Dental Materials Syllabus for 2013-2014
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Course

DHYG-1319-001 Dental Materials

Prerequisites

CHEM 1406 or department chair consent

Course Description

Physical and chemical properties of dental materials including the application and manipulation of the various materials used in dentistry.

Student Resources Student Resources Website

Department Expectations

\N

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Hours

(3 sem hrs; 2 lec, 3 lab)

Class Type

On Campus Course

Syllabus Information

Textbooks

\ Clinical Aspects of Dental Materials,  (FourthEdition)   Marcia Gladwin, Michael Bagby

\

\  

Supplies

\ 1. Library Card for AC and/or city library
\ 2. Computer and Internet Access, printer, print cartridges
\ 3. Index cards, large scantrons, paper, pens, markers
\ 4. Additional Lab materials will be

Student Performance

\ End of Course Outcomes:  Differentiate between the various types of dental materials and their respective properties; and manipulate materials used in dentistry.

\

\ Instructor Objectives:  This course will enable the student to use dental materials in accordance with their design features and in accordance with the manufacturer's recommendations. In addition, the student will be taught safety precautions and OSHA compliance.  The semester will progress straight through the book and will include introduction to the Eaglesoft Dental Software that will be used in the Clinic along with the Casey patient education modules. 

\

\  After studying the material presented in this course of study and completing the projects in the lab, the student will be able to do the following:

\

\ 1. Identify the materials commonly used in dentistry for restorative and lab procedures.
\ 2. Demonstrate safe and appropriate handling of these materials
\ 3. Recognize the clinical appearance and intraoral presence of restorative materials
\ 4. Begin to understand the reasoning of a Dentist in choosing different materials
\ 5. Feel comfortable in answering basic questions from patients concerning dental materials
\ 6. Apply your knowledge base of dental materials to problems or opportunities that arise to help make reasonable opinions or suggestions and to help    educate your patients as to what action or treatments might be appropriate, to report or present your findings to the dentist for a diagnoses and treatment of your patients.
\ 7. Evaluate Case Studies and understand how to begin to build a patient Chart in Eaglesoft.
\ 8. Utilize Casey patient education system to better educate your patients about dental care.

\

\ The student will know that these goals have been successfully completed if after evaluated by course instructor, a final grade of “C” or greater is earned. 

\

\ Chapter Objectives

\

\ Objectives Chapter 1
\ 1. Summarize the reasons why a dental hygienist should be knowledgeable in
\ the science of dental materials.
\ 2. Discuss some of the conditions that make the oral cavity a hostile environment.
\ 3. Identify four characteristics or properties a dental material must possess to
\ survive in the oral environment.
\ 4. Explain how the following organizations evaluate and/or classify dental
\ drugs, materials, instruments, and equipment:
\ • American Dental Association (ADA)
\ • U.S. Food and Drug Administration (FDA)
\ • International Standards Organization (ISO)
\ 5. Name three ways dental materials may be classified, and discuss each.
\ 6. Specifically discuss the locations of all six cavity classifications and the
\ appropriate restorative material to be used for each. Include the following in
\ your discussion:
\ • Anterior and/or posterior
\ • Involvement of incisal angle
\ • Involvement of proximal surface
\ • Smooth surfaces versus pit and fissures

\

\ Objectives Chapter 2
\ After studying this chapter, the student will be able to do the following:
\ 1. List the phases into which materials are classified. Discuss the varying
\ amounts of attraction between the molecules and atoms of each phase.
\ Recall the differentiating characteristics of each phase.
\ 2. Explain the basic difference between primary and secondary bonds.
\ 3. Name the three types of primary bonds, and describe the differences
\ between them.
\ 4. Summarize the similarities and differences of secondary bonds, which
\ include permanent dipoles, hydrogen bonds, and fluctuating dipoles.
\ 5. Contrast the bonding characteristics of metals, ceramics, plastics, and
\ composites.

\

\ Objectives Chapter 3
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe or define the key words and phrases.
\ 2. Relate the physical properties of materials discussed in this chapter to
\ their use in dentistry.
\ 3. Define wetting. Include in the definition a drop of liquid and the contact
\ angle formed with the surface.
\ 4. Name the units of measure for the following properties:
\ • Density
\ • Heat capacity
\ • Stress
\ • Strain
\ • Modulus of elasticity
\ 5. Define “proportional limit,” and name two other nearly equivalent terms.
\ 6. Name the four types of stress, and provide an example of each found in
\ everyday life.
\ 7. Describe two situations in which dental materials are subjected to bending
\ stresses when in function.
\ 8. Compare the properties of “toughness” and “hardness,” and provide
\ examples.
\ 9. Explain the difference between stress relaxation and creep.
\ 10. Discuss the phenomenon of stress concentration, and compare its effects
\ on a poorly placed amalgam restoration as well as on a properly placed
\ one.

\

\ Objectives Chapter 4
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe an “adhesive.”
\ 2. Explain the difference between micromechanical bonding and macromechanical
\ bonding, and provide an example of each type.
\ 3. Recall three benefits the patient receives from restorations that are bonded
\ to tooth structure.
\ 4. Compare the differences of the microanatomy of enamel and of dentin
\ regarding etching and bonding. The comparison should include the following
\ terms:
\ • Orthophosphoric acid
\ • Enamel tags
\ • Smear layer
\ • Hybrid layer
\ • Primer
\ • Adhesive
\ 5. Discuss two of the earlier fallacies about dentinal bonding and how
\ research has changed current practice.
\ 6. Summarize the main differences between glass ionomer cements and
\ dentinal bonding.

\

\ Objectives Chapter 5
\ After studying this chapter, the student will be able to do the following:
\ 1. Name the two types of polymerization reactions commonly seen in dental
\ materials, and explain the meaning of “addition” in “addition polymerization.”
\ 2. Discuss the following properties of restorative resins:
\ • Polymerization shrinkage
\ • Coefficient of thermal expansion
\ • Abrasion resistance
\ 3. Summarize the relationship between a filler particle, the matrix, and the
\ coupling agent of a composite restorative material.
\ 4. Compare the advantages and disadvantages of light-cure and chemicalcure
\ composite materials.
\ 5. Explain the importance of proper eye protection when light-curing dental
\ materials.
\ 6. Relate the importance of the following procedures and/or characteristics
\ of dental composites:
\ • Depth of cure
\ • Addition of material in increments
\ • Inhibition by air
\ • Unreacted C_C bonds
\ • Shades
\ • Shortcomings of the matrix
\ 7. Summarize the importance of the following properties in relation to the
\ fillers (particles) found in dental composites:
\ • Composition
\ • Size
\ • Amount
\ • Abrasion resistance
\ • Refractive index
\ • Clinical detection
\ 8. Choose one of the three types of dental composites, and justify its use in
\ the following dental situations:
\ • Bonding orthodontic brackets to enamel
\ • Class V “gingival notch” restoration
\ • Small Class I or II restoration
\ 9. Briefly explain the reason(s) for the development of flowable and condensable
\ composites.
\ 10. Discuss the role the dental hygienist should play in the placement and
\ maintenance of pit and fissure sealants.
\ 11. Discuss the use of a primer with pit and fissure sealants.
\ 12. Briefly describe “preventive resin restoration” and “composite cements.”
\ 13. Assess the positive and negative characteristics of light-cure and chemicalcure
\ glass ionomer cements.
\ 14. Discuss the similarities between compomers, glass ionomers, and
\ composites.

\

\ Objectives Chapter 6
\ After studying this chapter, the student will be able to do the following:
\ 1. Differentiate between an amalgam alloy and a dental amalgam.
\ 2. Describe the composition of conventional and high-copper dental amalgams.
\ 3. Describe the function (effects) of the major elements of dental amalgams.
\ 4. Describe the self-sealing property of amalgam.
\ 5. Describe the following shapes of amalgam alloy particles:
\ • Lathe cut
\ • Spherical
\ • Blend or admix
\ 6. Describe the effect of moisture contamination on amalgam.
\ 7. Describe acceptable mercury hygiene practices.
\ 8. Describe the use and advantages of direct gold restorations.
\ OPTIONAL
\ 9. Explain the trituration and setting processes.
\ 10. Describe the reactions involved in both conventional and high-copper
\ amalgams.
\ 11. Describe the composition, relative strength, and relative corrosion resistance
\ of the four most common amalgam phases.

\

\ Objectives Chapter 7
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe the use of dental cements as a:
\ • Luting agent
\ • Base
\ • Filling material
\ • Temporary restoration
\ • Intermediate restoration
\ • Periodontal pack
\ • Temporary cement
\ 2. Explain the importance of adhesion and microleakage to the clinical use of
\ a dental cement.
\ 3. Differentiate between a base and a liner.
\ 4. Describe the use of a cavity varnish or cavity sealer.
\ 5. Describe the relative properties of the component liquids and powders of
\ dental cements.
\ 6. Explain the setting reaction of a typical dental cement.
\ 7. Based on the properties of the liquid and the powder, discuss the
\ properties of:
\ • Zinc oxide–eugenol (ZOE) cement
\ • Zinc phosphate cement
\ • Polycarboxylate cement
\ • Glass ionomer cement
\ • Composite cement
\ • Calcium hydroxide base
\ 8. Summarize the mixing process for the first four cements in objective #7 and
\ how it relates to the setting reaction.
\ 9. Describe the use and advantages of a composite cement.

\

\ Objectives Chapter 8
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe the use of impression materials during indirect restorative
\ procedures.
\ 2. List the oral structures from which impressions are made.
\ 3. Differentiate between a model, a cast, and a die.
\ 4. Describe the various types of impression trays.
\ 5. List the desirable qualities of an impression material.
\ 6. Differentiate between:
\ • Elastic and inelastic impression materials
\ • Reversible and irreversible impression materials
\ 7. Describe the composition and setting mechanism of:
\ • Wax and impression compound
\ • Zinc oxide–eugenol (ZOE)
\ • Agar or reversible hydrocolloid
\ • Alginate
\ • Polysulfides
\ • Condensation silicones
\ • Polyethers
\ • Addition silicones
\ 8. Compare the properties, use, and cost of the above impression materials.
\ 9. Describe the effect of water temperature on the setting rate of alginate.
\ 10. Describe the effect of water and heat on the setting rate of polysulfides

\

\ Objectives Chapter 9
\ After studying this chapter, the student will be able to do the following:
\ 1. Define the following terms: study model, cast, and die.
\ 2. Discuss the major differences between dental plaster, stone, and improved
\ stone.
\ 3. Explain the meaning of initial and final setting times.
\ 4. Give three examples of how to increase and decrease the setting times of
\ gypsum products.
\ 5. Discuss wet and dry strength as it relates to gypsum products.
\ 6. Summarize the recommended technique for use of gypsum products for
\ measuring, mixing, and filling the impression. Include hand and vacuum
\ mixing.

\

\ Objectives Chapter 10
\ After studying this chapter, the student will be able to do the following:
\ 1. Discuss the factors that affect treatment planning for a fixed indirect
\ restoration.
\ 2. Explain the lost-wax casting process used in dentistry to make metal
\ restorations.
\ 3. Describe the types of alloys used to make all-metal crowns, ceramometal
\ crowns, and partial denture frameworks.
\ 4. Recall the types of porcelain used to simulate the color of teeth.
\ 5. List the advantages and disadvantages of all-metal, ceramometal, and allceramic
\ restorations.

\

\
\ Objectives Chapter 11
\ After studying this chapter, the student will be able to do the following:
\ 1. List the uses of acrylic resins in dentistry.
\ 2. Explain the physical and chemical stages of polymerization of acrylic resins.
\ 3. Describe the function of the components of heat-cure and cold-cure acrylic
\ resin systems.
\ 4. Describe the steps involved in construction of a denture.
\ 5. Summarize the procedures used to reline a denture.
\ 6. Explain a dental hygienist’s role in maintenance of an acrylic prosthesis.

\

\ Objectives Chapter 12
\ After studying this chapter, the student will be able to do the following:
\ 1. List the indications and contraindications for dental implants.
\ 2. Describe the materials used for dental implants.
\ 3. Recall the types and uses of dental implants.
\ 4. Describe osseointegration.
\ 5. Discuss the maintenance of dental implants.

\

\ Objectives Chapter 13
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe the components of a fixed orthodontic appliance.
\ 2. Discuss the caries risk of orthodontic patients and the dental hygienist’s role
\ in preventing caries and periodontal disease in these patients.
\ 3. Summarize the procedures involved in root canal therapy.
\ 4. Explain the use of periodontal packs and sutures.

\

\ Objectives Chapter 14
\ After studying this chapter, the student will be able to do the following:
\ 1. Using the criteria listed in Table 14.1, differentiate between porcelain and
\ composite materials.
\ 2. Discuss how the following criteria may help a clinician to distinguish
\ between tooth tissues and restorative materials or between two types of
\ restorative materials:
\ • Radiographic characteristics
\ • Surface smoothness
\ • Tactile and auditory sensations
\ • Location
\ 3. Distinguish between other tooth tissues and restorative materials by using
\ the criteria listed in Table 14.1.
\ 4. Describe some common procedures routinely performed by a dental
\ hygienist that could be detrimental to teeth and restorative materials.
\ 5. Verbally compare the expected differences in the surfaces of enamel and a
\ gold crown after polishing with a relatively abrasive agent.
\ 6. Recall the recommended instrumentation technique around the margins of
\ cast restorations.
\ 7. Explain the causes of possible damage to restorations from the use of
\ high-speed instrumentation.
\ 8. Propose a possible scaling-and-polishing protocol for a patient with the
\ following oral findings:
\ • 4 mm of recessed gingiva
\ • Class V glass ionomer restorations in the maxillary left quadrant
\ • Two gold crowns in the mandibular right quadrant
\ • Three composite restorations in the maxillary anterior segment

\

\ Objectives Chapter 15
\ After studying this chapter, the student will be able to do the following:
\ 1. Identify various dental tissues and materials on a radiograph.
\ 2. Explain why, radiographically, dental tissues and materials appear
\ radiopaque or radiolucent.
\ 3. Integrate the radiographic appearance of dental tissues and materials with
\ clinical information to assess the patient’s status of health or disease.

\

\ Objectives Chapter 16
\ After studying this chapter, the student will be able to do the following:
\ 1. Briefly define the following terms:
\ • Cutting
\ • Abrasion
\ • Finishing
\ • Polishing
\ • Abrasive
\ 2. Recall six common abrasives that may be used for clinical or laboratory procedures.
\ 3. Explain the difference between two-body and three-body abrasion. 
\     Provide an example of a polishing procedure that exemplifies each type of abrasion
\ 4. Summarize factors that may influence the rate of abrasion, and explain why
\ the dental hygienist must have a clear understanding of these factors when
\ providing patient care.
\ 4.
\ 5.Discuss the reasons why tooth structure and restorations are polished.
\ 6. Recall the details of the polishing process. Include the series of steps,
\ scratches produced, and wavelength of visible light.7.6. Explain what it means to selectively polish.
\ 7. Explain what it means to selectively polish
\ 8. Describe the characteristics of an acceptable prophylaxis paste.
\ 9. Describe the difference between a cleaning agent and a polishing agent.
\ 10. Identify the types of restorations that cannot be polished with an air powder polisher.

\

\ Objectives Chapter 17
\ After studying this chapter, the student will be able to do the following:
\ 1. Define tooth whitening, and explain the difference between vital and nonvital
\ tooth whitening.
\ 2. Explain the difference between intrinsic and extrinsic stains, and list examples
\ of each.
\ 3. Identify two chemical agents used for vital tooth whitening, and explain the
\ process by which whitening agents whiten teeth.
\ 4. Identify two chemical agents used for nonvital tooth whitening.
\ 5. List the factors that affect the success of tooth whitening.
\ 6. Compare and contrast patient-applied and professionally applied vital
\ whitening.
\ 7. List contraindications for both patient-applied and professionally applied
\ tooth whitening procedures.
\ 8. Discuss measures to prevent or alleviate tooth whitening side effects.
\ 9. Become familiar with the statement made by the ADA on the safety and efficacy of tooth whitening.

\

\ Objectives Chapter 18
\ After studying this chapter, the student will be able to do the following:
\ 1. List the different oral appliances used in dentistry.
\ 2. Describe the reasons for the use of oral appliances.
\ 3. Name the different thermoplastic materials used in the fabrication of oral
\ appliances, and discuss the properties of these materials.
\ 4. Explain the steps involved in fabricating an oral appliance.
\ 5. Describe the proper maintenance of oral appliances.
\ 6. Prepare a script or dialogue that may be used for patient education regarding
\ oral appliances.

\

\ Objectives Chapter 19
\ After studying this chapter, the student will be able to do the following:
\ 1. Explain the basic differences between carbon-steel and stainless-steel
\ instruments.
\ 2. Discuss the processes of passivation and electropolishing.
\ 3. Summarize the problems or conditions that can affect instruments, including
\ corrosion, rust, pitting, spotting, and stains.
\ 4. Explain why it is important to inspect instruments.
\ 5. Explain the reasons for sharpening instruments, and determine the appropriate
\ time and frequency of sharpening.
\ 6. Discuss the cleaning of instruments, both immediately after use and when
\ timely cleaning is not possible.
\ 7. Recall the advantages and disadvantages of the four methods of sterilizing
\ instruments.
\ 8. Design an instrument maintenance schedule or cycle that could be used
\ routinely in a private-practice office setting.

\

\ Objectives Chapter 20
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe safety and risk in terms of common hazards in everyday life and
\ work in a dental office.
\ 2. Define and appreciate the practice of universal precautions in dentistry.
\ 3. Identify the types of personal protective equipment (PPE) that must be
\ used for the practice of dentistry in the operatory and laboratory.
\ 4. Explain the criteria for selection of PPE during dental procedures.
\ 5. Determine the methods of sterilization or disinfection that can be used to
\ decontaminate each type of instrument or item in the dental operatory or
\ laboratory.
\ 6. Evaluate surface disinfectants that may be used in the dental office.
\ 7. Recall the methods that may be used to prevent cross-contamination during
\ distribution of dental supplies.
\ 8. Describe effective ways to manage contamination caused by aerosols and
\ splatter.
\ 9. Discuss safe handling and disposal of sharp items contaminated with
\ blood or saliva.
\ 10. Appreciate the significance of an office exposure control plan and protocol
\ for managing exposure to bloodborne pathogens.
\ 11. Describe the infectious, physical, and chemical hazards in a dental office.
\ 12. Recognize office and laboratory housekeeping practices that contribute to
\ infection control and safety.

\

\ Objectives Chapter 21
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe an effective infection-control protocol for handling impressions
\ and dental appliances that are transferred between the dental operatory
\ and the dental laboratory within the dental office or to an outside
\ commercial laboratory.
\ 2. Discuss and demonstrate the procedure for disinfecting dental impressions.
\ 3. Explain and demonstrate the procedure for disinfecting dentures and other
\ dental appliances after they have been processed or adjusted.
\ 4. Describe and apply the infection-control protocol that must be followed
\ when grinding or polishing dentures and other appliances.
\ 5. Review the preferred method (or methods) of sterilizing or disinfecting
\ instruments or items used during manipulation of dental materials and
\ prostheses.

\

\ Objectives Chapter 22
\ After studying this chapter, the student will be able to do the following:
\ 1. Give reasons why correct dispensing, timing, and mixing of materials are
\ important.
\ 2. Discuss the difference in setting times of dental materials in the oral cavity
\ and on the instrument tray.
\ 3. Summarize the recommended guidelines for light-activated dental materials.

\

\ Lab and Clinical Chapter Objectives:

\

\ Objectives Chapter 23
\ After performing the laboratory/clinical exercises in this chapter, the student will
\ be able to do the following:
\ 1. Describe the use or purpose of the following materials:
\ • Calcium hydroxide
\ • Zinc phosphate
\ • Glass ionomer
\ • Zinc oxide–eugenol (ZOE)
\ • Temporary cement
\ 2. Demonstrate the proper mixing technique for the materials listed above,
\ and then evaluate the mix according to the criteria stated in this chapter.
\ 3. Recall the approximate mixing and setting times for the liners, bases, and
\ cements discussed in this chapter.
\ 4. Clean the cement spatula or mixing instrument and slab with the appropriate
\ cleaning agent before the material sets.

\

\ Objectives Chapter 24
\ After performing the laboratory/clinical exercises in this chapter, the student will
\ be able to do the following:
\ 1. List the indications and contraindications for placing the rubber dam.
\ 2. Describe the purpose of the rubber dam armamentarium (rubber dam,
\ rubber dam clamp, punch, etc.).
\ 3. Summarize the steps for placement and removal of the rubber dam.

\

\ Objectives Chapter 25
\ After performing the laboratory/clinical exercises in this chapter, the student will
\ be able to do the following:
\ 1. Discuss the factors determining the success of a sealant.
\ 2. List the indications and contraindications for applying a sealant.
\ 3. Describe the acceptable, but different, methods for preparing the enamel
\ surface for a sealant.
\ 4. Summarize the steps of applying a sealant.
\ 5. Evaluate a placed sealant regarding proper isolation, coverage, and defects.
\ 6. Explain the importance of recall visits for sealant maintenance.
\ 7. Professionally speak to a parent of a child who is in need of sealants.
\ Include in the discussion the rationale, procedure, time involved, and
\ prognosis.

\

\ Objectives Chapter 26
\ After studying this chapter, the student will be able to do the following:
\ 1. Describe, understand, and explain the sequence of steps for the placement and carving of a dental amalgam restoration.
\ 2. Name the instruments and materials used for placement of dental amalgam restorations.
\ 3. Explain the rationale for amalgam finishing and polishing.
\ 4. Recall the benefits of properly finished and polished amalgams.
\ 5. List two indications for finishing and polishing amalgams.
\ 6. Discuss the possible results of poor amalgam placement and carving.
\ 7. Assess an amalgam restoration to determine whether it needs replacement
\ or finishing and polishing.
\ 8. Differentiate between the procedures of amalgam finishing and amalgam
\ polishing.
\ 9. Explain the importance of temperature control and related factors during
\ finishing and polishing.
\ 10. Evaluate a well-finished and polished amalgam according to the criteria
\ provided in this chapter.

\

\
\ Objectives Chapter 27
\ After studying this chapter, the student will be able to do the following:
\ 1. Select the appropriate tray for the patient by using the criteria listed in this
\ chapter.
\ 2. Prepare the impression trays with rope wax, including the palatal area of
\ the maxillary tray.
\ 3. Discuss the aspects of patient preparation for alginate impressions.
\ 4. Demonstrate proper mixing of the alginate as well as loading, seating, and
\ removal of the tray to obtain acceptable alginate impressions.
\ 5. Evaluate the impression by using the criteria listed in this chapter, and
\ determine if the impression is acceptable.

\

\ Objectives Chapter 28
\ After studying this chapter, the student will be able to do the following:
\ 1. Demonstrate the following laboratory procedures:
\ • Use a gypsum product to pour a study model from an impression.
\ • Trim the study model on the model trimmer.
\ 2. Differentiate between the two methods of diagnostic cast/study model
\ fabrication.
\ 3. Describe and demonstrate the cast cuts that are used to trim a study model
\ for patient consultation and dental treatment planning.
\ 4. Explain the laboratory safety procedures and necessary equipment for use
\ in the laboratory mandated by the Occupational Safety and Health
\ Administration.
\ 5. Critique the completed study model for acceptable cuts.

\

\ Objectives Chapter 29
\ After studying this chapter, the student will be able to do the following:
\ 1. List the differences between the acrylic resin and visible light–cured (VLC)
\ tray fabrication techniques.
\ 2. Briefly describe the characteristics of an exothermic reaction.
\ 3. Name the three purposes of an impression tray.
\ 4. Recall the four reasons why a dentist may choose to fabricate a custom tray
\ for a patient rather than use a stock tray.
\ 5. Explain the purpose of the occlusal stops that are designed in a custom
\ impression tray.
\ 6. Discuss two methods of trimming a custom tray.

\

\ Objectives Chapter 30
\ After studying this chapter, the student will be able to do the following:
\ 1. Briefly discuss the rationale for dental hygienists to learn the preparation
\ and technique of addition silicone impression material.
\ 2. Recall the reasons for using addition silicone impression material.
\ 3. Explain the tray preparation that is necessary for use of addition silicone
\ impression material.
\ 4. Summarize the steps involved in:
\ • Preparing the putty (tray) material
\ • Preparing the wash (syringe) material

\

\ Objectives Chapter 31
\ After studying this chapter, the student will be able to do the following:
\ 1. List the indications and contraindications for use of patient-applied, professionally
\ supervised whitening techniq

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