Staining, selective polishing, whitening, and flouride

What is tooth stain?

A: Discoloration of teeth or deposits on teeth that can be classified as extrinsic or intrinsic. [2026 BDH1...uoride.pdf | PDF]

What is extrinsic stain?

A: Stain that originates from sources outside the tooth and can usually be removed by scaling or polishing.

What is intrinsic stain?

A: Stain that originates within the tooth structure and cannot be removed by scaling or polishing.

What are common causes of extrinsic staining?

A: Food, beverages, tobacco, cannabis, and chromogenic bacteria. [2026 BDH1...uoride.pdf | PDF]

What are chromogenic bacteria?

A: Color-producing bacteria that can cause orange, green, or black staining.

What causes yellow extrinsic stain?

A: Oral biofilm

What causes black extrinsic stain?

A: Iron in saliva, iron supplements, metallic dust, or black line stain.

What causes brown extrinsic stain?

A: Tobacco products and food or beverage pigments.

What causes green extrinsic stain?

A: Chromogenic bacteria and fungi, often in children with enamel deformities

What causes gray/brown-green extrinsic stain?

A: Smoking cannabis or tobacco

What causes red-black extrinsic stain?

A: Chewing betel nut or betel leaf

What are common causes of intrinsic staining?

A: Antibiotic use, fever, trauma, infection, excess fluoride, restorations, pulpal necrosis, and caries.

What causes dental fluorosis?

A: Excessive fluoride ingestion during enamel development

white spots or brown pits in the enamel

What causes hypocalcification?

A: High fever during enamel development

white spots near incisal edge or front of tooth

What causes demineralization?

Q: How does demineralization appear?

A: Acid erosion of enamel caused by oral biofilm.

A: White or brown spots on enamel.

What causes tetracycline staining?

A: Use of tetracycline during tooth development.

What color is tetracycline staining?

A: Grayish-brown discoloration

What does pulpal necrosis cause?

A: Gray or black tooth discoloration

the pulp has died bc the tooth has lost its blood supply

How can amalgam restorations discolor teeth?

A: Tin migrates into enamel and dentin, causing a gray shadow.

What is the primary method for removing extrinsic stain?

A: Rubber cup polishing

What are the common prophylaxis paste grits?

A: Fine, medium, coarse, MI paste, and superfine.

Q: What 5 variables affect polishing abrasiveness?

A: Abrasiveness, quantity, contact time, speed, and pressure.

What should always be done after polishing?

flossing

What type of handpiece is used for rubber cup polishing?

A: Slow-speed dental handpiece

Why should newly erupted teeth not be polished routinely?

A: Their enamel is not as strong, especially in primary teeth

What enamel defects contraindicate polishing?

A: Decalcification, hypocalcification, hypoplasia, demineralization, and carious lesions

Why are areas of recession contraindicated for polishing?

A: Cementum and dentin may be exposed.

Why are hypersensitive teeth contraindicated for polishing?

A: Polishing can increase sensitivity.

Why is polishing contraindicated when no extrinsic stain is present?

A: It is unnecessary and can remove tooth structure

Why is polishing around implants discouraged?

A: It may damage implant surfaces.

What respiratory conditions contraindicate polishing?

A: COPD and asthma due to aspiration risk. [2026 BDH1...uoride.pdf | PDF]

Why is active periodontitis a contraindication to polishing?

A: Polish particles may become trapped in inflamed tissues

Why should polishing be avoided in immunocompromised patients?

A: Aerosols increase bacterial aspiration risk. [2026 BDH1...uoride.pdf | PDF]

Define selective polishing.

A: Polishing only where extrinsic stain exists and where treatment will not damage teeth, restorations, tissues, or health.

What are the two main whitening agents?

A: Carbamide peroxide and hydrogen peroxide.

What concentration of carbamide peroxide is used for whitening?

A: 10-35%

What concentration of hydrogen peroxide is used for whitening?
A: 5-40%

What are the three main whitening options?
A: OTC products, professionally dispensed home-use products, and in-office bleaching

What OTC whitening products are available?

A: Toothpastes, strips, rinses, and boil-and-fit trays.

Why are whitening toothpastes not recommended long-term?

A: They may be abrasive and are intended for short-term whitening use

What does titanium dioxide do in whitening toothpaste?

A: Covers extrinsic stain but does not change internal tooth color.

What concentration of carbamide peroxide is typically used in professionally dispensed home whitening?

A: 10-30%

How long are custom trays worn for home whitening?

A: 2-4 weeks for 1-2 hours daily or overnight

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

A: Approximately 35%

What activates in-office bleaching agents?

A: LED lights or lasers

How many appointments are typically required for in-office bleaching?

A: 1-3 appointments over 2-4 weeks

What is intracoronal bleaching?

A: Bleaching performed inside an endodontically treated non-vital tooth

What are the major side effects of in-office bleaching?

A: Tooth sensitivity, gingival burns, and reversible pulpitis

Which patients should not receive whitening?

A: Pregnant or breastfeeding patients.

Name common contraindications for whitening.

A: Caries, defective restorations, recession, cervical erosion, sensitivity, enamel cracks, allergies, and photosensitizing medication

What is fluoride?

A: A naturally occurring nutrient that helps prevent caries and promotes remineralization

During what age range can excess fluoride cause fluorosis?

A: During tooth development, approximately ages 0-8 years

Which fluoride compound is considered most effective?

A: Stannous fluoride

What side effect can stannous fluoride cause?

A: Extrinsic black staining.

What fluoride concentration is found in most commercial toothpastes?

A: About 1100 ppm

Name three common fluoride formulations in toothpaste.

A: Sodium fluoride (NaF), sodium monofluorophosphate (NaMFP), and stannous fluoride (SnF₂)

What fluoride concentration is found in high-fluoride dentifrices such as Prevident 5000 and Clinpro 5000?

ideal for high-caries-risk patients as it contains 5000 ppm.

What concentration of fluoride is found in fluoride mouth rinses?

A: 0.02%-0.05% NaF (about 200-500 ppm

Why are fluoride rinses not recommended for young children?

A: Risk of swallowing

What are the indications for fluoride varnish?

Increased caries risk, orthodontic treatment, recession, xerostomia, low fluoride exposure, and children under 6

Why is fluoride varnish recommended for children under 6?

A: Less fluoride is swallowed compared with other applications

What post-op instructions are given after Profluorid varnish?

A: Avoid hard foods, hot/alcoholic drinks, brushing, and flossing for 4-6 hours

What is unique about Clinpro varnish?

A: Water-based and has no restrictions after 15 minutes

How long are fluoride gel trays left in place?

4 minutes

How much fluoride gel is dispensed for tray application?

A: 2 mL total divided evenly between trays.

What instructions are given after fluoride gel application?

A: No eating, drinking, rinsing, or brushing for 30 minutes