Preventive Procedures - Outcome 5

Question 1

Indications for Polishing

Answer 1

-Before cementing orthodontic bands, crowns, and bridges
-Before placing a dental dam
-Before applying dental sealants
-Before using acid etching solution

Question 2

Coronal polishing is typically considered when?

Answer 2

Coronal polishing is typically considered after scaling, root planing, and other periodontal treatments. It is a selective procedure, meaning not every patient or tooth requires polishing.

Question 3

What is Coronal polishing reserved for?

Answer 3

Polishing is generally reserved for teeth with visible stains, especially on a routine basis. Over time, excessive polishing can erode tooth structure and alter the teeth’s morphology. Therefore, protecting tooth structure is crucial when deciding if coronal polishing is appropriate. The need for polishing and the choice of cleaning agents should be based on each patient’s specific needs

Question 4

Information to Share with Patients about Polishing

Answer 4

-Stains and deposits removed by polishing will reappear if proper home care is not maintained. Inform patients that certain foods and beverages can contribute to staining.
-Polishing agents used in the dental office are too abrasive for daily home use. It is crucial to preserve the surfaces of both teeth and restorations
-Explain the concept of “selective” polishing and why it is unnecessary to polish all teeth at every visit. Make sure to cover:
-The purpose of rubber cup polishing
-The impact of repeated polishing on teeth
-The rate at which plaque reforms after coronal polishing
-How patients can reduce stains through effective home care

Question 5

Evaluation Before Coronal Polishing

Answer 5

Before starting the coronal polish, evaluate the patient’s oral and medical conditions to identify any factors that might modify or contraindicate the procedure. After thoroughly explaining the procedure to the patient, obtain written consent before proceeding.

Question 6

Summary of Contraindications for Polishing

Answer 6

-No visible stains are present
-Increased risk for dental caries
-Respiratory problems
-Areas of hypersensitivity
Restorations (composite, gold, or porcelain) that may be damaged by polishing pastes
-Newly erupted teeth
-Soft, spongy tissue that bleeds easily
-Immediately after deep scaling or root planing
-Communicable diseases that may be spread by aerosol production
-Premedication has not been taken
-Implant abutments
-Allergies to polishing pastes
-Hypo-mineralized areas
-Orthodontic appliances or other fixed/temporary restorations that may require adjustments

Question 7

Guidelines for Performing Coronal Polishing:

Answer 7

-Complete oral hygiene education before the polishing procedure.
-Ensure that supragingival and subgingival calculus have been removed prior to polishing.
-Most stains should be removed or disorganized through scaling or root planing before polishing to minimize adverse effects.

Question 8

Types of Polishing Agents

Answer 8

Various prophylaxis pastes are available, and they vary significantly in abrasiveness. These pastes contain abrasives similar to those in toothpaste but at higher levels, making it essential to choose the right product and teeth to polish.

Types of Polishing Agents:
-Cleaning Agents
-Polishing Agents

All polishing agents contain abrasives. The choice of agent depends on the surface being cleaned or polished.

Question 9

Characteristics of Abrasive Particles (in coronal polish)

Answer 9

Shape - rounded dull edged particles are better for polishing, irregular sharp edged particles create deeper scratches and grooves

Hardness - harder particles remove enamel more quickly, abrasives must be harder than the surface they are polishing otherwise the abrasive itself will wear down instead of the surface of tooth.

Strength - particles that break into small, sharp pieces are more abrasive compared to those that wear down gradually.

Particle Size (Grit) - larger particles in pastes are more abrasive, smaller particles create finer scratches and a smoother polish. Pastes are labelled as extra-fine, fine, medium, coarse, or extra-coarse, but these terms are not standardized.

Question 10

Effective & Safe Polishing Agents

Answer 10

Have dull edges
Disintegrate Slowly
Are rounded
Are fine

Question 11

Less Effective Polishing Agents are..

Answer 11

Harder, rougher particles with larger sizes are more abrasive. As these factors decrease, surface abrasion decreases, resulting in a smoother polish.

Question 12

Quantity of Abrasive/Polishing Agent Applied

Answer 12

-More particles applied per unit of time increase the rate of abrasion.

-Most commercial preparations are suspended in a liquid to reduce frictional heat.

-Dry powders, which have more particles, can increase frictional heat. They should be mixed with a liquid to avoid thermal injury.

Question 13

Speed of Application of coronal polish

Answer 13

-Higher speeds result in greater abrasion.
-Pressure should be reduced as speed increases.
-Rapid abrasion can produce excess heat from friction, which is undesirable.

Question 14

The Pressure of application of coronal polish

Answer 14

Heavier pressure increases abrasion but can lead to excessive heat.

Pressure should be kept below 15 psi (pounds per square inch) to avoid excessive speed and maintain control during the polishing process.

Question 15

Choose the abrasive agent based on:

Answer 15

-The surface being polished (e.g., enamel, exposed root surfaces like cementum and dentin, or restorative materials).

-The type and amount of stain or soft deposit that needs to be removed.

-Always start with the least abrasive agent that effectively removes the stain.

Question 16

Common Abrasive Agents for Coronal Polishing

Answer 16

-Commercial Premixed Pastes (varying grit abrasiveness)
-Fluoride Paste
-Pumice (fine grit)
-Chalk
-Silex (superfine)
-Zirconium Silicate

Question 17

Types of Cleaning Agents

Answer 17

Cleaning agents differ from abrasives in shape and hardness.

Types of Cleaning Agents:
Feldspar
Alkali
Aluminum Silicate

Question 18

Commercial Preparations Include.. for polishing

Answer 18

Forms: Available as powders or pastes.

Packaging: Can be purchased in individual packets or bulk jars. For bulk jars, transfer enough material for one patient into a dappen dish or finger cup before starting the procedure.

Question 19

Polishing compounds for composite/ceramic restorations

Answer 19

Special polishing compounds are available that do not damage composite or ceramic restorations and enhance their luster. Typically, composites are polished with aluminum oxide pastes, while porcelain is polished with diamond paste.

Question 20

Common Ingredients in Commercial Pastes

Answer 20

-Abrasives: For cleaning and polishing.
-Binders: Hold abrasive particles together.
-Humectants: Retain moisture and keep the paste pliable.
-Preservatives: Prevent chemical changes and microbial growth.
-Coloring and Flavoring Agents: Some pastes contain gluten, which can be a concern for patients sensitive to wheat. Choosing gluten-free products can prevent allergic reactions.
-Supplemental Ingredients: Additives to enhance enamel surface, reduce dentinal hypersensitivity, and improve tooth whitening.

Question 21

Evaluating Deposits Before Coronal Polishing

Answer 21

Before starting coronal polishing, it is crucial to assess the deposits on the teeth. Determine whether the stain is removable and, if so, if it can be effectively removed by polishing or if scaling is required. (Extrinsic or Intrinsic Stain?)

Also, check for supragingival calculus, as polishing over calculus can burnish it, making it harder to detect and remove.

Question 22

Selecting a Prophylaxis Paste

Answer 22

-Infection Prevention: Use individually packaged products to follow infection control protocols.
-Fluoride Paste: Only use the necessary amount of fluoride-containing paste to prevent children from ingesting excess fluoride.
-Restorations and Implants: Abrasive pastes can scratch restorations and titanium implants. Use cleaning agents designed for specific restorative materials if polishing is needed.
-Avoid Bristle Brushes: Do not use bristle brushes on restorations, as they may damage the surface.
-Enamel Sealants: Before applying an enamel sealant, use an oil-free prophylaxis paste. Check the Manufacturer’s Instructions to see if fluoride-containing pastes are contraindicated; typically, a fine flour of pumice and water is recommended.
-Green Stain: Green stain often indicates demineralization. Instruct the patient to remove this stain during oral hygiene practice to avoid further damage from polishing.

Question 23

When cleaning and polishing, observe the following:

Answer 23

a. Use a cleaning agent or a low-abrasive prophylaxis paste.

b. Apply the polishing cup at a slow speed.

c. Use a light, intermittent touch.

Question 24

What is Air Polishing?

Answer 24

Air polishing is a method used for stain removal that combines warm water pressure with air to project a controlled stream of sodium bicarbonate powder onto the tooth surface. This technique is less abrasive than traditional polishing pastes, although some powders used in air polishing can be more abrasive and should be used with care

Question 25

Air Polishing Technique

Answer 25

Uses sodium bicarbonate powder, which is less abrasive than conventional pastes.

Question 26

Air Polishing Angulation - why is it crucial?

Answer 26

Proper angling is crucial to minimize aerosols and avoid soft tissue damage.

Question 27

Alternative Names for Air Polishing

Answer 27

Air abrasive polishing or air powder polishing.

Question 28

Indications for Use of Air Polishing

Answer 28

1. Effective for removing heavy stains from mature enamel.
2. Ideal before applying enamel sealants or cementing orthodontic bands.
3. Efficient for cleaning around orthodontic appliances without compromising the integrity of composite or cement materials.

Question 29

Contraindications for Air Polishing

Answer 29

1. Avoid in patients:
   -On a restricted sodium diet or with controlled hypertension.
   -With chronic or infectious respiratory conditions.
   -Wearing contact lenses (except with physician guidance).
   -With communicable infections that may contaminate aerosols.
2. Not suitable for:
   -Immature enamel, exposed dentin, or cementum.
   -Demineralized enamel areas or soft, spongy gingiva.

Avoid use on:
-Restorative materials such as cast restorations, porcelain, cement, composites, and amalgam.

Question 30

Can a DA preform Air Polishing?

Answer 30

Currently, air polishing is not within the scope of practice for dental assistants in Alberta.

Question 31

What is the purpose of a selective coronal polish? How would you explain this to your patient?

Answer 31

The purpose of a selective coronal polish is mainly for esthetics, as stain itself does not contribute to disease. To selectively
remove any visible extrinsic stains and plaque biofilm from the coronal portions of the teeth, only the mildest abrasive paste will be
used. Some stains cannot be removed by polishing. Only those stains on the surface of the tooth that can be removed by polishing
will be treated.

Question 32

What is the difference between an oral prophylaxis and a coronal polish?

Answer 32

An oral prophylaxis includes several procedures to help reduce or prevent oral diseases, of which coronal polishing is one

Question 33

List all the basic supplies and equipment required to complete a selective coronal polish.

Answer 33

Polishing motor, handpiece and contra-angle, rubber cup and bristle brush, low volume suction, air/water syringe, mirror and
explorer, patient bib.
Disclosing agent, Vaseline, cotton tipped applicators, polishing paste, cotton 2x2 gauze, floss

Question 34

How should you position the patient in the dental chair for the maxillary arch? How should you position yourself on the operator
chair? How would you position the light to help you see the mandibular arch?

Answer 34

Maxillary arch – patient’s chin up, operator at high clock position, light over chest
Mandibular arch – patient’s chin down, operator at low clock position for facial aspect, high clock position for lingual aspect, light
directly over head

Question 35

What type of grasp will you use to hold the instrument you will use to polish? Will you need to use a fulcrum? Why or why not?

Answer 35

Modified pen grasp is used for the working hand.
Intraoral fulcrum is always used for stability and safety in the use of the instrument.

Question 36

How will you control the handpiece? For Polishing

Answer 36

A rheostat or foot pedal is used to control the speed of the handpiece.

Question 37

Describe how you would perform a polishing stroke? Where do you start on the tooth? What direction does the stroke follow?

Answer 37

A light, sweeping stroke starting from the gingival third to the occlusal/incisal edge is used

Question 38

What will you use to remove the stains from the occlusal surfaces of teeth?

Answer 38

A bristle brush should be used with a light dabbing motion from the centre of the occlusal surface out towards the edges

Question 39

What post-operative instructions should be given to the patient after polishing?

Answer 39

A brief review of clinical findings, including where the stain and plaque biofilm were located, tips on how to effectively remove
biofilm at home to minimize re-accumulation, and a discussion on tobacco cessation would be valuable

Question 40

How would you document polishing in patient’s chart?

Answer 40

Today’s date, selective coronal polishing using (mild, medium and/or coarse) polishing paste (including flavor).

Question 41

Cleaning Agents VS Polishing Agents

Answer 41

Cleaning Agents
* Are non-abrasive and do not scratch surface materials
* Can be used on any tooth surface or restorative surface without scratching the surface.
* Particles used for cleaning include feldspar, alkai and aluminum silicate.
* However, the majority of polishing pastes do contain abrasive particles that are usually harder than the surface being
polished

Polishing Agents
* Act by producing scratches in the surface of the tooth or restoration by the friction of the abrasive particle and the softer
tooth or restorative surface.

Question 42

What factors affect the abrasive action of polishing pastes?

Answer 42

Factors that will affect abrading the tooth surface during polishing include pressure, speed, shape, size, strength and
hardness of the abrasive particles. Cleaning and polishing abrasive agents incorporated into the prophylaxis paste contain
different shapes and edges that scratch the surface of the enamel. The grit or size is the main factor

Question 43

Sarah Lovelace is 9 years old. She has biofilm and black line stain generalized throughout. What procedural steps will you
follow and what grit of polishing of paste will you choose?

Answer 43

Least abrasive (fine), scaling should be completed first. If fine did not remove the stain then try medium then if necessary
course

Question 44

Jennifer Scott has come in for her hygiene appointment. Jennifer has no stain; however, she has mild gingivitis and biofilm
throughout. Jennifer insists she has a coronal polishing procedure completed today. What procedural steps will you follow and what grit of polishing paste will you choose?

Answer 44

Explain the reason for polishing and the effects on the tooth- if the patient still insists on having the procedure done. A cleaning agent only should be used.

Question 45

Mr. John Wilson had a prosthetic heart value placed 3 years ago and reports he has been in excellent health. He is a light
smoker and has some light tobacco stain to be removed from the lingual and facial aspects of his maxillary and mandibular
teeth. He also has a porcelain veneer on tooth 2.1 which has light tobacco stain on the facial aspect. What procedural steps
will you follow? Would you choose the same polishing agent that you use to polish a tooth surface? Why or why not?

Answer 45

Ensure the patient has taken his pre-medication before starting the procedure.
No one type of polishing agent is intended for every tooth surface, and it should not be used on restorative materials that are softer
than the abrasive agent. When polishing restorative materials, dental assistants should use a prophylactic paste that is specifically
designed for restorations. -
Porcelain should be polished with a diamond paste

Question 46

Create a Smooth Tooth Surface - by polishing

Answer 46

One of the primary indications for coronal polishing is to create a smooth tooth surface. This smoothness helps in reducing the adherence of plaque, calculus, and stains. A smooth surface is also more aesthetically pleasing and can contribute to overall oral hygiene.

By removing minor surface irregularities, coronal polishing can make it easier for patients to maintain their oral health. This is particularly important for individuals who are prone to plaque buildup and staining.

Question 47

Enhance Fluoride Absorption - by polishing

Answer 47

Another important indication for coronal polishing is to enhance fluoride absorption. A smooth tooth surface allows for better penetration of fluoride treatments, which are essential for strengthening enamel and preventing decay.

Fluoride treatments are more effective when the teeth are free of plaque and surface stains. Therefore, coronal polishing is often performed before the application of fluoride to maximize its benefits.

Question 48

Coronal Polishing - before placing Dental Sealants

Answer 48

Coronal polishing is also indicated before the placement of dental sealants. Sealants are protective coatings applied to the chewing surfaces of the back teeth to prevent cavities.

For sealants to adhere properly, the tooth surface must be clean and free of debris. Polishing ensures that the surface is adequately prepared, thereby enhancing the longevity and effectiveness of the sealants.

Question 49

Bonding of Brackets - after coronal polishing

Answer 49

Before the bonding of orthodontic brackets, coronal polishing is often performed. A clean and smooth tooth surface is crucial for the brackets to adhere securely.

This step helps in ensuring that the brackets remain in place throughout the orthodontic treatment. It also reduces the risk of bracket failure, which can prolong the treatment duration.

Question 50

Coronal Polishing - before cementation of Crowns & Bridges

Answer 50

Before the cementation of crowns and bridges, coronal polishing is often performed. A clean and smooth tooth surface is essential for the proper adhesion of these restorations.

Polishing helps in removing any debris or plaque that could interfere with the cementation process. This ensures that the crowns and bridges fit securely and function effectively

Question 51

Temporary Cement Residue Removal - by Coronal Polishing

Answer 51

Coronal polishing is also used to remove temporary cement residues. After temporary restorations are removed, remnants of the cement can remain on the tooth surface.

Polishing helps in cleaning these residues, preparing the tooth for the final restoration. This step is important for ensuring the success and longevity of the permanent restoration.

Question 52

Essential Tools for Polishing

Answer 52

Handpieces and attachments are crucial for effective coronal polishing procedures. The low-speed handpiece, commonly used in these procedures, can be equipped with various attachments such as bristle brushes and polishing cups. Bristle brushes are ideal for removing stains from deep pits and fissures, while soft, webbed polishing cups are used to clean and polish the smooth surfaces of the teeth.

Prophy angles, which can be either reusable or disposable, are another essential attachment. Reusable prophy angles must be sterilized after each use, whereas disposable angles are discarded after a single use.