Deposits and Polishing Agents in Dentistry: An Overview of Techniques and Materials

What are polishing agents?

use of an abrasive agent in removing pellicle, plaque, stain* (primarily stain)

professional and home care

What are the goals for removing deposit safely?

removing tooth structure with a fine coarse polishing paste (using a rougher one would remove parts of enamel)

abrading gingival tissue (can happen if polish tool is used at a high speed and too much pressure)

producing excessive heat (doing it too long affects pulp chamber, children have larger pulp chamber)

use less pressure, moist polishing agent, slower speed

Define abrasive

agent composed of particles hard enough to cut or scratch a softer material

Define abrasion

wearing away of a surface by friction

Define polishing

production of smooth, glossy surface thru use of finer particles

What are the characteristics abrasive particles?

shape (circular, irregular)

hardness (soft, medium, hard)

strength of product (less or more concentrated)

size of grit

What do we want in a successful polishing agent?

softer

rounder in shape

smaller grit

less concentrated in polishing agent

What are the professional polishing agents?

pumice (powder mixed with water or paste, mixed into prophi paste)

whiting (used for polishing restorations, crowns, fillings bc it doesn't scratch as easy)

commercial preparations (different brands with pumice mixed in)

Describe FLUORIDE as an active ingredients of commercial dentifrice? (toothpaste)

caries reduction (anti-caries)

Describe ANTIMICROBAL as an active ingredients of commercial dentifrice? (toothpaste)

anti-plaque/ anti-gingivitis, plaque reduction, thereby reducing inflammation

Triclosan (Colgate Total): primarily for reduction in plaque and inflammation; the fluoride in the product reduces caries (NO LONGER USED)

baking soda/hydrogen perioxide

Describe anti-calculus toothpaste

tartar control

to reduce the level of calculus growth; does not eliminate

Describe whitening toothpaste

improved whitening of teeth, but probably removes stains more than 'whitens' (semantics)

Describe desensitizing toothpaste

reduces root sensitivity, does NOT reduce tissue sensitivity

Describe antihalitosis/malodor tooth paste

reduces bad breath

Describe the ADA Seal of Acceptance

caries prevention (fluoride)

prevention of gingivitis (triclosan)

hypersensitivity

calculus reduction

whitening

Active ingredient = effective in clinical studies, award is based on active ingredient

What are the abrasive agents of commercial dentifrice inactive's ingredients?

20-40%

deposit removal

ex: pumice, silicates, aluminum oxide

must be compatible with fluoride

What are the humectant of commercial dentifrice's inactive ingredients?

20-40%

retains moisture

ex: glycerin, sorbitol

What are the water of commercial dentifrice's inactive ingredients?

20-49%

solvent, desired consistency

What is the % of sweetener of commercial dentifrice's inactive ingredients?

2-3

What are the preservative of commercial dentifrice's inactive ingredients?

1%

increases shelf life

What are the flavoring of commercial dentifrice's inactive ingredients?

less than 1%

enhances flavor

ex: mint

What are the colors of commercial dentifrice's inactive ingredients?

less than 1%

enhance appearance

What are the foaming agents (surfactant) of commercial dentifrice's inactive ingredients?

1-2%

lower surface tension, create foaming effect

ex: sodium lauryl sulfate

What are the thickening agent (binder) of commercial dentifrice's inactive ingredients?

1-2%

prevent separation of ingredients

higher content in gels (vs. pastes)

Describe levels of abrasiveness

How do we select a polishing agent professionally?

use least abrasive agent

follow principles of selective polishing

How do we select a polishing agent for home use?

relate to patient needs

use ADA seal to help pick

(ex. caries, stain, calculus, gingivitis, hypersensitivity)

What is the role of mechanical polishing?

remove extrinsic stains

plaque removal

can polish restorative materials (not white or aesthetic materials)

prep teeth for caries preventative agents like sealants or fluorides

increase patient motivation/expectation

What are the side effects of polishing?

Bacteremia

Aerosol production

Splatter created

Tooth structure removed

Removal of fluoride-rich layer

Heat production

What are the new ADA positions on polishing?

Not as much tooth structure removed as thought with polishing (questioning quality of previous studies)

Patients were never on board with non-polishing concept

If clinician follows good, appropriate protocol, then minimal damage to patient

Describe selective polishing

polish where needed based on patient need --> areas of stain and plaque remaining after instrumentation

allows patient to be more involved in treatment

Describe the technique of polishing

access: select polishing agent based on patient need (stains, restorations, start w less abrasive)

stay off areas of contraindication: sensitive areas, amelogenesis imperfecta

be mindful of speed, pressure, strokes

Describe polishing technique --> application of paste

quantity (dry vs wet)

speed (fast vs slow)

pressure (heavy vs light)

List things to be cautious about when polishing (5)

1. avoid over polishing

2. use least abrasive agent

3. use lowest effective speed

4. use light pressure with intermittent strokes

5. use moist abrasive