Prophylaxis

Question 1

How do you test whether a stain is intrinsic or extrinsic?

Describe some stain colours.

Answer 1

• The “scratch test” is usually used to distinguish between extrinsic and intrinsic discoloration
• Run the lateral surface of a tip of an explorer on the tooth surface and with light pressure make oblique strokes. If it is extrinsic stain, a small amount can usually be removed
• Intrinsic discoloration cannot be removed by using the “scratch test”
• Extrinsic and Intrinsic discolorations vary from brown, black, grey, green, orange, and yellow
• Intrinsic discoloration may also be red or pink caused from a dead dental pulp

Question 2

List and describe 3 things an operator must consider before proceeding with Hand Oral Prophylaxis

Answer 2

1. Discuss medical care:
   Are there any medication or mouth rinses that may be contributing towards staining? e.g Chlorhexidine or Stannous Fluoride
2. Discuss diet and habits:
   Extrinsic staining caused by foods, beverages, or habits should be addressed with the appropriate Oral Hygiene advise (rinse after coffee or chew sugar free gum) or encouragement of smoking cessation
3. Discuss tooth brushing and ID cleaning:
   Effective tooth brushing twice a day with a dentifrice helps to prevent extrinsic staining. Electric toothbrushes help slow stain development. If spaces allow, ID Brushes should be recommended

Question 3

List the implements an Operator needs for Oral Prophylaxis (5)

Answer 3

Hand pieces for polishing

Prophylaxis cups

Prophylaxis brushes

Prophylaxis paste

Prophylaxis holders

Question 4

Describe hand pieces for polishing.

What is the problem with fast hand pieces?

Answer 4

• Polishing handpieces should be operated at 3000 RPM
• Hand pieces designed for Prophylaxis are normally colour coded Green indicating their maximum speed (5500 rpm) is safe for polishing
• Faster can be dangerous as it may cause patient discomfort, gingival abrasion
• High speed operation creates prophy paste splatter more readily, causing an infection-control concern

Question 5

Describe prophylaxis cups for polishing

Answer 5

• Different designs (screw ons, slip ons/ snap ons, latch type)
• Hold the paste in during polishing
• Screw-in cups maintain a more concentric shape during polishing and, as a result, tend to wobble less

Question 6

Describe prophylaxis brushes for polishing

Answer 6

• Can be tapered, flat and cap- shaped

* Used only on occlusal surfaces, not gingival, and use mainly for sealant applications

Question 7

Describe prophylaxis paste for polishing, in terms of historical pastes and modern day pastes

Answer 7

• Old pastes used to contain pumice and water. This was very abrasive and would reduce gloss on many restorations

• Today, pastes are used with cups and contain fluorides
• The pastes are available in fine, medium and course grits
• There are pastes today e.g “Clinpro Prophy Paste” which contain perlite particles which break down as you polish from a coarse to a fine grit
• Some patients may be sensitive or not want the colours, flavourings, and additives
• Gluten intolerant patients, use EnamelPro

Question 8

Describe safe prophylaxis and demonstrate practically an effective Oral Prophylaxis Technique

Answer 8

1. Wet the tooth first and it should remain moist during polishing to avoid frictional heat
2. Rotate the entire handpiece, as you work around a tooth, from distal towards mesial surface. Pause for a second on the distal, buccal and mesial surfaces
3. Polishing rubber cup should be gently pressed against the corresponding tooth surface to reach subgingival area at least 0.5 mm and interproximal sites as much as possible

Question 9

List the things an operator should consider after prophy

Answer 9

1. Floss the whole mouth
2. Rinse the whole mouth and suction the patient’s mouth
3. Ask them if they can feel any residual prophy paste in their mouth, if so rinse again
4. Check to make sure there is no paste on their face before they leave your dental chair