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CURRENT CONCEPTS

IN CORONAL

POLISHING

Harold A. Henson, R.D.H., M.Ed., Ph.D.

Director, Center for Teaching and Learning

Associate Professor

Conflict of Interest

Harold A. Henson, R.D.H., M.Ed., Ph.D.

Neither I nor members of my

immediate family have any financial

relationship with commercial entities

that may be relevant to this

presentation.

Reflective Question

• During the dental hygiene process of care what do most

patients remember “the most” or “associate” with the

polishing procedure?

What is it??

Why do we polish?

• Reduce adhesions of plaque, calculus, stain

• Smooth surfaces

• Esthetics

• Reduce corrosion

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Definition

•Polishing: the abrasion of a

surface to eventually reduce the

size of the scratches until invisible

to the naked eye.

D110

• Polishing is part of oral prophylaxis code D1110 in the

American Dental Association’s (ADA) Code on Dental

Procedures and Nomenclature (CDT).

• It has become a routine procedure for hygiene

appointments.

• Polishing produces smooth surfaces on teeth and

restorations.

• These smooth surfaces reduce the adherence of dental

biofilms and remove extrinsic stains.

• Rubber cup polishing entails polishing for every patient

and polishing every tooth during an oral prophylaxis.

The Mechanics

• Is a means of creating a smooth, glossy surface using

abrasive grits that create progressively smaller scratches.

• Polishing pastes contain some sort of abrasive particle.

• Polishing agents produce scratches in the surface of the

tooth or restoration by the friction that is created between

the abrasive particle and the tooth or restorative surface.

• Particle size is a factor that affects how abrasive a grit

actually is.

• The smaller the grit, the smaller the scratches.

The Mechanics

• Use polishing grits in a progression of coarse to fine

applications create a smooth, lustrous finish.

• Coarse grit pastes can create deep scratches. They can

also roughen tooth surfaces, making them more

susceptible to collect plaque biofilm and stain.

• Smooth surfaces resist adhesion of bacteria and stain.

• If coarse grit is utilized, it should be followed by fine grit.

• Using a new polishing cup or brush for each sequentially

smaller grit can also enhance successful polishing.

SELECTIVE POLISHING To Be or Not to Be….

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Essential Selective Polishing

ABRASIVES AND

POLISHING AGENTS

Current Purchase Trends

• Currently, the majority of polishing pastes purchased are:

1. Coarse (80%)

2. Medium (10%)

3. Fine (10%)

• This tells us that a “one-paste-fits-all” approach is still the

common polishing modality for patients.

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Abrasives

• Abrasives are materials that cut or grind the surface,

leaving grooves and a rough surface, while polishing

produces a smooth, glossy surface with fine abrasive

materials.

• It is important to understand abrasives and their

characteristics and their actions to select the best

materials for the patient without damaging the tooth.

• Abrasives remove small amounts of enamel during the

polishing procedure; therefore, it is best to follow the

coronal polish procedure with a fluoride treatment and/or

to use a fluoride prophy agent.

Abrasives

• Abrasives are materials composed of particles that come

in powders or pastes.

• They are selected according to the amount of stain and

soft deposits that are to be removed. Abrasives should

always be as moist as possible yet easy to use without

dripping or spattering.

• These particles have characteristics that affect their

abrasiveness

Rate of Abrasion

• By increasing the speed of the handpiece, the rate of abrasion

is increased accordingly. This also increases the heat

production.

• The pressure can control the rate of abrasion. The firmer the

pressure, the more abrasive. Also, frictional heat increases.

• The amount of abrasive material used affects the rate of

abrasion. The more material that is used, the faster the

abrasive works.

• The type of abrasive used determines the rate of abrasion. The

larger and harder the particles, the faster the abrasion. Also,

the rate of heat production increases.

• The dryer the abrasive materials, the more abrasive they are.Bird, D. L., & Robinson, D. S. (2013). Modern dental assisting. Elsevier Health Sciences.

Abrasives

• Select an abrasive material that is coarse enough to cut

through the deposits and stains and polish until the

surfaces are as smooth as possible.

• Then, select a finer material, if needed, to polish the

surface until it is smooth and free of deposits and stains.

• Usually, one abrasive is enough to complete the task, but

if the patient has a lot of stain, a more coarse abrasive

should be used.

• Select a polishing agent recommended by the

manufacturer of the restorative material.

Abrasives

• In the case of gingival recession, a finer abrasive is used

on these areas after finishing all other areas with a

coarser abrasive.

• When using two types of abrasives, completely finish with

one abrasive, and then rinse the patient's mouth

thoroughly before beginning with another abrasive.

• Use separate dappen dishes, rubber cups, and brushes

for each abrasive.

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Mohs Scale of Relative Mineral Hardness

• The The Mohs scale was devised by Friedrich Mohs in 1812 and has been a valuable aid to identifying minerals ever since. Here are the ten standard minerals in the scale.

1. Talc2. Gypsum 3. Calcite4. Fluorite 5. Apatite (Enamel)6. Orthoclase feldspar 7. Quartz8. Topaz9. Corundum

10. Diamond

Relative Hardness - Moh’s Scale

• Diamond=10

• Silicon Carbide=9-10

• Emery=9-10

• Aluminum Oxide=9

• Zirconian Silicate=7-7.5

• Quartz=7

• Tin Oxide=6-7

• Pumice=6

• Garnet=6.5-7

• Composites=5-7

• Enamel=5-6

• Base Metals=5-6

• Porcelain=6-7

• Amalgam-4-7

• Gold=3-4

• Dentin=3-4

• Acrylic=2-3

• Gypsum=2

Types of Abrasives

• Abrasives come in powders and pastes and in bulk form

or individually packaged.

• Besides the abrasive, most commercial preparations

contain water, a binder, humectant (retains moisture),

color, and a flavoring.

Zirconium Silicate

• Used for stain removal and polishing.

• This material may be used on gold restorations, exposed

dentin, and tooth-colored restorations, as well as enamel.

Tin Oxide

• A very fine polishing agent used on enamel and metallic

restorations.

• Used in a paste form, it is mixed with water, alcohol, or

glycerin.

Flour of Pumice

• Used to remove stains from the enamel.

• It is relatively coarse and should be followed by a fine

polishing agent.

• It is not used on exposed dentin, tooth-colored

restorations, or gold restorations because of its high

abrasiveness.

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Chalk (Whiting)

• A mild abrasive, it is used in some prophylactic pastes.

Fluoridated Prophylaxis Paste

• Commonly used

• Fluoride is added to commercially prepared prophylaxis

pastes to replace the fluoride lost in the enamel surface

during the polishing procedure due to abrasion.

• Fluoride prophylaxis pastes should not be used if the

teeth are to receive enamel sealants after the coronal

polish.

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Jones (2016). Selective Polishing: An Approach to Comprehensive Polishing

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PROPHY ANGLES

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Results revealed no statistically significant difference between the two DPAs in extrinsic tooth stain removal.

There was a statistically significant interaction among rpm (3000) of the DPA and the grit abrasivity of the prophylaxis paste

suggesting that additional study may be indicated since coarse prophylaxis pastes remove stain more rapidly, but in doing so,

can scratch and roughen the tooth enamel

LATEX

HYPERSENSIVITY

Latex Free Prophy Cups

• Always purchase latex

free prophy cups to be

on the safe side!

• Also use latex free

materials when you know

that a patient has latex

sensitivity.

ERGONOMICS

Remember????

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Midwest Shorty Polishing Variables

• Most manufacturers recommend operating the slow

speed handpiece at 3,000 rpm.

• Excessive pressure can contribute to increased abrasion

against the surface being polished.

• Contact time should be limited per tooth, ideally between

1 to 2 seconds.

• Other factors include the quality, size, shape and

hardness of the abrasive particles.

• The firmer a polishing cup, the more pressure must be

applied to flare the cup against the tooth surface.

• Look for lightweight handpieces

• Ergonomic prophy angles

• Lightweight hoses

Midwest RDH Handpiece

Remember – Part II??? Midwest Featherweight Hose

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Young™ Dental Hygiene Handpiece• Has a unique silhouette that fits the

contours of the hand to deliver superior

comfort and control.

• A contra-angled connector combined

with a nose cone that rotates 360˚ allow

the handpiece to follow natural

movement, greatly reducing wrist and

hand fatigue.

CORDLESS SLOW

SPEED HANDPIECES

NSK Hygiene Pro iStar Cordless Prophylaxis Handpiece

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Nupro Freedom™ System … providing enhanced control, comfort & freedom

Project: Swish

• SmartMode™ Technology provides the latest advance in handpiece speed control, without the need for buttons or foot pedals. • Allows the user to control the DPA speed more

intuitively. The DPA speed will increase as it is gently pressed against the tooth and its speed will decrease as less pressure is applied.

• Reduced noise and vibration, providing a more pleasant polishing experience for both the patient and the clinician.

• Provides 25% more speed and power than previous Freedom models.

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STERILIZATION OF

SLOW SPEED

HANDPIECE

Reflection Question

• What are your greatest challenges in sterilizing slow

speed handpieces?

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April 11, 2018

Sterilization and Maintenance

• READ THE MANUFACTURER’S DIRECTIONS!

• Must be sterilized in between patients! One per patient.

• Must have appropriate inventory to last through the day.

• Make sure to lubricate the handpiece prior to sterilization.

PATIENT EDUCATION

AND

PROFESSIONAL RESPONSIBILITY

Reflective Questions

• What do you say when a patient wants white teeth using

only the prophy paste?

• How many patients enjoy the polishing procedure?

• How many patients hate the polishing procedure?

Patient Education

• It is important to let the patient know the thought process

behind selective polishing prior to performing the

procedure.

• This in turn enhances the patient’s experience, adding

value to the procedure. This is called pre-framing.

• Pre-framing involves explaining the procedure to the

patient before and after it is completed to ensure they

have a complete understanding.

• For example, when the patient is in the chair, the hygienist

can let the patient know the purpose of abrasive type

pastes and cleansing pastes.

• Patient concerns can also be addressed at this time.

http://youngdental.com/wp-content/uploads/2016/09/1608cei_Jones_rev51.pdf

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Patient’s Needs

• Cleaning and polishing agents must be selected based on

the patient’s individual needs – amount of stains and type

of restorations

• Preservation of the surfaces of both the teeth and

restorations is of primary importance during all cleaning

and polishing procedures.

• One size prophylaxis paste is not appropriate for every

patient and is unethical and clinically the wrong choice.

• To use such a practice is to ignore a patient’s individual

needs, can worsen hypersensitivity and cause significant

damage to esthetic restorations.

Wilkins, E. M. (2017). Clinical practice of the dental hygienist. 780-81.

Philadelphia, PA.

FIGURE 45-1 Scanning Electron Photomicrograph of A Composite

Restoration Polished with Coarse Prophylaxis Paste

Wilkins, E. M. (2017). Clinical practice of the dental hygienist. 782.

Philadelphia, PA.

Professional Responsibility

• It is your responsibility to be current in knowledge of the

procedures to prevent damage to the restorations during

the appointment.

• You should explain to the patient that coronal polishing is

for esthetic reasons and not for therapeutic or health

reasons.

• Stains on the teeth are not the causative factor in oral

disease.

Wilkins, E. M. (2017). Clinical practice of the dental hygienist. 780-81.

Philadelphia, PA.

References • Barnes, C. M. (2012). Shining a new light on selective polishing.

• Bird, D. L., & Robinson, D. S. (2013). Modern dental assisting. Elsevier Health Sciences.

• https://www.cdc.gov/oralhealth/infectioncontrol/statement-on-reprocessing-dental-handpieces.htm

• Jones, T. (2016). Selective Polishing: An Approach to Comprehensive Polishing. Retrieved from http://youngdental.com/wpcontent/uploads/2016/09/1608cei_Jones_rev51.pdf

• LaCross, I., Darby, M., Stull, S. S., & Lynch, C. M. (2007). In Vitro Evaluation of the Reciprocating Disposable Prophylaxis Angle Versus the Rotating Disposable Prophylaxis Angle in Extrinsic Stain Removal Effectiveness. American Dental Hygienists Association, 81(4), 105-105.

• McCombs, G., & Russell, D. M. (2014). Comparison of Corded and Cordless Handpieces on Forearm Muscle Activity, Procedure Time and Ease of Use during Simulated Tooth Polishing. American Dental Hygienists Association, 88(6), 386-393.

• Milleman, J. L., Milleman, K. R., Clark, C. E., Mongiello, K. A., Simonton, T. C., & Proskin, H. M. (2012). NUPRO sensodyne prophylaxis paste with NovaMin for the treatment of dentin hypersensitivity: a 4-week clinical study. American Journal of Dentistry, 25(5), 262.

References

• Neuhaus, K. W., Milleman, J. L., Milleman, K. R., Mongiello, K. A., Simonton, T. C., Clark, C. E., ... & Seemann, R. (2013). Effectiveness of a calcium sodium phosphosilicate containing prophylaxis paste in reducing dentine hypersensitivity immediately and 4 weeks after a single application: a double‐blind randomized controlled trial. Journal of Clinical Periodontology, 40(4), 349-357.

• Pence, S. D., Chambers, D. A., van Tets, I. G., Wolf, R. C., & Pfeiffer, D. C. (2011). Repetitive coronal polishing yields minimal enamel loss. American Dental Hygienists Association, 85(4), 348-357.

• Tsai, W. S., Placa, S. J., & Panagakos, F. S. (2012). Clinical evaluation of an in-office desensitizing paste containing 8% arginine and calcium carbonate for relief of dentin hypersensitivity prior to dental prophylaxis. American Journal of Dentistry, 25(3), 165.

• Wilkins, E. M. (2017). Clinical practice of the dental hygienist. 780-81. Philadelphia, PA. Harold.A.Henson@uth.tmc.edu