Ch 32- tooth polishing

Tooth polishing introduction

Patients may seek care because they are dissatisfied with the appearance of their teeth.

First steps when a patient is concerned about tooth appearance

Identify the source of concern and the type of stain.

Extrinsic tooth stains

Stains that can usually be removed by hand-activated, sonic, ultrasonic scaling, rubber-cup polishing, or air polishing.

Intrinsic tooth stains

Stains within the tooth that are hereditary, developmental, associated with aging, or caused by enamel or dentin defects.

Tetracycline staining

Intrinsic blue/gray staining.

Examples of extrinsic stains

Tobacco, snuff tobacco, and black line.

Examples of intrinsic stains

Tetracycline staining and fluorosis.

Primary procedures for extrinsic stains

Rubber-cup polishing and air polishing.

Extrinsic stain removal

Only cosmetic.

Are tooth stains pathologic?

Tooth stain is not pathologic.

Rubber-cup polishing

Removal of extrinsic stains after scaling, when indicated.

Rubber-cup polishing equipment

Low-speed handpiece, prophy angle and/or brush, and prophy paste.

Rubber-cup polishing patient acceptance

Highly accepted by patients and easy to learn and perform.

Current polishing standard of care

Selective polishing.

What may be used instead of prophy paste if necessary?

Toothpaste.

Prophy paste formulation

Splatter-free formulations are available.

Prophy paste particle size (grit)

Influences cleansing rate and scratch pattern.

Fine prophy paste grit

Produces the least surface abrasion.

Coarse prophy paste grit

Can scratch and roughen surfaces, making them more likely to accumulate plaque and stain.

Large prophy paste particles

More coarse.

Smaller prophy paste particles

Increase tooth surface cleanliness, luster, and smoothness.

Possible prophy paste ingredients

Fluoride, remineralizing agents, whitening ingredients, or desensitizing agents.

Prophy paste standard

No set standard.

FDA classification of prophy paste

An abrasive agent.

Evidence-based prophy paste recommendation

Use the finest grit that achieves the desired result.

Why should coarse polish not be used on every patient?

It can cause hypersensitivity, tooth roughness, and restoration damage.

Five variables affecting polishing efficiency and tooth structure loss

Abrasiveness, quantity of agent, contact time, speed/RPM, and applied pressure/force.

Abrasiveness and tooth structure loss

The harder the abrasive, the greater the abrasion rate.

Quantity of polishing agent

Never use a dry abrasive agent.

Contact time and abrasion

Longer contact time increases abrasion and frictional heat.

Speed/RPM and abrasion

Greater speed increases abrasion and frictional heat.

Applied pressure and abrasion

Greater force increases abrasion.

Recommended polishing force

Light, intermittent touch.

Rubber-cup polishing effect on enamel

Removes the microscopic outer layer of tooth enamel.

Fluoride-rich enamel layer

May be removed during rubber-cup polishing.

Saliva and enamel

Saliva minerals constantly replenish and remineralize enamel.

Effect of polishing on enamel

Minimal, but cementum and dentin can wear over time.

Demineralized enamel areas

White spots lose significantly more structure than intact enamel.

Polishing and fluoride

Recommend daily fluoride.

Polishing particles and inflamed tissue

Particles may embed in inflamed tissue and delay healing.

Polishing trauma

Caused by improper technique.

Polishing effects on restorations

Can roughen restoration surfaces.

How can restoration damage be reduced?

Use pastes designed for cosmetic restorations and a slow, light, intermittent touch.

Polishing dental implants

Not recommended.

Ways to prevent polishing damage

Use proper technique and control speed, time, and pressure; select the least abrasive agent and selectively polish; avoid polishing when contraindicated.

Rubber-cup polishing contraindications

No extrinsic stain, newly erupted teeth especially primary teeth, enamel hypocalcification or hypoplasia, enamel demineralization, active unrestored caries, exposed cementum or dentin from recession, dentinal hypersensitivity, acute gingival or periodontal inflammation, and paste ingredient allergy.

Polishing restored tooth surfaces

Use a special polishing agent on composite, bonding, glass ionomer, porcelain, gold, or titanium.

Polishing after deep scaling

Consider particle impaction risk when gingival tissues may be irritated after deep scaling, periodontal debridement, or root planing.

Rubber-cup polishing equipment

Rubber cup may be screw-type or snap-on.

Polishing brushes

Flat or pointed bristle brushes may be screw-type, latch-type, or snap-on.

Polishing brush use

Occlusal surfaces and fossae.

Rubber-cup polishing technique

Fill the cup with paste.

Polishing direction

Begin at the cervical area and move toward occlusal or incisal.

Polishing pressure

Use enough pressure to make the cup flare.

Polishing speed and motion

Low speed with intermittent, dabbing, overlapping strokes.

Polishing retraction

Use a mouth mirror.

Polishing approach

Use a systematic approach.

Polishing rinsing

Rinse teeth as needed.

Polishing flossing

Floss to remove abrasive, then rinse.

After polishing

Fluoride application is recommended.

Recommended polishing cup

A soft cup.

Why use a soft polishing cup?

The flared edge reaches into the sulcus or interproximal areas.

Polishing cup material

Use latex-free cups.

Cup placement

Flare the cup under the gingival margin and into interproximal areas.

Hand-activated scaling instruments

Curets and sickles are effective, especially in areas inaccessible to the rubber cup.

Scaling and cementum

Avoid over-instrumentation on cementum.

Stain and root structure

Removing less root structure reduces the chance of root sensitivity after scaling and debridement.

Slender scaling tips

Access concavities and rotated or overlapped teeth.

Sonic and ultrasonic scaling

Remove less tooth structure but leave a rough surface.

Sonic and ultrasonic scaling effectiveness

Both are equally effective at removing stain, plaque, and calculus.

Safest exposed-root scaling choice

Low power and thin tips.

Air polishing

A specialized device with a handpiece delivering pressurized water and prophy powder.

Air polishing time

Requires less time than traditional polishing when used supragingivally.

Air polishing stain removal

Removes stain three times as fast as hand scaling.

Air polishing operator benefit

Less operator fatigue.

Air polishing use before sealants

Preferred for cleaning and removing extrinsic stain from pits and fissures before placing dental sealants.

Supragingival air polishing

Standard air-polishing handpiece removes stain and biofilm.

Shallow subgingival air polishing

Up to 4 mm; standard handpiece with glycine or erythritol, angled toward sulcus for biofilm removal.

Subgingival air polishing

Up to 9 mm; subgingival nozzle with glycine or erythritol powder.

Subgingival glycine polishing benefits

Effective or more effective than traditional hand and ultrasonic instrumentation for biofilm removal up to 4 mm with standard handpiece or 9 mm with subgingival nozzle.

Glycine polishing and root surfaces

Less damaging to root surfaces.

Glycine polishing and implants

Improves outcomes for implants.

Erythritol powder

Also has antibacterial effects.

Powder selection

Depends on the air-polishing unit.

Supragingival powders

More abrasive and should not be used subgingivally.

Subgingival powders

Least abrasive and minimally abrasive to root surfaces and dental materials.

Subgingival powder stain removal

Takes longer to remove stain.

Powder use duration

Use any powder for the minimum time needed to achieve the result.

Sodium bicarbonate powder

Supragingival use; safe for orthodontics; causes significant surface defects in restorations.

Calcium carbonate powder

Supragingival use; causes defects in intact enamel and significant surface defects in restorations.

Aluminum trihydroxide powder

Supragingival use; can cause enamel defects and significant restoration surface defects.

Calcium sodium phosphosilicate powder

Supragingival use; can cause enamel defects and significant restoration surface defects.

Glycine powder

Supragingival and subgingival use; safe on gingiva, mucosa, implants, and orthodontics; more comfortable than other powders.

Erythritol powder

Supragingival and subgingival use; safe for implants and orthodontics; least abrasive powder and more comfortable than other powders.

Common soft-tissue effects of air polishing

Gingival bleeding and abrasion.

Air-polishing tip direction

Point away from gingiva to avoid tissue trauma unless using glycine or erythritol.

Subgingival air-polishing time

5 seconds per site with continuous movement.

Sodium bicarbonate taste

Salty.

How can sodium bicarbonate taste be managed?

Lay wet gauze on the tongue or use flavored powder.

Air polishing and restorations

Avoid extended air polishing on all restorative materials.