Tips for Stain Removal

We frequently encounter patients who present with extrinsic staining from sources such as coffee, tea, red wine, tobacco, or chlorhexidine. These stains can be removed by various techniques including scaling, rubber cup polishing, air-powder polishing, and bleaching. This task becomes more challenging in the presence of gingival recession. In such cases, it is important to select tools and techniques that remove the stain effectively while minimizing potential damage to the exposed root surface.

Scaling with hand instruments or ultrasonic scalers is an essential step in stain removal. This is  important when the stain is embedded in calculus. Instrumentation can aid clinicians reach stains located in tight contacts and interproximal areas where they may not be able to reach by polishing.

When rubber cup polishing, several factors should be considered including prophy angles, prophy pastes, and handpieces. With prophy angles, personal preference is typically the determining factor. A recommendation would be to try out any samples you receive to see which prophy angle works best for you. You may find that you like different ones for various situations. However, some characteristics to look for in a quality prophy angle are soft, flexible rubber cups that are ribbed or webbed. Many cups have webbing on both the internal and external surface of the cup, which aids in stain removal and holds paste well.^1,2

Contra-angled prophy angles allow easier access to hard-to-reach areas. When selecting a prophy paste, the abrasiveness should be matched to the patient’s individual needs. For patients with moderate to severe staining, a medium grit paste can be used followed by a fine grit paste to smooth the tooth surface.³ A smoother tooth surface is less likely to attract future stains. Although air-driven and cordless handpieces are most common for dental hygiene procedures, electric handpieces are beneficial for maintaining constant torque when in use.

Air-powder polishing is also an effective and efficient choice for stain removal. The powder spray can be adapted in areas where the prophy angle may be too large to adapt. Although sodium bicarbonate is not recommended for exposed root surfaces, low-abrasive polishing powders, such as glycine and erythritol, are acceptable choices for removing biofilm and stain in these areas.^4,5

Tray-applied 10% carbamide peroxide bleaching is also a safe option for stain removal and to prevent staining between hygiene visits. If your patient consistently presents with staining at hygiene visits, bleaching may be an ideal option since it does not remove tooth structure like scaling and polishing procedures do.⁶ Additionally, your patient may be brushing aggressively or using the wrong toothbrush to remove stains and causing more recession and abrasion.

Managing stains in patients with gingival recession requires a careful approach that balances both esthetic concerns and oral health. Good communication and patient education are key to this approach. Explain the relationship between habits, oral health, and staining to your patients. By selecting the right tools, employing these techniques, and emphasizing preventive care, we can deliver outstanding results while preserving root surfaces.

References

1. Gehrig JS. Fundamentals of Periodontal Instrumentation. Burlington, Massachusetts: Jones and Bartlett Publishers; 2020.
2. Boyd LD, Mallonee LF. Wilkins’ Clinical Practice of the Dental Hygienist. 14th ed. Burlington, Massachusetts: Jones and Bartlett Learning; 2023.
3. Barnes CM. The science of polishing. Dimensions of Dental Hygiene. 2009;7(11):18-22.
4. Sahrmann P, Ronay V, Schmidlin PR, Atinn T, Paque F. Three-dimensional defect evaluation of air polishing on extracted human rootsJ J Periodontol. 2014;85:1107-1114.
5. Kröger JC, Haribyan M, Nergiz I, Schmage P. Air polishing with erythritol powder – in vitro effects on dentin loss. J Indian Soc Periodontol. 2020;24: 433-440.
6. Haywood VB, Heymann HO. Nightguard vital bleaching: how safe is it? Quintessence Int. 1991;22.7:515-523.

From Dimensions of Dental Hygiene. March/April 2025; 23(2):46.