching?

Over-bleaching or dehydrated dentin weakens tooth structure

How is coronal fracture managed or prevented?

Minimize bleaching cycles, reinforce crown post-treatment

What causes apical periodontitis as a complication of internal bleaching?

Bleaching done in poorly obturated or previously untreated canals

How is apical periodontitis prevented in internal bleaching?

Ensure proper RCT seal before bleaching

What must always be confirmed before performing internal bleaching to prevent periapical complications?

Complete obturation

What isolation method must always be used to prevent soft tissue contact with bleaching chemicals?

Rubber dam isolation

What combination is considered the safest and most effective for internal bleaching?

Sodium perborate plus water

Why should heat application be avoided during internal bleaching?

To prevent cervical root resorption

What is the maximum recommended limit for internal bleaching cycles?

2 to 3 sessions maximum

What is the recommended time spacing between internal bleaching sessions?

Spaced at least 1 to 2 weeks apart

What must be placed into the access cavity after internal bleaching is complete?

A permanent coronal seal