Protocol for Polishing

Caren M. Barnes, RDH, MS, is a professor, Department of Surgical Specialities, and the coordinator of Clinical Research, Cruzan Center for Dental Research, both at the University of Nebraska Medical Center, College of Dentistry, Lincoln.

The practice of selective polishing begins with evaluating the client to assess the value of polishing over the potential adverse effects on enamel and root tissues. Please describe this concept.

Evaluating the client’s needs and behaviors is the fundamental principle of selective polishing. Selective polishing differs from rubber cup polishing in that rather than polishing every client during an oral prophylaxis procedure, the client is evaluated for the type of stain(s) present; the client’s oral health behaviors, such as smoking or drinking pigmented beverages; health of soft tissues; demineralization; and appropriate grit of polishing paste or cleaning agent.^1-3

Selective polishing is the removal of extrinsic stains only on enamel surfaces or if the client requests the procedure.1,2 Once polishing has been completed, topical fluoride must be applied to replace that removed during the polishing procedure. A full-mouth treatment or topical fluoride or fluoride varnish in individual areas are both acceptable. The fluoride treatment reduces the solubility of the enamel surface by replacing the apatite with fluorapatite.⁴ Additional contraindications for the use of prophylaxis polishing paste are listed in Table 1.¹

Describe how the use of fluoride in prophy pastes may help replace some of the fluoride lost from the outer surfaces of enamel and root tissues during polishing.

There is a misconception that fluoride-containing prophylaxis pastes will replenish the fluoride removed from the enamel surface during the polishing procedures. While fluoride-containing prophylaxis pastes may replace a small amount of the fluoride removed during polishing procedures, they are not the equivalent of a topical fluoride treatment.^3,5,6 Plus, dental insurance companies will not reimburse providers for a topical fluoride treatment when the only fluoride administered is that provided in the prophylaxis paste.

Describe the effects of abrasive polishes on demineralized tooth surfaces.

The importance of client assessment prior to prophylaxis polishing cannot be overemphasized. The impact of prophylaxis pastes on demineralization is significantly detrimental. Not only does prophylaxis paste remove most of the fluoride ion remaining on the surface, it may also render the enamel so damaged that it is quite difficult, if not impossible, to remineralize. Therefore, the dental hygienist must identify areas of demineralization and treat those areas with a topical fluoride treatment or fluoride varnish.⁷

Coarse abrasives may roughen tooth surfaces facilitating an increase in biofilm accumulation. Is it advisable or necessary to use a less abrasive paste following the use of a coarse grit prophy paste?

Coarse abrasive polishing pastes leave deep irregular scratches of varying depths in the surface of enamel and may leave a rougher surface than existed prior to polishing.^8,9 In order to leave the smoothest surface possible after using a coarse prophylaxis paste, polishing with a medium grit paste, followed by a fine grit paste, is necessary. The rubber cup must be changed with each change of grit. Otherwise, the rubber cup retains the coarser grits and the desirable smooth surface is more difficult to accomplish. Table 2 contains a list of types of some abrasives used in commercially-prepared prophylaxis polishing pastes and their Moh’s Hardness Value compared to enamel and dentin.⁴

Is there a type of prophylaxis paste that is best for polishing esthetic restorations and teeth without stain?

Dental manufacturers have been sensitive to the issue of using the best, least destructive polish available for esthetic restorations. There is a difference between a polishing agent and a cleaning agent. Abrasive particles in polishing pastes are harder than the surface intended to be polished. The finer the abrasive material, the finer the scratches, thus the smoother and shinier the surface will be.^8-10 However cleaning agents do not contain abrasive particles. They contain a cleaning agent that is naturally occurring and do not abrade or alter the surface characterization of esthetic restorations or tooth structures.

Should dental implants be polished and what type of paste is best?

Implants are no different than tooth surfaces when it comes to deciding whether or not to polish them. For the most effective biofilm removal, air-powder polishing is the best.^12-14 Air-powder polishing can access areas that a rubber cup or rubber point cannot. Protecting any esthetic restorations in the immediate area is necessary prior to using air-powder polishing. The only esthetic material that is not adversely affected by air-powder polishing is porcelain.

Are there specific types of prophylaxis pastes best used for polishing both teeth and esthetic restorations without extrinsic stain?

According to the theory of selective polishing, patients receiving an oral prophylaxis who have no extrinsic tooth stain would not have their teeth polished with a rubber cup and polishing agent. This needs to be explained to the patient. However, there are patients who will insist on having their teeth polished even though the harmful effects have been explained.¹ Given these circumstances, a cleaning agent should be used for plaque removal because it does not contain abrasives. Toothpastes should be avoided for tooth polishing with a rubber cup because some are as abrasive as polishing pastes. If patients have esthetic restorations and no extrinsic stain is present, yet they request teeth polishing, the least abrasive agent—a cleaning agent specially formulated for restorative materials—is the best choice. A good alternative is a polishing agent that contains a scant amount of abrasives.

Flavor Added for Young Patients 3M ESPE, St Paul, Minn, has added a new flavor—bubblegum—to its line of Clinpro™ Prophy Pastes. The flavor is geared toward young dental patients. Mint is offered for adults. Clinpro is designed to remove stains while minimizing gloss reduction on microfill surfaces and abrasion to dentin and enamel. (888) 640-7121; www.3mespe.com.

New Flavor for Prophy Paste DENTSPLY Professional, York, Pa, introduces a new flavor for its NUPRO^® Prophy Paste—CherryBlast. Joining the other 10 Nupro flavors, CherryBlast also comes in the fresh flavor lock bag that maintains a 3-year shelf life. (800) 989-8826; www.professional.dentsply.com.

Paste Conveniently Packaged Waterpik^®,Fort Collins, Colo, offers its prophy paste conveniently packaged in a box of 200 single dose units with each box including an autoclavable prophy ring. Waterpik prophy paste offers minimal splatter and is designed to be tough on stains and plaque with minimal abrasion. (800) 525-2020; www.waterpik.com.

Prophy Paste Complements Angles OMNII Oral Pharmaceuticals, West Palm Beach, Fla, offers Singles Disposable Prophy Paste in three flavors—bubblegum, cherry, and mint. The pastes complement the Singles Disposable Prophy Angles. (800) 445-3386; www.omniipharma.com.

Drier Formula Prophy Paste Oral B, Boston, offers its own prophy paste in a drier formulation to limit splatter even at speeds as high as 2,000 revolutions per minute. It comes in a variety of grits and flavors. (800) 44-ORALB; www.oralb.com.

REFERENCES

1. Gutmann ME. Extrinsic and intrinsic stains and their management. In: Darby ML, Walsh MM. Dental Hygiene Theory and Practice. 2nd ed. St Louis: Saunders; 2003:442.
2. Wilkins E. Extrinsic stain removal. Clinical Practice of the Dental Hygienist. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 1999:607-616.
3. Barnes CM, Covey D, Johnson WW, St Germain HA. Maintaining restorations for senior dental patients. Journal of Practical Hygiene. 2003;12:25.
4. Anusavice HJ. Finishing and polishing materials. Phillip’s Science of Dental Materials. 11th ed. St Louis: Saunders; 2003:362-363.
5. Koch G, Petersson LG, Johnson G. Abrasive effect and fluoride uptake from polishing and prophylactic pastes. Sven Tandlak Tidskr. 1975;68(1):1.
6. Maloney J. Fluorides and chlorhexidine. In: Darby ML, Walsh MM, eds. Dental Hygiene Theory and Practice. 2nd ed. St Louis: Saunders; 2003:546.
7. Featherstone JBD. Elements of a successful adult caries preventive program. Compendium. 2001;8: 1-9.
8. Barnes CM, Covey D, Walker MP, Johnson WW. Essential selective polishing: the maintenance of aesthetic restorations. Journal of Practical Hygiene. 2003;12:18-24.
9. Gladwin M, Bagby M. Polishing materials and abrasion. Clinical Aspects of Dental Materials, Theory, Practice and Cases. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2004: 208-209.
10. REALITY Annual Edition 2001. Houston: Reality Publishing Co; 2001:451-462.
11. Hodson KA. Postoperative care for aesthetic restorations: A challenge for dental hygienists. Journal of Practical Hygiene. 1998; 7:19-24.
12. Barnes CM, Fleming LS, Mueninghoff LA. SEM evaluation of the in-vitro effects of an air-abrasive system on various implant surfaces. Int J Oral Maxillofac Implants. 1991;6:463-469.
13. Parham PL Jr, Cobb CM, French AA, Love JW, Drisko CL, Killy WJ. Effects of an air-powder abrasive system on plasma-sprayed titanium implant surfaces: an in vitro evaluation. J Oral Implantol. 1989;15:78-86.
14. Atkinson DR, Cobb CM, Killoy WJ. The effect of an air-powder abrasive system on in vitro root surfaces. J Periodontol. 1984;15:13.

From Dimensions of Dental Hygiene. June 2004;2(6):26, 28, 30, 32.