Dental Polishing and Patient Safety Quiz

Cosmetic Polishing Procedures

• Coronal polishing is a cosmetic procedure aimed at removing extrinsic stains from tooth enamel.
• A therapeutic procedure is a dental procedure used to maintain health or treat disease to restore health.
• A cosmetic procedure is non-essential and undertaken for aesthetic reasons, improving appearance.
• Coronal polishing offers no therapeutic benefit as dental stains do not cause periodontal disease, dental caries, or other oral diseases.
• Historically, all teeth were polished at the completion of prophylaxis.
• Researchers suggest coronal polishing is not necessary on a routine basis.
• Over time, polishing can remove tooth structure, leading to morphological changes.
• The ADHA and the American Academy of Periodontology include tooth polishing in their definitions of the term "oral prophylaxis."

Types of Stains

• Extrinsic stains occur on the outer surfaces of teeth, and the most common examples are chlorhexidine and tobacco stains.
• Intrinsic stains occur within the enamel and cannot be removed by polishing.
• Examples of intrinsic stains include tetracycline stains and stains from silver amalgams or endodontic (root canal) treatment.

Precautions

• Adverse effects of coronal polishing include: aerosol production and splatter, creation of bacteremia, and iatrogenic damage to tooth surfaces.
• Dental aerosols are invisible airborne particles dispersed into the surrounding environment by dental equipment.
• Spatter consists of airborne particles that land on people and objects. Polishing splatter includes polishing paste, microorganisms, and saliva.
• Power-driven equipment should be used but with caution for patients with high susceptibility to infection, such as individuals with respiratory/pulmonary disease, immunocompromised, or debilitated individuals.
• Patients and clinicians should use eyewear to protect their eyes from splatter.
• Some constituents of prophylaxis pastes are chemicals that can cause inflammation in the eye.
• Bacteremia is the presence of bacteria in the bloodstream.
• Bacteria in the oral cavity can enter the bloodstream during hand or powered instrumentation and coronal polishing.
• Individuals susceptible to bacteremia include those with damaged heart valves, prosthetic heart valves, prosthetic joint replacements, rheumatic heart disease, congenital heart disease, cardiac bypass surgery within the last six months, or dialysis patients.
• Iatrogenic damage is a problem brought on by something a clinician does.

Other Considerations

• Stain removal uses an abrasive agent to remove the surface layer of enamel.
• Tiny amounts of enamel are removed during polishing.
• Minimizing the amount of tooth structure removed is essential.
• Polishing areas of demineralization is contraindicated to prevent interrupting enamel surface remineralization.
• Polishing generates heat, so use a wet agent with minimal pressure and low speed.
• Primary teeth are vulnerable to heat generation during polishing due to their large pulp chambers.
• Coronal polishing can injure gingiva if incorrect techniques are used.
• Polishing of exposed cementum and dentin is contraindicated.
• Tooth sensitivity may be common in affected areas.

Polishing Procedures

• Apply a sufficient amount of paste to 2-3 teeth at a time, applying more as you progress through the mouth.
• Adapt the polishing cup carefully to all surfaces, keeping it parallel to the surface.
• Maintain adaptation of the cup and keep the rim flared slightly.
• Maintain a slow, constant speed.
• Complete the procedure using an efficient and logical sequence.
• Appropriate seating positions, illumination, and saliva ejectors can control aerosols.
• Rinse the patient periodically for comfort.

Fluoride Treatments

• Fluoride varnish and trays prevent dental problems.
• During fluoride application, ensure that the tray is placed so that the fluoride is in contact with teeth.

Components of Polishing System

• Includes dental handpieces, prophy angles, and cup attachments.

Rubber Cup Method

• A rubber cup filled with polishing agent removes extrinsic stains from tooth crowns.

Clinical Application

• Patient education on controlling stains from drinks, food, and tobacco cessation.
• Proper brushing and flossing habits.
• Scaling of stains.
• Polishing with appropriate agents and techniques.

Polishing Agents

• Polishing agents are abrasive in nature, created by the shape, hardness, strength, and size of the particles.
• Polishing pastes have a range of grit sizes (course to fine).
• Use the least abrasive paste necessary to achieve desired results.
• Polishing agents have enhancements like remineralization, hypersensitivity, and whitening.

Types of Prophy Angles

• Reusable Right-Angle: Straight shank to re-use; needs autoclaving between uses.
• Disposable Right-Angle: Disposable after single use.
• Contra-Angle: Bent shank to facilitate neutral wrist position.
• Latch Type: Latch secures attachment to the angle.
• Threaded Head: Attachment type with screws for attachment.

Angle Attachments

• The "working ends" or attachments that are applied.
• Included webbed cups and ribbed cups and petite webbed cups.

Other Notes

• Polishing brushes, disposable all-in-one angles are also used.
• Cup adaptation should be parallel to the surface of the tooth being treated.
• Apply the rubber cup at the correct speed and pressure.