Dent 112 Introduction to Chairside

Coronal Polish Lecture

Supplies:
Prophy angle and handpiece
Prophy paste

Recall knowledge of a handpiece and prophy angle assembly, use and

maintenance.

I. Handpieces
A. Slow speed connected to electrical supply
B. Prophy angles
1. screw in
2. snap on over a knob
3. fit into angle with a mandrel and
latching mechanism.
4. disposable
II. Cups
A. degrees of flexibility
B. interior walls
1. ribbed open
2. ribbed webbed
3. ribbed turbine
C. Reverse threads are used so that the rubber cup will not unscrew while
running in a clockwise rotation against the tooth.
III. Brushes
A. soft bristle - recommended
B. firm bristle
IV. Maintenance
A. clean and sterilize
B. disposable - throw away
C. cups and brushes - throw away

Recall knowledge of stains and tooth deposits

I. Tooth deposits
A. Calculus
B. Plaque
C. Acquired Pellicle
II. Stains
A. Endogenous - stains that originate within the tooth from
systemic disturbances.
1. Developmental
a. fluorosis
b. tetracycline
c. hypocalcification
d. amelogenesis imperfecta
e. dentinogenesis imperfecta
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f. dentin dysplasia
2. Environmental origin
a. incipient caries
b. active caries
c. secondary caries
d. pulpal necrosis
B. Exogenous - stains that originate outside the tooth from
exposure to environmental agents.
1. factors predisposing patients to accumulation of stain
are:
a. enamel roughness
b. organic salts in saliva
c. increased or decreased salivary flow
d. poor oral hygiene

C. Intrinsic stains
1. exogenous or endogenous origin and become incorporated into
the tooth structure and cannot be removed by the patient or by
professional polishing an scaling.
D. Extrinsic stains
1. on the exterior of the tooth and can be removed by the
individual or the dental professional.
2. Kinds - see handout

Discuss the composition and properties of agents used for polishing, including their
clinical and histological effects.

I. Composition of toothpastes
Reasons for use
1. Control pellicle thickness
2. Ensure regular, low doses of fluoride
II. Professional prophy pastes
A. Change the tooth surface by frictional grinding, rubbing,
scraping and scratching.
B. Removes the surface layer of the tooth which contains the
highest level of fluoride
C. May damage the surface of restorations by scratching and
roughening them.
D. Produces heat which can damage the pulp.
E. Ingredients are essentially the same as for toothpastes
except the level of abrasives in much higher.
F. Factors determining abrasiveness:
1. particle hardness
2. shape
3. size
4. concentration
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G. Categories - although no standard definitions.

1. fine
2. medium
3. course
4. extra-course

Discuss the indications and contraindications for polishing teeth including the concept
of selective polishing

I. Indications
A. Polishing has little or no therapeutic value.
B. Used for the cosmetic removal of acquired stains.

II. Contraindications
A. No stains that the patients find objectionable.
B. Intrinsic stains. These cannot be removed by polishing.
C. Recession with root sensitivity. Polishing will increase
sensitivity of exposed root surfaces.
D. Recession without root sensitivity. This is a relative
contraindication as it may create sensitivity, especially on a
tooth with a previous history on sensitivity. Roots are also
softer and subject to greater abrasion.
E. Patients at risk for caries. Polishing removes the surface layer of the tooth
where the highest concentration of fluoride is found, thereby reducing
caries resistance.
F. Thin enamel
G. Demineralized areas. These are softer and subject to greater
loss of tooth substance during polishing.
H. Newly erupted teeth. The surfaces of these teeth are not yet fully
mineralized.
I. Restorations of gold or other materials that may be easily
scratched by abrasives.
J. Highly inflamed hemorrhagic tissue, which might be easily
traumatized during polishing.
K. Communicable diseases due to the infectious hazards posed by the
aerosols and splatter they produce.
III. Selective polishing
A. the procedure should be limited only to those extrinsic stains that have
not been removed during scaling and root planing andthat are
unacceptable esthetically to the patient.

Explain adverse reactions that could occur during polishing

I. Questionably cause bacteremia

II. Adverse reactions to teeth:
A. Will cause loss of tooth structure
Dent 112 Introduction to Chairside

B. Can scratch restorations

C. Can cause sensitivity
D. Will produce heat which can injure pulp

Explain information to discuss with the client regarding polishing teeth.

I. It is done for cosmetics

II. It will be done selectively

Procedure

I. Carry abrasive to the tooth in the rubber cup

A. usually a full rubber cup of abrasive will be sufficient for one or
two teeth.
II. Flare the lip of the cup and slip it slightly subgingivally to clean the most coronal
aspects of the sulcus. For proximal surfaces slide the lip of the cup as far
proximally as possible and slightly under the contact point area.
III. Using a fulcrum, use intermittent light strokes and slow r.p.m.
IV. Adapt the lip of the cup into the occlusal groves to remove stains. A brush may
be applied to these areas if stains persist. Brushes should not be use on any other
tooth surface.

v. Chair and patient positions for each quadrant for a right-handed operator are as
follows.
1. Using direct and indirect vision
2. Positioning for the maxillary right quadrant
a. Operator position-8 to 9 o'clock position
b. Patient position-head turned away and slightly up for buccal surfaces; head
turned toward operator and up for lingual surfaces
3. Positioning for the maxillary anterior area
a. Operator position 8 to 9 o'clock position; use mouth mirror for lingual, may
need 11 to 12 o'clock position
b. Patient position--head tipped up slightly for facial surfaces
4. Positioning for the maxillary left quadrant
a. Operator position-8 to 9 o'clock position
b. Patient position-head turned toward operator and slightly up for buccal
surfaces; head turned away from operator for lingual surfaces
5. Positioning for the mandibular left quadrant
a. Operator position-8 to 9 o'clock position
b. Patient position--head turned toward operator for buccal surfaces; head
turned away from operator for lingual surfaces
6. Positioning for the mandibular anterior area
a. Posterior position-8 to 9 or 11 to 12 o'clock position
b. Patient position--head in various positions for operator to gain access
7. .Positioning for the mandibular right quadrant
a. Operator position-8 to 9 o'clock position
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b. Patient positioned with head turned slightly away for the buccal surfaces;
head turned toward operator for the lingual surfaces
8. Positioning for a left-handed operator
a. Approximately the 3 to 4 o'clock position.

VI. Floss to remove any residual interproximal stain.

VII. Irrigate.
VIII. Check for residual stain.