Coronal polishing and stain

what are the 4 contraindications to polishing listed?

-communicable disease

-respiratory problems (ex. severe asthma or COPD/Emphysema)

-patients at risk for bacteremia (bacteria in the mouth introduced into the bloodstream)

-allergy to polishing products

what are some examples of individuals who are susceptible to bacterial infections and always require a pre-med?

Artificial heart valves

Previous endocarditis

Complex cyanotic congenital heart defect

Congenital heart defect repair

-6 months if fully repaired

-Always if there is any residual effect

Heart transplant with valvular dysfunction

Surgically constructed systemic pulmonary shunts or conduits Joint replacement—only if physician requests it

what are some examples of individuals who are immunocompromised that are susceptible to bacterial infections and may need a pre-med, discussed with physician?

Immunosuppression

Autoimmune disease or drug induced immunosuppression HIV/AIDS

Uncontrolled diabetic

Cancer/cancer therapy

Dialysis or transplant patient

Malnourishment

Hemophilia

Sickle Cell Anemia

what pre-med should be taken if theyre not allergic to penicillin?

Adults: 2.0 grams of amoxicillin

Children: 50 milligrams/kilogram

What pre-med should be taken if they are allergic to penicillin?

Adults: 2.0 grams of cephalexin

Children: 50 milligrams/kilogram

what pre-med is no longer recommended?

clindamycin

what are the indications for polishing?

Completed after scaling removal of calculus deposits Cosmetic removal of biofilm and extrinsic stains

is coronal polishing therapeutic?

NO - it is not used to maintain health or treat a disease to restore health

what is enamel made up of?

96% inorganic (mineralized) hydroxyapatite rods

what is dentin?

70% inorganic (mineralized), dentinal tubules, yellowish second layer not visible

what is cementum?

dull yellow layer that covers root surface, 50% mineralized, very thin at cervical margin (CEJ)

what does the pulp contain?

blood vessels and nerves

anatomical crown ends at vs. clinical crown ends at

ends at CEJ vs ends at the gingival margin

what are some concerns during polishing to consider for the gingiva?

Inflammation—irritated by polishing and paste Gingival recession—root can be delicate or sensitive

what do salivary glands do?

moisturizes the mouth and supplies minerals for plaque and calculus

submandibular gland:

Below the tongue Submandibular ~70% of saliva Wharton's Duct

parotid gland:

~20% of saliva Near the maxillary molars Stensen's Duct

what is a pellicle?

Thin, clear, tenacious film; Acellular; Insoluble proteins, fats, etc

characteristics of a pellicle:

Source is saliva and sulcular fluids

Forms within minutes of removal

Provides barrier to acids

Provides an attachment for plaque and calculus

what cannot be polished away?

calculus - must be scaled off

what is materia alba?

Accumulation of materials and bacterial growth, provides source for plaque biofilm growth, living and dead microbes, food debris, desquamated epithelial cells

how does materia alba appear?

Soft bulky mass, cottage cheese-like white to yellow

which dye is the most common and stain plaque pink/red?

erythrosin

which dye uses a special light that doesnt cause obvious staining?

fluorescein dye

what do the two tone disclosing agents indicate?

blue is for thicker plaque and red is for thinner plaque

what can stains be caused by?

Foods Bacteria Tobacco Metals Medications Imperfect tooth development Trauma

intrinsic stain:

inside the tooth structure that cannot be moved

extrinsic stain:

outside tooth and can be removed

exogenous stain originates from

outside the tooth

-may be extrinsic or intrinsic

Endogenous stain originates from

inside the tooth

-typically intrinsic during formation or after from trauma

extrinsic stains adhere to

pellicle, calculus, and soft deposits

what does yellow stains indicate?

-poor oral hygiene and plaque biofilm accumulation

-dull yellow to light brown color

-most common on buccal surfaces of max molars and the linguals of mand molars

what do black line stains indicate?

-chromogenic bacteria (ferric sulfide or hydrogen sulfide + iron in the saliva and gingival exudates)

-often seen in females

-not related to poor oral hygiene

-requires scaling, then polish

-tends to reform

what do tobacco stains indicate?

-tar from tobacco products

-pigments from the tobacco penetrate the pits and fissures on the enamel and dentin surfaces

-can become intrinsic

-requires scaling then polish

what do brown stains indicate?

-food and beverage pigment

-food with tannis (wine, soda, coffee, tea, dark fruits)

-requires scaling then polish

what else can cause brown stains?

-certain medications such as chlorhexidine, stannous fluoride, extended antibiotic

-requires scaling then polish

what does green stains indicate?

-light to green or yellowish green

-most often in children

-can be irregular or streaked

-facial cervical 1/3 of the anteriors

green stains are formed due to?

chromogenic bacteria, fungi, decomposed hemoglobin and inorganic elements that grow in light

how should you treat green stains?

Should not be scaled due to demineralization

-Can be lightly polished

-May use hydrogen peroxide or other bleaching agent

what does orange stains indicate?

-less common

-similar to green, often found on anteriors

-caused by chromogenic bacteria from poor oral hygiene

how should you treat orange stains?

If demineralized, scaling is contraindicated. Can use 3% hydrogen peroxide to loosen and bleach followed by selective polish

how can demineralization appear?

"White spot lesions", Cervical, Around orthodontic bands, Chalky appearance

how do you treat demineralization?

Treat with remineralizing products: calcium, phosphate, fluoride

what can cause intrinsic stains from an internal source?

-Antibiotic Use

-TETRACYCLINE STAIN -> AVOID in late pregnancy or in children < 8

-Fever Trauma Infection

-Exposure to large amounts of fluoride (fluorosis)

-Blood and pulpal tissues break down as a result of pulpal bleeding or death of the pulp tissue

-Pigments penetrate the dentin and show through enamel

what does the variety of intrinsic stain look like?

Light yellow, Gray or greenish, Reddish brown or orange, Dark brown or black

what can cause intrinsic stain from an external source?

-dental amalgam

-the metallic ions may penetrate the tooth surface to become part of the tooth structure

what are metallic stains?

-can be intrinsic (penetrate tooth surface) or extrinsic (adhere to pellicle)

-metals/metallic salts inhaled in industrial settings

->copper dust: green to bluish green

->iron dust: brown stain

-taken orally ex. iron drugs = black stain

what is Amelogenesis Imperfecta?

Disturbance of ameloblasts

Teeth yellow/brown in color

Much of the enamel is missing

what is Dentogenesis Imperfecta?

Disturbance of odontoblasts (cells that make dentin)

Dentin is soft and enamel chips away

Enamel is translucent or grayish

what is Genetic Hypoplasia or Hypomineralization?

Imperfect development

White spots or missing enamel due to disturbance of ameloblasts or vitamin deficiency

what is fluorosis?

Excessive fluoride intake during development—white spots to dark pitting depending on severity

what are the 3 principles for application of abrasives?

1. Quantity - Wet Agent

-More particles applied, the faster the rate of abrasion

2. Speed of Application

-The greater the speed, the faster the rate of abrasion

-Handpiece speed should be

what are the negative effects of polishing?

1. excessive polishing can damage tooth structure

2. polishing can damage exposed cementum or dentin

3. demineralized tooth surfaces can lose more surface structure

4. heat generation can damage pulp

5. teeth sensitivity

coarse abrasives may roughen tooth surfaces causing what?

increased plaque and biofilm accumulation

when using a coarse paste, you should follow with a?

fine paset

what are some contraindications for coronal polishing?

1. newly erupted teeth - mineralization is incomplete

2. restorations - can be scratched

3. implants -abutments should be but crowns may be polished

4. demineralization and decayed areas - can remove small amounts of enamel

5. very inflamed gingival tissue - irritation and delayed healing can occur

6. lack of stain or plaque - no extrinsic stain and no visible plaque

what is selective polishing?

Avoiding polishing in areas where there is no stain, plaque or when tooth polishing can cause damage

what must be explained to the patient?

Polishing is a cosmetic procedure with no health benefits

If polishing is done too often, it can damage the teeth

Most patients expect to have all surfaces polished

what is the current theory?

If using remineralizing polishing paste, all natural tooth surfaces could benefit from polishing agents

what are the contents of prophy pastes?

-abrasive 50-60%

-water 10-20%

-Humectant 20-25%

-Binder 1.5-2%

-artificial sweetener, flavoring, coloring

super fine silex that can be used for stain removal

silex (silicon dioxide)

pumice flour/superfine pumice can be used for stain removal

pumice (volcanic origin)

various grades are used for different polishing techniques

calcium carbonate (whitening, calcite chalk)

polishing agents for metallic restorations

tin oxide (putty powder, stannic oxide)

what are the different prophy paste grits?

-fine: recommended for less abrasion to the tooth surface

-medium

-coarse: only for heavy stain; 80% for commercial sales

what are the remineralizing agents/desensitizing specialty pastes?

-help reinforce tooth structure

-does not replace a fluoride treatment

-CPP: casein phosphopeptide

-ACP: Amoephous Calcium Phosphate

->milk based

->calcium and phosphate bind with other FL-ions

->help w/ remineralizing and desensitizing

what is desensitizing specialty paste?

-pro argin desensitizing technology

-alginine and calcium carbonate are used to block open tubules

-prophy paste used at start for hypersensitivity

what are the prophy cup angle options?

•Disposable plastic: Most common

•Metal: Reusable, autoclavable

what are the different prophy cup materials?

•Natural or Synthetic Rubber

-Natural rubber are more flexible

•Non-latex cups

-Most common

what are the textures like for prophy cups?

•Firm or soft

•Ribbed or smooth

•Webbed: stain removal

what are smaller diameter prophy cups used for?

•Rotated or overlapping anterior teeth

•Orthodontic appliances

what are the cons of prophy paste cups with paste built in?

the cup can be firm and uncomfortable for the patient.

what are the characteristics of bristle brushes?

•Flat or Tapered

•Soft or Firm

•Firm brushes may be utilized to remove stains from pits and fissures ONLY

-Avoid facial, lingual or proximal surfaces due to possible laceration of tissues

•Soft brushes are helpful around orthodontic brackets

what might cordless handpieces by preferable?

•Lighter weight

•Balanced

•Quieter

•More time efficient

•Freedom of movement

what does the modified pen grasp look like for coronal polishing?

•All fingers in contact as a unit

•Offers the most control

•Facilitates handpiece movement

•Facilitates wrist arm movement

•Rest handpiece in V of hand

•Transfers weight from fingers to hand

•Decreases fatigue

neutral wrist:

•Straight, not bent or pinched

•"Handshake position"

you should apply just enough pressure to make the cup ___

flare

what working stroke are you using?

•Use intermittent dabbing/wiping strokes

how long should each stroke last?

1-2 seconds

the stroke starts at the gingival third to the...

incisal/occlusal third

how do you maintain adaptation?

by rotating handpiece or pivoting on fulcrum as necessary

how does the prophy jet work compared to prophy polishing cup?

•Removal of extrinsic stains

•Prophylaxis of orthodontic patients.

Preparation of tooth surfaces prior to bonding and sealant procedures

w/ a prophy jet, what are the teeth sprayed w/?

•an abrasive powder

•Sodium bicarbonate (ProphyJet®)

•Non-sodium (JET Fresh®) powder

•Aluminum Trihydroxide

what is comparable to the prophy jet?

handpiece is similar to cavitron tips

prophy jet contraindications and warning

•Do not direct the stream at soft tissue or into sulcus.

•Avoid direct contact of prophy powder with restorations

•Baking soda/salt based powder may be contraindicated for patients on low sodium diets

•Never operate the system without fluid flowing

•A dampened 2x2-gauze pad can be placed on the patient's lip to protect the skin and increase patient comfort.

prophy jet polishing technique:

•Place nozzle tip 3 to 4 mm away angled slightly apically on the incisal to middle third of the tooth

•Angulation: Posterior 80º; Anterior 60º; Occlusal 90º

•Constant circular motion, interproximal to interproximal (sweeping motion).

• Polish 1 to 2 teeth for 1 to 2 seconds and rinse.

•Use your hand and patient's cheeks or lips to contain aerosols.

Rinse slurry from patient's mouth as needed

why do we floss at the end of polishing?

•To determine any rough surfaces

•To remove any residual plaque

•To remove any residual paste

•To educate the patient on technique

how should you respond to a patient asking what floss to use?

-its whatever the patient prefers

-most are made of nylon

what are some examples of floss types?

•Unwaxed

•Waxed, including tape

•Polytetrafluoroethylene (Glide)

•Braided and Woven

•Tufted (Super floss)

•G-floss and tapered G-floss -(like mesh or gauze)

waxed dental floss is recommended for:

•Patients with tight proximal contacts

•Patients with defective and overhanging restorations

•Sliding through tight contacts while resisting fraying

what is dental tape or ribbon?

•Dental tape or ribbon is waxed floss that is wider and flatter than conventional floss

•It is sometimes preferred by people with large surface areas to be flossed

mandibular arch, which fingers do you use to guide the floss?

index fingers

maxillary arch, which fingers do you use to guide the floss?

thumb and index fingers

what do you use interdental brushes?

•Proxabrush

•Embrasures

•Furcations

•Cleaning under abutments and wires

are interdental brushes better than flossing?

Studies have shown that interproximal brushes are equal to or more effective than floss for biofilm removal