Tooth polishing | |
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Specialty | Dentistry |
ICD-9-CM | 96.54 |
MeSH | D003775 |
Tooth polishing procedures are done to smooth the surfaces of teeth and restorations. [1] The purpose of polishing is to remove extrinsic stains, remove dental plaque accumulation, increase aesthetics and to reduce corrosion of metallic restorations. [1] [2] Tooth polishing has little therapeutic value and is usually done as a cosmetic procedure after debridement and before fluoride application. [3] Common practice is to use a prophy cup—a small motorized rubber cup—along with an abrasive polishing compound.
There is evidence of tooth polishing dating back to Roman and Greek times. However, Pierre Fauchard, 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. [4] Within the last century, Alfred Fones, 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.
Prophylactic paste contains abrasives that vary in size, shape, and hardness. [5] Based on these variants, pastes are available in fine, medium, coarse and super-coarse grits. [1] 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 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 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. [5] Short intermittent strokes should be used in order to avoid damage.
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.
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 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 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 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, Addison's or Cushing's disease, and some medications (mineralocorticoid steroids, anti-diuretics, potassium supplements). [6]
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. [1] 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. [2]
Many factors may lead to discoloration of the external layer of the tooth called the enamel. [5] 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.
This outermost fluoride rich layer of enamel is removed when tooth polishing is provided. [5] 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 discomfort or necrosis of the dental pulp. [5]
Surfaces of restorations may be damaged by conventional tooth polishing with prophylactic paste. [5] 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 powder, emery, or coarse pumice to prevent roughened or scratched surfaces. [5] It is important to refer to manufacturer's directions before using any product on dental restorations.
Trauma to soft tissues may result from improper technique or prior inflammation of tissues. [5] Particles within the prophylactic paste can go below the gumline and cause inflammation or delayed healing.
Aerosols are produced during tooth polishing and may transmit infectious diseases to other people in the dental office. [5] 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.
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. [5] 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.
Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.
Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it is an abrasive that aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, and delivers active ingredients to help prevent tooth decay and gum disease (gingivitis). Owing to differences in composition and fluoride content, not all toothpastes are equally effective in maintaining oral health. The decline of tooth decay during the 20th century has been attributed to the introduction and regular use of fluoride-containing toothpastes worldwide. Large amounts of swallowed toothpaste can be poisonous. Common colors for toothpaste include white and blue.
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.
Tooth enamel is one of the four major tissues that make up the tooth in humans and many animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off-white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.
Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation. Tooth regeneration is an ongoing stem cell–based field of study that aims to find methods to reverse the effects of decay; current methods are based on easing symptoms.
Tooth whitening or tooth bleaching is the process of lightening the colour of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic colour of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching.
In dental anatomy, the cementoenamel junction (CEJ) is the location where the enamel, which covers the anatomical crown of a tooth, and the cementum, which covers the anatomical root of a tooth, meet. Informally it is known as the neck of the tooth. The border created by these two dental tissues has much significance as it is usually the location where the gingiva (gums) attaches to a healthy tooth by fibers called the gingival fibers.
Dental explorers, also known as sickle probes, are tools found in the dental arsenal that are frequently utilised. The explorer is designed with a sharp tip at the end to improve tactile perception.
Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.
Fluoride therapy is the use of fluoride for medical purposes. Fluoride supplements are recommended to prevent tooth decay in children older than six months in areas where the drinking water is low in fluoride. It is typically used as a liquid, pill, or paste by mouth. Fluoride has also been used to treat a number of bone diseases.
Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.
Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months. ECC is characterized by the presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth. ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child. The main bacteria responsible for dental cavities are Streptococcus mutans (S.mutans) and Lactobacillus. There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.
In dental anatomy, the gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.
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 and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.
Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other problems by regular brushing of the teeth and adopting good hygiene habits. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.
Tooth remineralization is the natural repair process for non-cavitated tooth lesions, in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralization can contribute towards restoring strength and function within tooth structure.
Tooth pathology is any condition of the teeth that can be congenital or acquired. Sometimes a congenital tooth disease is called a tooth abnormality. These are among the most common diseases in humans The prevention, diagnosis, treatment and rehabilitation of these diseases are the base to the dentistry profession, in which are dentists and dental hygienists, and its sub-specialties, such as oral medicine, oral and maxillofacial surgery, and endodontics. Tooth pathology is usually separated from other types of dental issues, including enamel hypoplasia and tooth wear.
Tooth discoloration is abnormal tooth color, hue or translucency. External discoloration is accumulation of stains on the tooth surface. Internal discoloration is due to absorption of pigment particles into tooth structure. Sometimes there are several different co-existent factors responsible for discoloration.
Enamel microabrasion is a procedure in cosmetic dentistry used to improve the appearance of the teeth. Like tooth whitening it is used to remove discolorations of the tooth surface but microabrasion is both a mechanical and chemical procedure.
Topical fluorides are fluoride-containing drugs indicated in prevention and treatment of dental caries, particularly in children's primary dentitions. The dental-protecting property of topical fluoride can be attributed to multiple mechanisms of action, including the promotion of remineralization of decalcified enamel, the inhibition of the cariogenic microbial metabolism in dental plaque and the increase of tooth resistance to acid dissolution. Topical fluoride is available in a variety of dose forms, for example, toothpaste, mouth rinses, varnish and silver diamine solution. These dosage forms possess different absorption mechanisms and consist of different active ingredients. Common active ingredients include sodium fluoride, stannous fluoride, silver diamine fluoride. These ingredients account for different pharmacokinetic profiles, thereby having varied dosing regimes and therapeutic effects. A minority of individuals may experience certain adverse effects, including dermatological irritation, hypersensitivity reactions, neurotoxicity and dental fluorosis. In severe cases, fluoride overdose may lead to acute toxicity. While topical fluoride is effective in preventing dental caries, it should be used with caution in specific situations to avoid undesired side effects.