11- Scaling and Polishing Outline

Learning Objectives

  • Differentiate Terms to Know: Gain a clear understanding of key terminologies involved in dental cleaning procedures, ensuring effective communication and application in practice.

  • Identify CDT Codes: Become familiar with the Current Dental Terminology (CDT) codes specifically associated with dental cleanings, ensuring compliance and proper billing practices.

  • Importance of Preparation: Recognize the significance of adequate preparation for scaling and polishing procedures, both for operational efficiency in the operatory and for enhancing patient comfort and safety.

  • Select Appropriate Instruments: Skillfully select instruments for debridement based on the type, location, and severity of deposits on tooth surfaces, ensuring optimal cleaning outcomes.

  • Demonstrate Proper Adaptation of Instruments: Master the techniques for adapting debridement instruments to the unique contours of different teeth, enhancing the efficacy of the cleaning process.

  • Explaining Consequences of Angulation: Comprehend the importance of maintaining the correct angulation (70°) during scaling to safely and effectively remove debris without causing tissue damage.

  • List Steps of Instrumentation for Cleaning: Outline the essential steps for activating instruments during cleaning to ensure systematic and comprehensive removal of stains and calculus.

  • Discuss Negative Effects of Excessive Lateral Pressure: Understand the risks associated with applying excessive lateral pressure during scaling, including the potential for patient discomfort and damage to teeth and soft tissues.

  • MOHS Hardness Values: Familiarize oneself with the MOHS hardness values of dental tissues, restorations, and polishing agents to make informed choices when performing procedures.

  • Considerations for Polishing: Identify patient-specific considerations and contraindications for polishing to tailor treatments that align with individual health needs.

  • Clinical Approaches for Biofilm Removal: Explore evidence-based clinical approaches for effective biofilm and stain removal during treatment, ensuring optimal oral hygiene outcomes.

  • Difference Between Cleaning and Polishing Agents: Distinguish between cleaning agents (non-abrasive) and polishing agents (abrasive) to select appropriate materials based on patient needs and the condition of teeth.

  • Selection of Polishing Paste: Determine the ideal abrasiveness of polishing paste for each patient, considering factors such as enamel condition and the presence of restorations.

  • Effects of Abrasive Properties: Assess the shape, size, and hardness of abrasive properties in polishing paste and their effects on dental surfaces during procedures.

  • Steps for Cleaning/Polishing: Provide a thorough, step-by-step guide to the cleaning/polishing process, ensuring nothing is overlooked in patient care.

Terms to Know

  • Abrasion: Defined as the wearing away of surface material by friction which can occur during dental procedures if not managed correctly.

  • Abrasive: Refers to materials that possess the ability to cut or scratch softer materials, often used in polishing agents to enhance the finish of dental surfaces.

  • Grit: Indicates the particle size of abrasive agents, affecting their efficacy and potential impact on soft and hard dental tissues.

  • Polishing: The process of producing a smooth, glossy surface through friction, essential for aesthetic purposes in dental restorations.

  • RPM: An acronym for revolutions per minute, which denotes the speed setting of rotary instruments used during cleansing and polishing.

  • Scaling: The procedure involved in the removal of soft deposits, calculus, and stains from tooth surfaces, essential in preventive dentistry.

  • Burnish: This term refers to a dental deposit where the outer layer has been removed, making it smooth yet difficult to eliminate completely.

  • MOHS Hardness Scale: A scale used to measure mineral hardness and scratch resistance, crucial in understanding the durability of dental materials.

Rationale for Scaling and Polishing

  • Primary Goal: The ultimate goal is to ensure the complete removal of all deposits from tooth structures, promoting optimal oral hygiene.

  • Knowledge of Tooth Morphology: Understanding the morphology of teeth is critical to effectively perform scaling and polishing. Different teeth have varying shapes and surfaces that require tailored approaches.

  • Skill Mastery: A high degree of skill is essential for employing instruments to avoid damaging tissues and to ensure thorough cleaning.

  • Patient Focus: The objective is to develop safe, thorough procedures that minimize patient discomfort and trauma while ensuring effective treatment outcomes.

Preparation for Scaling

  • Patient Explanation: Clearly communicate to patients about the types of deposits, instruments used (both hand-held and power-driven), and what sensations to expect, including pressure, possible bleeding, and sensitivity.

  • PPE Compliance: Ensure all Personal Protective Equipment (PPE) is properly in place for both clinician and patient to maintain a safe environment.

  • Operatory Preparation: Systematically prepare the operatory — organizing instruments, preparing spare gauze, ensuring suction devices are ready, and maintaining a neutral body position to reduce fatigue during procedures.

Instrument Selection

  • Selection Guidelines: Instrument choice should be based on the specific area of scaling, referencing an instrument lecture chart for appropriate selections.

  • Different Instruments for Different Deposits: Use distinct instruments for supra-gingival (often scalers, universals) versus subgingival scaling (such as Gracey curettes and universals) for comprehensive care.

  • Instruments for Challenging Cases: For tough calculus, select rigid instruments, and for deposits over 5 mm subgingivally, consider using extended shank instruments or advanced options like ultrasonics and periodontal files.

Instrument Adaptation

  • Proper Contact: The last 1-2 mm of the cutting edge of the instrument should maintain contact with the tooth. Misaligned instruments can lead to trauma and ineffective cleaning.

  • Correct Angulation: Maintain a cutting angle of 70° to effectively remove stains and calculus without risking damage to supporting tissues. Incorrect angulation can lead to trauma and worsen the patient experience.

Activation of Instruments

  • Preparation Steps: Ensure adequate visibility, confirm locations of deposits using dry air or radiographs before initiating the scaling process.

  • Choosing Instruments: Select the appropriate instrument and establish a modified pen grasp to ensure control during procedures.

  • Execution: Maintain consistent contact with the tooth surface, ensuring the appropriate angle and applying controlled lateral pressure according to the hardness of deposits being removed.

  • Post-Activation Check: After activation, confirm the complete removal of deposits through thorough inspections using explorers, air, and light.

Effects of Excessive Lateral Pressure

  • Risk Assessment: Applying too much lateral pressure may lead to unintentional tooth structure removal, loss of instrument control, and damage to tissues, resulting in increased discomfort for the patient.

Cleaning and Polishing

  • Assessment Protocol: After scaling, assess for any lingering stains or biofilm on teeth, employing abrasive cleaners for stubborn stains and non-abrasive cleansers for effective biofilm management.

MOHS Hardness Values for Dental Materials:

  • Material Ratings:

    • Composites: Values between 2.0-3.0 on the MOHS scale indicate moderate softness and vulnerability to abrasives.

    • Cementum: Similar to composites, cementum has a hardness value of 2.5-3.0.

    • Enamel: With a hardness of 5.0, enamel is significantly harder, making it vital to choose less abrasive agents during polishing procedures.

Considerations and Contraindications for Polishing

  • Patient Screening: Assess for potential contraindications before polishing, which can include respiratory issues, a high risk for caries, thin enamel, sensitivity, compromised restorations, and various environmental factors, ensuring patient safety and comfort.

Cleaning Agents vs. Polishing Agents

  • Distinction in Use: Cleaning agents are characterized as non-abrasive materials, typically deployed when no stains are present. In contrast, polishing agents selectively and carefully wear down tooth structure using a range of abrasive materials to achieve a smooth finish while preserving tooth integrity.

Procedure to Clean/Polish

  • Guideline Overview: Execute the following steps: gather necessary equipment, prepare the patient adequately, review the patient's health history, articulate the cleaning/polishing procedure clearly, apply gentle, controlled pressure during polishing, allow the patient to rinse, and perform aftercare with oral inspection and flossing to assess the completion of the dental procedure.

Patient Education

  • Information Sharing: Educate patients on the impacts of biofilm, calculus, and overall oral health, providing them with rationales for cleaning, and emphasizing preventive measures to deter the return of stains and calculus. Ensure all treatments are meticulously documented for future reference and patient following-ups.