Stain Removal and Polishing Flashcards
What is coronal polishing?
Esthetic procedure to remove extrinsic staining. Very little therapeutic benefit
ADHA recommends polishing only when needed
What is selective polishing?
Removal of a soft deposit not removed by scaling/root planing
Includes the selection of polishing agent to be used- least abrasive possible to reduce wear
What is therapeutic polishing?
Polishing the root surfaces that are exposed during surgery to reduce endotoxin and microflora on the cementum
What does two-body mean?
Prophy cup with the paste already in the cup
What does three-body mean?
Prophy cup that needs to be manually filled with prophy paste
Loose particles move in a space between the tooth and application device
What is bacteremia?
When bacteria is introduced into the blood stream
Can occur even with very little manipulation of the gingiva like toothbrushing
Can you polish a patient who needs pre-medication? Why?
Yes, but only if they have taken the medication. Polishing that may interact even minorly with the gingiva can cause bacteria to enter the blood stream
Effects of polishing; environmental factors
Aerosols- produced by hand-piece, extended in air. Put US at risk, as well as future patients and other employees
Spatter- Patient and operator must wear protective eyewear
Negative polishing effects on the teeth
Removal of tooth structure
Demineralized areas are lost faster
Smear layer over dentin can be removed- sensitivity can occur
Paste can cause scratches on restorations
Too much pressure for too long without water can increase heat
What happens with removal of tooth structure?
Coarse abrasive may remove a few microns of fluoride rich outer enamel
What happens when polishing causes demineralized areas to be lost faster?
Can interrupt remineralization
How can sensitivity occur from polishing?
Thin enamel/exposed dentin is very vulnerable. Smear layer over dentin can be removed
Effects of polishing on the gingiva
Trauma at higher speeds
Surface epithelium at margins is vulnerable
Can make gumline sore, reducing patient compliance with brushing/flossing
Can force polishing particles into gum tissue
No polishing after perio/gingival treatment
Body can react to abrasives as foreign bodies and slow healing
Working with the patient to remove their extrinsic stain
Discuss the stain with the patient. Explain where it comes from and based on their diet/lifestyle/habits whether it will come back, if it is inside or outside the tooth, and whether or not we will be able to remove it.
Remove stain as much as you can carefully with instrumentation
Preparing teeth for caries prevention agents
Some DHCP use polishing with pumice beforehand. This is not necessary, a dry toothbrush is adequate before fluoride treatments
Contraindications for polishing
No stain High risk for caries Tooth sensitivity Demineralization Amelogenesis/dentinogenesis imperfecta Respiratory problems Restorations Exposed dentin/cementum Newly erupted teeth Acute periodontal infection
When to postpone polishing treatments
Following perio surgery/SRP
If patient has an active communicable disease
If they are immunocompromised
If the gingiva is spongy
Proper polishing technique
Use as little time as possible Use light pressure Low speed Most minimal abrasive possible Use water for minimal heat production Rubber cup at 90 degrees
Choosing a polishing agent
Chosen based on the individual
Use multiple sizes on one patient
One size grit for every patient is unethical
Use least abrasive grit possible
Using a cleaning agent with no grit will give that “clean feeling”
Cleaning agents
Round, flat, non-abrasive particles Produces a higher luster ProCare-- mix with water or NaFl CPR is an alumina polish Can be use on any surface Does not harm restorations
Characteristics of polishing agents
Shape
Hardness
Grit
Polishing agents- shape
Irregular particles with sharp edges with deeper grooves abrade faster than round ones
Polishing agents- hardness
Particles must be harder than the surface to be abraded. Hard particles abrade faster
Polishing agents- Grit
The larger the more abrasive.
Finer will achieve more gloss- called powders or flours in increasing order of fineness
What size grits are polishing agents available in?
Extra fine, fine, medium, coarse and extra coarse
How do we determine what size grit to use
Follow manufacturers recommendations
Medium is highest we go for in task. Reevaluate if stain medium does not remove
If using medium, follow with fine/extra fine or cleaning agent
Principles of application of polishing agents
Quantity applied- the more particles, the higher the rate of abrasion
Speed of application- Greater the speed, faster the abrasion rate, increases heat
Pressure of application- Greater the pressure, faster the rate of abrasion
Pumice. Which is the least abrasive?
Comes from volcanoes- used for polishing
Pumice flour is the least abrasive. Most commonly used in commercially prepared prophy paste
Types of polishing agents
Silex XXX
Pumice
Calcium carbonate- mild abrasive
Diamond- only used on porcelain surfaces
Tin oxide- Last step on amalgam restorations
Emery- Used for composites and margins of porcelain (Aluminum oxide) Not used on enamel
Jeweler’s Rouge- Iron oxide impregnated on paper disc. Used for polishing gold crowns in the lab
Composition of commercially prepared polishing agents
Abrasive agent 50-60% Water 10-20% Humectants (glycerol) 20-25% Binders 1.5-2% Flavoring and color agents/sweeteners
Additives to polishing agents
Fluoride
Amorphous Calcium Phosphate
Whitening
Sensitivity blockers
Fluoride as a polishing agent additive
Not proven effect to prevent decay
Benefit- Fl ions mixing with saliva- aiding in remineralization
Amorphous Calcium Phosphate as a polishing agent additive
Aids in mineralization
Benefit is mixing with salvia
Whitening as a polishing agent additive
Contain 35% hydrogen peroxide
Gel applied to tooth then polished into tooth with paste and cup
Used more for maintenance of whitening
Sensitivity blockers as additives to polishing agents
Products used can block tubules (arganine) or provide medication THROUGH tubules (potassium nitrate)
How are polishing agents packaged?
Pre-measured disposable cups
Powders to mix chair-side
Premixed in a tub
What are the three types of prophy angles
Disposable prophy angle
Disposable angle with abrasive impregnated rubber cup
Stainless steel prophy angle (brush or cup)
Procedure for stain removal
Review med history Review radiographs Choose your paste Review biofilm control Complete all scaling Evaluate stain removal need Explain the procedure Provide safety glasses Encourage nose breathing
Why do we review radiographs before treatment?
Look for restorations- cleaning paste will likely be used on restorations, not a polishing paste
WHat speed do we use with our handpiece?
Slow speed- 5000RPM
How do we hold the handpiece?
Like all other instruments; modified pen grasp, intra oral fulcrum
How do we adapt the polishing cup to the tooth?
Fill cup and place parallel to the tooth surface. Start power BEFORE placing the cup on the tooth
Use an on and off patting motion
How do we move the prophy angle around the mouth?
Use an on and off patting motion Work from most distal first Work from gingival 3rd to occlusal 3rd Just enough pressure to slightly flare cup Slowest speed possible Should not hear high pitched noise
Procedure for selective polishing
Rubber cup touches tooth surface for 1-2 seconds
Move on to other area of tooth
Control saliva with saliva ejector
Do not have patient close mouth on ejector
Use cup or bristle brush to clean occlusal
If using 2 agents, use 2 different cups
Why do we flush the mouth after polishing?
To remove abrasive particles from in between the teeth and gingival margin
May floss as you go
How to use bristle brush for polishing
Soak in warm water to soften Occlusal surfaces only Distribute paste first Firm finger rest Bring almost to tooth before activating Slowest RPM Avoid soft tissue Short brushing motion- 1-2 sec at a time
