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Tooth polishing is done to smooth the surfaces of teeth and restorations. The purpose of polishing is to remove extrinsic stains, remove
dental plaque Dental plaque is a biofilm of microorganisms (mostly bacteria, but also fungi) that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found be ...
accumulation, increase aesthetics and to reduce corrosion of metallic restorations. Tooth polishing has little therapeutic value and is usually done as a cosmetic procedure after debridement and before fluoride application. Common practice is to use a prophy cup—a small motorized rubber cup—along with an abrasive polishing compound.


History

There is evidence of tooth polishing dating back to Roman and Greek times. However,
Pierre Fauchard Pierre Fauchard (January 2, 1679 – March 21, 1761) was a French physician, credited as being the "father of modern dentistry". He is widely known for writing the first complete scientific description of dentistry, ''Le Chirurgien Dentiste'' (''" ...
, the father of modern dentistry, is credited for the introduction of tooth polishing to remove dental stains. Early polishing pastes consisted of finely ground coral, egg shells, ginger or salt. Within the last century,
Alfred Fones Alfred Civilion Fones (1869 – March 15, 1938) was an American dentist from Bridgeport, Connecticut, who has been called the founder of the profession of dental hygiene, starting in 1906. Fones created the name "dental hygienist" and in 1913 esta ...
, the founder of dental hygiene, began educating students on coronal tooth polishing. Prior to the 1970s tooth polishing was provided to all patients as part of their complete care. As of the 1990s to 2000s, evidence suggests that full mouth polishing is not always necessary. Full mouth polishing is still widely practiced but selective polishing is recommended by many educational institutions.


Equipment


Prophylactic Paste (Polishing Paste)

Prophylactic paste contains abrasives that vary in size, shape, and hardness. Based on these variants, pastes are available in fine, medium, coarse and super-coarse grits. There are also various flavours of prophylactic paste available. Some prophylactic pastes contain fluoride to aid in the remineralization of the enamel surface and others help reduce dentinal sensitivity.


Rubber cup

Rubber cups, also called prophy cups, are used in the hand-piece. Polishing paste, prophylactic paste, usually containing fluoride, is used with the rubber cups for polishing. Rubber cups should not be used over the
cementum Cementum is a specialized calcified substance covering the root of a tooth. The cementum is the part of the periodontium that attaches the teeth to the alveolar bone by anchoring the periodontal ligament.Illustrated Dental Embryology, Histology, ...
area as it may remove a layer of cementum at the cervical area. There are two popular types of prophy cups: 4 webs and 6 webs. Risk of generating frictional heat, and increased abrasion to the tooth surface may result from increased contact time, increased speed of rotation, and increased pressure of the cup on the tooth. Short intermittent strokes should be used in order to avoid damage.


Bristle brush

Bristle brushes are used in the prophylaxis angle with a polishing paste. The use of the brush should be confined to the crown to avoid injury to the gingiva and cementum.


Prophy angle

Currently, the most commonly used tool for tooth polishing is prophy angle. It integrates a rubber cup into a high torque gear, which can be plugged into a low speed handpiece and drive rubber cup to polish teeth.


Dental tape

Dental tape is used for polishing the proximal surfaces of teeth that are inaccessible to other polishing instruments. It is also used with polishing paste. Particular care should be taken to avoid injury to the gingiva. The area should be cleaned with warm water to remove all remnants of the paste.


Air-powder polishing

Air-powder polishing is used with a specially designed handpiece. This device is called ''Prophy-jet''. It delivers an air-powder slurry of warm water and
sodium bicarbonate Sodium bicarbonate ( IUPAC name: sodium hydrogencarbonate), commonly known as baking soda or bicarbonate of soda, is a chemical compound with the formula NaHCO3. It is a salt composed of a sodium cation ( Na+) and a bicarbonate anion ( HCO3− ...
for polishing. It is very effective for the removal of extrinsic stains and soft deposits. There are several contraindications for air polishing. These include: sodium restricted diet, hypertension, respiratory illnesses, infectious diseases,
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease in which a gradual loss of kidney function occurs over a period of months to years. Initially generally no symptoms are seen, but later symptoms may include leg swelling, feeling tired, vo ...
, Addison's or
Cushing's disease Cushing's disease is one cause of Cushing's syndrome characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary (secondary hypercortisolism). This is most often as a result of a pituitary adenoma (spe ...
, and some medications (mineralocorticoid steroids, anti-diuretics, potassium supplements).


Selective Polishing

Current evidence suggest that prophylactic polishing is only necessary when extrinsic stain is present on the tooth surface. This suggests that tooth polishing should be based on the clients individual needs. Previously, tooth polishing was a service provided at every hygiene appointment, due to this many patients expect this as part of the routine care. This has placed dental professionals into an ethical dilemma on whether or not this service should be provided.


Extrinsic Stain

Many factors may lead to discoloration of the external layer of the tooth called the enamel. Foods and beverages such as coffee, tea, and red wine can stain the enamel. Chromogenic bacteria found in plaque that is left behind due to poor oral hygiene can also cause staining. Other external factors that can lead to extrinsic staining are smoking, some antimicrobial rinses, and environmental working conditions where there is exposure to metallic dust. In most circumstances this stain can be removed by prophylactic polishing.


Adverse Effects


Teeth

This outermost fluoride rich layer of enamel is removed when tooth polishing is provided. The mineral components of saliva and polishing pastes containing fluoride can assist in remineralizing this outer layer. The enamel surface is strong enough to withstand repeated tooth polishing, but it should be avoided on newly erupted teeth, exposed root surfaces and areas of demineralization. If polishing does occur on these surfaces, fluoride therapy can minimize the risk of dental caries. Excessive pressure can lead to frictional heat that may cause pulpal discomfort or necrosis of the dental pulp.


Restorations

Surfaces of restorations may be damaged by conventional tooth polishing with prophylactic paste. Materials such as gold, amalgam, composite, porcelain and titanium implants can be polished by using specifically designed pastes such as those that contain rouge, tripoli, cuttle, emery, coarse pumice to prevent roughened or scratched surfaces. It is important to refer to manufacturer's directions before using any product on dental restorations.


Soft Tissues

Trauma to soft tissues may result from improper technique or prior inflammation of tissues. Particles within the prophylactic paste can go below the gumline and cause inflammation or delayed healing.


Environment

Aerosols are produced during tooth polishing and may transmit infectious diseases to other people in the dental office. This can become problematic because some microorganisms remain in the air for an extended period of time and can contaminate hard surfaces. Occupational injuries are also possible for the clinician due to improper technique, ergonomics and the weight of the handpiece.


Precautions

There are a number of precautions that clinicians should be aware of when deciding if tooth polishing is indicated. Precautions include; teeth without existing stain, newly erupted teeth, tooth decalcification, hypo-calcification, hypoplasia, demineralization, rampant caries. Areas with exposed root surfaces should also be avoided as well as, areas with tooth sensitivity and gingival inflammation. Tooth polishing should also be avoided in the case of allergies and communicable diseases.


See also

*
Tooth scaling Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus (scaling or debridement) and then smoothing, or planing, ...
Scaling is a process by which plaque and calculus are removed from both supragingival and subgingival tooth surface.No deliberate attempt is made to remove tooth substance along with the calculus. *
Root planing Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus (scaling or debridement) and then smoothing, or planing, ...
is the process by which residual embedded calculus and portions of cementum are removed from the roots to produce a smooth, hard, clean surface. * Debridement (dental)


References

* {{Dentistry Dentistry procedures Oral hygiene