PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

(2) mild fluorosis;
(3) yellowing due to ageing;
(4) single teeth with sclerosed pulp chambers and canals.


Armamentarium


(1) rubber dam with clamps and floss ligatures;
(2) Orabase gel;
(3) topical anaesthetic;
(4) gauze;
(5) 37% phosphoric acid;
(6) heating light with rheostat;
(7) 30-volume hydrogen peroxide;
(8) polishing stones;
(9) fluoride drops (0-2 years: drops).


Technique



  1. Take preoperative periapical radiographs and perform vitality tests. Replace any
    leaking restorations.

  2. Clean the teeth with pumice and water to remove extrinsic staining. Take
    preoperative photographs with a tooth from a 'Vita' shade guide registering the shade,
    adjacent to the patient's teeth.

  3. Apply topical anaesthetic to gingival margins.

  4. Coat the buccal and palatal gingivae with Orabase gel as extra protection from the
    bleaching solution.

  5. Isolate each tooth to be bleached using individual ligatures. The end teeth should be
    clamped (usually from second premolar to second premolar).

  6. Cover the metal rubber dam clamps with damp strips of gauze to prevent them from
    getting hot under the influence of the heat source.

  7. Etch the labial and a third of the palatal surfaces of the teeth with the phosphoric
    acid for 60 s, wash, and dry. Thoroughly soak a strip of gauze in the 35% hydrogen
    peroxide and cover the teeth to be bleached.

  8. Position the heat lamp 13-15 inches (33-38 cm) from the patient's teeth. Set the
    rheostat to a mid-temperature range and increase it until the patient can just feel the
    warmth in their teeth, and then reduce it slightly until no sensation is felt.

  9. Keep the gauze damp by reapplying the hydrogen peroxide every 3-5 min using a
    cotton bud. Make sure the bottle is closed between applications as the hydrogen
    peroxide deactivates on exposure to air.

  10. After 30 min remove the rubber dam, clean off the Orabase gel, and polish the
    teeth using the shofu stones. Apply the fluoride drops for 2-3 min.

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