Extrinsic Stain Removal

Extrinsic Stain Removal Notes

Chapter Overview

  • Focus on the removal of extrinsic stains from teeth as an aesthetic procedure rather than a therapeutic one.

Objectives

  • Describe difference between cleaning agent and polishing agent:
    • Cleaning agents may cause scratches to the tooth surface.
    • Polishing agents do not cause scratches and produce higher luster.
  • Explain basis of polishing paste grit selection:
    • Selection is based on the level of staining and tooth sensitivity.
  • Discuss rationale for avoiding polishing procedures on areas of demineralization:
    • Polishing can damage tooth structure in demineralized areas.
  • Explain how abrasive particle qualities affect abrasive qualities of polishing paste:
    • Properties include shape, hardness, strength, and particle size.
  • Explain types of powdered polishing agents:
    • Include agents like pumice, silex, and calcium carbonate, each with different abrasiveness.
  • Explain patient conditions that contraindicate air-powder polishing:
    • Contraindications include respiratory issues, certain diseases, and oral cavity conditions.

Introduction

  • Agents must be selected according to the patient’s needs, considering both tooth structure and restorations.
  • Preservation of tooth and restoration surfaces is vital; improper paste selection can aggravate hypersensitivity.

Purpose of Stain Removal

  • Stains do not contribute to oral diseases; their removal is for aesthetic reasons only.

Science of Polishing

  • Types of Polishing:
    • Two-Body Abrasive Polishing: Involves the instrument and the tooth (most common for hygienists).
    • Three-Body Abrasive Polishing: Involves the polishing agent, the tool, and the tooth.

Effects of Cleaning and Polishing

  • Bacteremia: Potential introduction of bacteria into the bloodstream.
  • Inflammatory Response: Can occur in some patients.
  • Precautions:
    • Be aware of aerosol production and spatter, especially in immunocompromised patients.
Effects on Teeth
  • Effects:
    • Removal of tooth structure, especially in demineralized areas or thin enamel/cementum/dentin.
    • Heat production that can cause discomfort.
  • Effects on Gingiva:
    • Potential tissue trauma affecting gum health.

Indications for Stain Removal

  • Extrinsic Stains:
    • Educate patients on stain prevention (e.g., from coffee, tea, red wine, tobacco).
    • Perform scaling and root debridement before caries-preventive procedures.
    • Use pumice paste or airflow polishing before placing sealants (no prophylaxis paste).
  • Motivational Aspect: Enhancing patient motivation to maintain oral hygiene.

Clinical Application of Stain Removal

  • Summary of Contraindications for Polishing:
    • No staining present.
    • Patients with respiratory difficulties.
    • Tooth sensitivity concerns.
    • Presence of restorations and titanium implants.

Procedural Suggestions for Clinical Practice

  • Initial Education:
    • Discuss the causes of dental stains.
  • Stain Removal:
    • Implement scaling and root debridement techniques.
  • Removal Techniques:
    • Use low-abrasion paste applying light pressure at low speed.

Cleaning & Polishing Agents

  • Characteristics of Effective Agents:
    • Non-abrasive agents produce higher luster.
    • Cleaning agents may use coarse to fine abrasiveness.

Factors Affecting Abrasive Action

  • Types of Characteristics:
    • Shape: Round, flat particles are desired.
    • Hardness: Affects abrasion capacity.
    • Body Strength and Size (Grit): Larger particles can affect the procedure's efficacy and safety.

Types of Abrasive Agents

  • Pumice: Primarily used for stain removal.
  • Silex: Comes in coarse and superfine grit; also for enamel application.
  • Calcium Carbonate: Less abrasive, available in grits.
  • Tin Oxide: Used for polishing teeth and restorations.
  • Emery: For preparing restorations but not directly on enamel.
  • Rouge: Polishing precious metals in laboratories.
  • Diamond Particles: Used for polishing porcelain surfaces.

Cleaning & Polishing Ingredients

  • Clinically available as pastes or powders.
    • Examples include:
    • Fluoride paste.
    • Amorphous calcium phosphate mixtures.
    • Products designed for dentin hypersensitivity.

Procedure for Stain Removal: Coronal Polishing

  • Initial Steps:
    • Explain the procedure to the patient. Provide necessary protections such as eyewear and bib.
    • Ensure proper patient positioning and breathing considerations.

Environmental Preparation

  • Procedures to minimize contaminated aerosols:
    • Utilize water flushing and pre-procedural rinses.
    • High-Volume Evacuator (HVE) usage is recommended.
    • Protective barriers for both clinician and patient.

Power-Driven Instruments

  • Handpiece: Should operate at low speed (around 5,000 rpm).
  • Prophy Angle Types: Includes contra- or right-angle.
Prophylaxis Angle Attachments
  • Attachments Available:
    • Rubber polishing cups.
    • Bristle brushes.
    • Rubber polishing points.
    • Each attachment is designed for specific uses.

Clinical Considerations with Prophylaxis Angle

  • Effects on Tissues:
    • Discomfort and diminished tactile sensitivity can occur with thick handpieces.
    • Need for moderate speed to avoid trauma.

Air-Powder Polishing

  • Principles of Application:
    • Utilizes specially formulated powders (e.g., sodium bicarbonate, aluminum trihydroxide, etc.).
  • Advantages:
    • Ergonomically favorable, less heat production, effective for heavy stains.
Recommendations and Precautions for Air-Powder Polishing
  • Contraindications:
    • Sodium restriction, respiratory issues, renal concerns, and other health conditions.
    • Avoid routine polishing of sensitive tissues like cementum and dentin.

Polishing Proximal Surfaces

  • Technique:
    • Use dental tape and floss with polishing agent, rinse thoroughly.

The Porte Polisher

  • Design: Specifically for extrinsic stain removal; features a wood point at a contra angle for versatile use.

Patient Education

  • Teach Patients:
    • Biofilm and stain formation processes.
    • Selective polishing relevance.
    • Importance of diligent biofilm removal to prevent stain return.
    • Abrasiveness of polishing agents in daily home use versus professional use.

References

  • Boyd, L. D., Mallonee, L. F., & Charolotte, W. J. (2023). Wilkins’ Clinical Practice of the Dental Hygienist (14th ed.). Jones & Bartlett Learning.