Coronal Polishing and Dental Sealants

Question 1

Dental stains

Answer 1

As a dental assistant, you will need to be able to correctly identify stains. Stains of the teeth occur in three basic ways:
1. A stain adheres directly to the surface of the tooth.

2. A stain is embedded in calculus and plaque deposits.
3. A stain is incorporated into the tooth’s structure.

It’s important to distinguish between the types of stains before coronal polishing is undertaken to remove them.

stains are primarily an esthetic problem. some types of stains can be removed, and other cannot. Other treatment options are available for patient who have stains that cannot be removed. These include professional and at home bleaching procedures, enamel microbrasion, and cosmetic restorative procedures such as laminate veneers and composite restorations.

selective polishing is procedure in which only those teeth or surfaces with stain are polished. The purpose of selective polishing is to avoid removing even small amounts of surface enamel unnecessarily.

Question 2

Polishing Esthetic type restorations

Answer 2

Many patients who are have crown and bridge restorations elect to have cosmetic resin, composite bonding, and veneers placed to enhance their smiles.

Improper oral care can quickly damage many of these types of restoration. Coarse polishing paste, use of acidulated phosphate fluorides, and even hard brushing with abrasive toothpaste can be destructive to the surfaces of restorative materials. A diamond, aluminum oxide, or low abrasion toothpaste should be used for these restorations.

Question 3

Types of dental stains

Answer 3

dental stains are categorized either endogenous or exogenous.

-endogenous stains: originate within the tooth as a result of developmental and systemic disturbances

-exogenous stains: originate outside the tooth in response to environmental agents.

• exogenous stains are divides to extrinsic or intrinsic.
• extrinsic stains: on the exterior of the tooth that can be removed , such as stains from food, drink and some tobacco.
• intrinsic stains: are caused by an Environmental source that cannot be removed because the stain has become incorporated into the structure of tooth. examples include stains from smoking, chewing, or dipping tobacco; and stains from dental amalgams.

Question 4

Endogenous stains

Answer 4

Dental fluorosis and tetracycline stain are types of endogenous stains.

Dental fluorosis: A type of endogenous stain that is attributed to the ingestion of excessive amount of fluoride during tooth development.

tetracycline stain: this stain is caused by the Administration of tetracycline during tooth development. This type of stains cannot be removed with coronal polishing.

Dental fluorosis is attributed to the ingestion of excessive amount of fluoride during tooth development. It occurs when fluoride consumption from all sources (water, fluoride supplement, food sources, toothpaste consumption) exceeds 1 ppm. Dental fluorosis usually appears as white streaks on the teeth. In server cases, it appears as brown spots with cracking and pitting. sever fluorosis is known as enamel motting. Cosmetic procedures for dental fluorosis can involve veneers or crowns.

Tetracycline stain is caused by the administration of Tetracycline during tooth development. Tetracycline given to mother while pregnant or prescribed to a child during tooth development can result is staining. This stain present as a gray to green stain. This type of stain cannot be removed with coronal polishing.

Question 5

Polishing Agents

Answer 5

Dental abrasive are polishing materials used to remove stains and to polish natural teeth, prosthetic appliances, restorations and casting. Dental abrasive are available in extra coarsa, coarse, medium, fine and extra fine grits. The coarser the agent, the move abrasive the surface. Even a fine grit agent removes small amounts of the enamel’s surface. the goal is to always use the abrasive agent that will produce the lease amount of abrasion to tooth surface.

Factors that influence the rate of abrasion including:
- the more agent used, the greater degree of abrasion
- The lighter the pressure, less the abrasion.
- The slower the rotation of the cup, the less the abrasion.

using a fulcrum on a nearby tooth will help operator control the amount of pressure used. Pressing too hard can cause friction and great amount of heat to be generated which can damage the tooth and the patient will fell a burning sensation.

Question 6

Removing plaque and stains

Answer 6

two primary methods of removing plaque and stains are

• Air powder polishing: The air powder polishing technique involves the use if a specially designed handpiece with a nozzle that a delivers a high pressure stream of warm water and sodium bicarbonate.
• Rubber cup polishing: most common techniques for removing stains and plaque and polishing the teeth. A rubber polishing cup is rotated slowly and carefully by means of prophylactic angle attached to the slow speed handpiece.

Question 7

Handpiece Rotary Polishing attachments

Answer 7

specific handpiece rotary attachments are used for coronal polishing.

-Polishing cups: soft, webed polishing cup are used to clean and polish the smooth surfaces of the teeth. The polishing cup is attached to the reusable prophyaxis angle by means of a snap on or screw on attachment.

-prophyaxis angle: commonly called a “prophy” angle this tool attached to the slow speed handpiece. The reusable prophy angle must be properly cleaned and sterilized after each use. A disposable angle is discarded after a single use.

• Bristle Brushes: bristle brushes, made of natural or synthetic materials, can be used to remove stains from deep pits and fissures of enamel surfaces.

Bristle Brushes can cause severe gingival lacerations and must be used with special care. They are not recommended for use on exposed cementum or dentin because these surfaces are soft and are easily grooved.

Question 8

Holding and operating the handpiece

Answer 8

The handpiece and prophlaxis angle are held in a pen grasp with the handle resting in the V shaped area of the hand between the thumb and index finger. Proper grasp is important because if the grasp is not secure and comfortable , the weight and balance of the handpiece can cause hand and wrist fatigue.

Use a low speed handpiece that operates to maximum of 20,000 rpm.

The rheotat control the speed of the handpiece. The operator use his or her toe to activate the rheostat with the sole remaining flat on floor. Apply a steady pressure with your toe on the rheostat to produce a slow. even speed. Release the rheostat to prevent debris from splattering when the handpiece is removed from the tooth for more than a moment.

Question 9

Polishing strokes

Answer 9

Proper polishing skroke techniques should be used during coronal polishing.

Fill the polshing cup witthe polishing agent and spread it over several teeth in the areas to be polished. Establish a finger rest and place the cup almost in contact with the tooth. Using the slowest speed, lightly apply the revolving cup to the tooth surface for one or two seconds. Be sure to note the following:

-the stroke should reach from the gingival third to the insisal third of the tooth.

• Use light pressure to make the edges of polishing cup flare slightly.
• Use a patting, wiping motion and an overlapping stroke.

it’s important that you place the fulcrum finger close to the tooth on which you are working doing so provides between control of the handpiece. The cup should be flared to adapt to contours, especially in the inter-proximal areas where most plaque and stain tends to build up.

Question 10

Patient preparation

Answer 10

The patient needs to be properly prepared prior to the polishing procedure

Preparing the patient for the polishing procedure including the steps here.

1. Check the patient’s medical history
   2 seat the patient and covering him/her to napkin
2. protective eyewear
3. explain the procedure to the patients and answer any questions.
4. inspect the oral cavity for lesion, missing teeth ,tori and so on.
5. apply a disclosing agent to identify areas of plaque

remove any prosthetic appliances.

Question 11

Patient positioning

Answer 11

After the patient has been propared, he or she needs to be properly positioned in the dental chair for coronal polishing.

Adjust the dental chair so that the patient is approximately parallel to the floor with the back of chair raised slightly. Adjust the head rest for the patient comfort and operator visibility.

To access the mandibular arch, position the patient’s head with the chin down. when the mouth is open, lower jaw should be parallel to the floor.

For access to the maxillary arch, position the patient’s head with the chin up.

Question 12

Operator positioning

Answer 12

Proper positioning of the operator also is critical because it contributes to efficiency.

The operator should keep his or her feet flat on the floor and the thighs parallel to the floor. The operator’s arms should be at waist level and even with the patient’s mouth. When performing a coronal polishing procedure, the right-handed operator generally begins by being seated in an 8 to 9 o’clock position. The left-handed operator generally begins by being seated at the 3 to 4 o’clock position.

The fulcrum provides stability for the operator and must be placed to allow for movement of the wrist and forearm. The fulcrum is repositioned throughout the procedure as necessary. The fulcrum can be either intraoral or extraoral, depending on a variety of circumstances, such as:

• Presence or absence of teeth
• Area of the mouth being polished
• How wide the patient can open his or her mouth

Question 13

polishing sequence

Answer 13

Full-mouth coronal polishing must be performed in a predetermined sequence to be certain that no area is missed. The best sequence is based on the operator’s preference and the individual needs of the patient.

Esthetic and porcelain restorations should be polished first, after which the remaining teeth are polished with the use of the appropriate methods for any stain that is present. This reduces the possibility that a coarse abrasive will remain in the rubber cup when esthetic restorations are being polished.

Unless otherwise indicated, the positions and fulcrums described in this lesson are for a right-handed operator.

The first step is to apply a disclosing agent. A disclosing agent is an oral solution that selectively stains tooth surfaces revealing bacterial plaque, pellicle, and soft debris. When this solution is rinsed off, tooth surfaces bearing plaque will remain stained. This results in better visibility of areas needing attention.

The disclosing agent also serves as a tool for patient education; you can give the patient a hand mirror and clearly show the areas with plaque build-up that need more attention during home care.

Question 14

Maxillary right posterior quadrant: Buccal Aspect polishing

Answer 14

use the steps listed here to polish buccal aspect of maxillary right posterior quadrat.

1. sit at the 8 to 9 o’clock position
2. Establish fulcrum on the maxillary right incisors.
3. use the mirror to retract the cheek and for indirect vision
4. Establish a fulcrum on the maxillary right incisors.

Question 15

Maxillary right posterior quadrant: lingual aspect polsihing

Answer 15

Use steps here to polish the loingual aspect of the maxillary right posterior quadrant

1. Remain seated at the 8 to 8 o’clock position.
2. have the patient turn his or her head up and toward you
3. hold the dental mirror in your left hand. In this position, your direct vision and the mirror image provide a view of the distal surfaces.
4. establish a fulcrum o the lower incisors and reach up to polish the lingual surfaces.

Question 16

Maxillary anterior teeth: facial aspect polishing

Answer 16

step 1: Remain seated at the 8 to 9 o’clock position.

step 2: Position the patient’s head tipped up slightly and facing straight ahead. make necessary adjustments by turning the patient’s head slightly toward or away from you.

step 3: use direct vision in this area
step 4: establish a fulcrum on the incisal edge of the teeth adjacent to the ones being polished.

Question 17

Maxillary anterior teeth: lingual aspect polishing

Answer 17

step 1: remain at the 8 to 9 o’clocl position or move to the 11 to 12 position

2.establish a fulcrum on the incisal edges of the teeth adjacent to the ones being polished
3. position the patient’s head so that it is tipped slightly forward.

4. use the mouth mirror for indirect vision and to reflect light on the area.

Question 18

maxillary left posterior quadrant: buccal aspect polishing

Answer 18

1.Sit at 9o’clock position
2. use the mirror to retract the ckeek and for indirect vision
3. Rest your fulcrum finger on the buccal occlusal surface of the teeth toward the front of the quadrant
4. Position the patient’s head upward and turn it slightly for better visibility.

Question 19

Mazillary left posterior quadrant: lingual aspect polishing

Answer 19

1. Remain at the 8 to 9 postion
2. have the patient turn in his/her head away from you.
3. use direct vision in this position. Hold the mirror in you left hand use it for a combination of retraction and reflection and reflecting light.
4. Establish a fulcrum on the buccal surface of the maxillary left posterior teeth or on the occlusal surface of the mandibular left teeth.

Question 20

Mandibular left osterior quadrant: buccal aspect plishing

Answer 20

step1: sit at the 8 to 9 position
step2: have the patent turn his or her slightly towards you
step3: use the mirror to retract the cheek and for indirect vision of distal and buccal surface.
step4: Establish a fulcrum on the incisal surface of the mandibular left anterior teeth and reach back to the posterior teeth.

Question 21

Mandibular left posterior quadrant: lingual aspect polishing

Answer 21

step 1. remain at the 9 position
2. have the patient turn his or her head slightly away from you
3. for direct vision, use the mirror to retract the tongue and reflect more light to the working area.
4.Establish a fulcrum on the mandibular anterior teeth and reach back to the posterior teeth.

Question 22

Mandibular anterior teeth: facial aspect polishing

Answer 22

step 1: Sit at eight the 8 to9 position or the 11 to 12 position

2. As necessary, instruct the patient to make adjustments in head position by turning either toward or way from you or by tilting his head up or down
3. Use your left index finger to retract the lower lip. Both direct and indirect vision can be used in this area.
4. Establish a fulcrum on the incisal edges of the teeth adjacent to the ones being polished.

Question 23

Mandibular anterior teeth: lingual aspect polishing

Answer 23

step 1. set either the 8 to 9 or qq to 12
2. as necessary, instruct the patient to make adjustments in head position by turning either toward or away from you or by tilting the head up or down.

3. Use the mirror for indirect vision, to retract the tongue, and to reflect light onto the teeth. Direct vision is often used in tis area when the operator is seated at the 12 o ‘clock position, but indirect vision can also be helpful

4.Establish a fulcrum on the mandibular cuspid incisal area

Question 24

Mandibular right quadrant: buccal aspect polishing

Answer 24

step 1. Sit at the 8 o’clock position
2. have the patient turn his/her head slightly away from you.
3. use the mirror to retract tissue and refelct light. You can also use the mirror to view the distal surfaces in this area.

4. Establish a fulcrum on the lower incisors

Question 25

Mandibular right quadrant: lingual Aspect polshing

Answer 25

step 1: step 1. Sit at the 8 o’clock position.

2.Have the patient turn his/her head slightly toward you.

3. use the mirror to retract the patient’s tongue
4. Establish a fulcrum on the lower incisors.

Question 26

final steps

Answer 26

Final Steps Dental floss and tape have two purposes after coronal polishing. The first is to polish the interproximal tooth surfaces. The second is to remove any abrasive agent or debris that might be lodged in the contact area. Place abrasive on the contact area between the teeth and work the floss or tape through the contact area, using a back-and-forth motion A floss threader can be used to pass the floss under any fixed bridgework to gain access to the abutment teeth.

After the polishing procedure, evaluate the patient to ensure the following:
* There is no remaining disclosing agent on any of the tooth surfaces.

• The teeth are glossy and reflect light from the mirror uniformly.
• There is no evidence of trauma to the gingival margins or any other soft tissues in the mouth.

Most patients are self-conscious about stains on their teeth and appreciate any tips you can give them on how to keep their teeth as white as possible. It is important to educate patients about the causes of stains. When stains are intrinsic, the dentist might want you to discuss possible cosmetic dental care options to satisfy their desire for attractive and stain-free teeth.

Question 27

Dental sealant

Answer 27

Dental sealant are highly effective in preventing in preventing dental carries in the pit and fissure areas of the teeth. Dental sealants are made of a resin material and applied to the pits and fissures of the teeth to prevent dental caries. A dental sealant is successful only if it firmly adheres to the enamel surface and protects the pits and fissures from the oral environment.

Sealants are especially useful for patient through the caries active period. sealants should be used as part of an overall oral health program taht includes fluorides, plaque control, regular dental prophylazis, and evaluation of dietary components.

Pit and fissures are fossa and grooves that failed to fuse during development. Bacteria accumulate in the narrow pits and fissures. Evan a single toothbrush bristle is too large to enter and clean pits and fissures. Areas that cannot be accessed during toothbrushing and flossing to remove harmful microorganisms are vulnerable to caries formation.

Question 28

Dental sealants overview,cont’d

Answer 28

Sealants are recommended for primary and permanent teeth that have pits and fissures. The sealant acts as a physical barrier. Dental sealants are a noninvasive means of preserving tooth structure and preventing dental decay.

During sealant placement, some bacteria will be trapped beneath the sealants. Some teeth with very small initial carious lesions might be inadvertently sealed.

Numerous studies have shown that neither of these occurrences will increase the chance of caries development or that caries will grow beneath the sealant. Several studies have shown that the number of bacteria in small, existing carious lesions that had been sealed decreased dramatically with time.

Question 29

Indication for dental sealants

Answer 29

sealants should be used as part of a preventative prevention program that includes the se of fluorides, dietary consideration, plaque control, and regular dental examination. sealants are indicated in the situation listed here

1. for teeth with deep pits and fissures
2. in recently erupted teeth (< 4. y)
3. for selected patients through the caries active period

Question 29

Contraindications to dental sealants

Answer 29

1. lack of pits and fissures
2. apparent occlusal decay
3. interproximal decay
4. insufficient eruption of tooth
5. soon to be lost primary teeth
6. poor patient cooperation in the dental chair.

Question 30

Types of Sealant Materials

Answer 30

Sealants can be clear, tinted, or opaque (white). Tinted or opaque sealants are more popular because they are easier to see than clear sealants during application and during checks for sealant retention on subsequent office visits. Some sealant brands have a tint that is visible during application but turns clear after polymerization.

A wide variety of sealant materials are available on the market. Sealants are classified by their method of polymerization, their sealant content, and their color. As a dental assistant, you need to understand the characteristics of the various sealant products that are available.

The major difference among the materials is the method of polymerization. There are two types of sealant materials and they are comparable in bond strength and rate of retention. The two types are described here.

• Self cured material: material is supplied as two part system. when these pastes are mixed together. they quickly polymerize.
• light cured sealants: do not require mixing. after the maxing. After the materials has been placed, it hardens during exposure to cueing light.

Question 31

Fluoride and sealant storage

Answer 31

Some types of sealants release fluoride after polymerization. The theory is that the fluoride released from the sealant creates a fluoride-rich layer at the base of the sealed groove. Clinical studies comparing the effectiveness of these two types of sealants still are underway.

Topical fluoride should not be applied to the enamel surface immediately before a sealant procedure, but can be applied immediately after sealant application. Always follow the sealant manufacturer’s instructions.

The manufacturer’s recommendations also must be followed for storage and use of sealants. Most etchant and sealant materials are designed to be used at room temperatures. In general, when storing sealant materials, be sure to follow the guidelines here.

1. Replace caps on syringes and bottles immediately after use
2. avoid exposing the. materials to high temperatures
3. avoid storing the materials in proximity to eugenol-containing products

Question 32

sealant material precautions

Answer 32

A number of safety precautions are recommended for dental staff and patients regarding the use of sealant materials. They include the following:

• Do not use sealants on patients with known acrylate allergies.
• Minimize exposure (yours and your patient’s) to these materials to reduce the risk of an allergic response.
• Use protective gloves and a no-touch technique.

If skin contact occurs, wash the exposed skin with soap and water. Acrylates can penetrate gloves. If the sealant makes contact with a glove, remove and discard the glove, wash your hands immediately with soap and water, and then reglove. If accidental eye contact or prolonged contact with oral soft tissue should occur, flush the area with large amounts of water. If irritation persists, contact a physician.

Question 33

factors affecting sealant retention

Answer 33

Dental sealants that are properly placed can last 5 to 10 years. Moisture contamination is the primary cause of sealant retention failure. Inadequate etching also is a factor in the loss of sealant retention. Dental sealants should be examined at each recall visit to be certain the sealant material has not been partially or totally lost.

Always read and carefully follow the manufacturer’s instructions when applying dental sealants. Application technique and etching times can vary between manufacturers. For example, some manufacturers discourage the use of a polishing paste that contains fluoride. Other manufacturers do not consider fluoride polishing pastes to be contraindicated.

Question 34

Dental sealant prcedure

Answer 34

before beginning the sealant procedures, you will prepare tray

Tray will contain
- Examination instruments
- Articulation paper and hoder
- sealant material
- dental floss to use when checking contact area after sealant placement
- a disposable preparing angle to use in preparing the tooth
- moisture control items (cotton rolls and a high volume evacuator)

• a dappen dish to hold liquid materials such as the pumice

After you have gathered the necessary tray and supplies, you will take the first steps i the sealant procedure: isolating and drying the tooth. Remember, moisture contamination during sealant placement can cause the sealant to fail.

Question 35

Etching the enamel

Answer 35

Next, apply a generous amount of etchant to all enamel surfaces to be sealed, extending slightly beyond the anticipated. margin of the sealant. Etchant is usually placed for a minimum of 15 seconds but no longer than 60 seconds.

An etching agent contains phosphoric acid. Patients and dental personnel should wear protective eyewear when etchants are being used. Avoid contact with oral soft tissue, eyes, and skin. In case of accidental contact, flush the exposed area immediately with large amounts of water. If eye contact is involved, immediately rinse the eye with plenty of water and seek medical attention.

After the allotted time for exposure of the enamel to the etchant, rinse the etched teeth thoroughly and then dry the surfaces with the air/water syringe.

When the surface of the enamel is etched, the dried etched surface will take on a frosty white matte appearance. If the frosty white matte enamel surface is not evident, repeat the etch step.

Question 36

Place the seal and cure the enamel

Answer 36

Place the sealant using the delivery method recommended by the manufacturer. Slowly introduce the sealant material to the pits and fissures to avoid damaging the micropores and to avoid the formation of air bubbles.

Next, cure the sealant using the UV light. Light cure the sealant for 60 seconds, or according to the package directions.

You should always evaluate the sealant after placement. To perform this evaluation:

1. Use an explorer to ensure that all margins have been sealed and that no microleakage can occur.
2. Floss the contacts to ensure that no excess sealant materials flowed into interproximal areas.
3. Check the occlusion with the use of articulating paper to ensure that the patient is comfortable when biting on the newly placed sealant.