Stain Removal and Polishing Flashcards by Faye Sitron

What is coronal polishing?

Esthetic procedure to remove extrinsic staining. Very little therapeutic benefit

ADHA recommends polishing only when needed

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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

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What is therapeutic polishing?

Polishing the root surfaces that are exposed during surgery to reduce endotoxin and microflora on the cementum

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What does two-body mean?

Prophy cup with the paste already in the cup

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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

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What is bacteremia?

When bacteria is introduced into the blood stream

Can occur even with very little manipulation of the gingiva like toothbrushing

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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

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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

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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

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What happens with removal of tooth structure?

Coarse abrasive may remove a few microns of fluoride rich outer enamel

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What happens when polishing causes demineralized areas to be lost faster?

Can interrupt remineralization

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How can sensitivity occur from polishing?

Thin enamel/exposed dentin is very vulnerable. Smear layer over dentin can be removed

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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

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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

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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

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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

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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

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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

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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 ```