Tooth polishing

Last updated
Tooth polishing
Tooth polishing 9332.JPG
Polishing a tooth using a prophy cup.
ICD-9-CM 96.54
MeSH D003775

Tooth polishing is 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.

Contents

History

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.

Equipment

Prophylactic Paste (Polishing Paste)

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 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 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 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 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]

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. [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]

Extrinsic Stain

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.

Adverse Effects

Teeth

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 pulpal discomfort or necrosis of the dental pulp. [5]

Restorations

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, emery, 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.

Soft Tissues

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.

Environment

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.

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. [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.

See also

Related Research Articles

Human tooth Calcified whitish structure in humans mouths used to break down food

The human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. 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 Paste or gel dentifrice used to clean and maintain the health of teeth

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). Salt and sodium bicarbonate are among materials that can be substituted for commercial toothpaste. Large amounts of swallowed toothpaste can be toxic.

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.

Tooth enamel

Tooth enamel is one of the four major tissues that make up the tooth in humans and many other 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. Calcium hardens the tooth enamel. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.

Tooth decay Deformation of teeth made by acids from bacteria

Tooth decay, also known as dental caries or cavities, is the breakdown of teeth due to acids made by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

Tooth whitening or tooth bleaching is the process of lightening the color 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 color of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching. Hydrogen peroxide is the active ingredient most commonly used in whitening products and is delivered as either hydrogen peroxide or carbamide peroxide. Hydrogen peroxide is analogous to carbamide peroxide as it is released when the stable complex is in contact with water. When it diffuses into the tooth, hydrogen peroxide acts as an oxidising agent that breaks down to produce unstable free radicals. In the spaces between the inorganic salts in tooth enamel, these unstable free radicals attach to organic pigment molecules resulting in small, less heavily pigmented components. Reflecting less light, these smaller molecules create a "whitening effect". There are different products available on the market to remove stains. For whitening treatment to be successful, dental professionals should correctly diagnose the type, intensity and location of the tooth discolouration. Time exposure and the concentration of the bleaching compound, determines the tooth whitening endpoint.

A dental explorer or sickle probe is an instrument in dentistry commonly used in the dental armamentarium. A sharp point at the end of the explorer is used to enhance tactile sensation.

Abrasion (dental)

Abrasion is the non-carious, mechanical wears 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.

Human tooth development

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.

Dental plaque is a biofilm of microorganisms 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 between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline, (supragingival) or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

Early childhood caries

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 caries are Streptococcus mutans and Lactobacillus. There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.

Veterinary dentistry

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

Dentin hypersensitivity is dental pain which is sharp in character and of short duration, arising from exposed dentin surfaces in response to stimuli, typically thermal, evaporative, tactile, osmotic, chemical or electrical; and which cannot be ascribed to any other dental disease.

Tooth brushing Manual abrasion of the surfaces of the teeth.

Tooth brushing is the act of scrubbing teeth with a toothbrush, usually equipped with toothpaste. Interdental cleaning can be useful with tooth brushing, and together these two activities are the primary means of cleaning teeth, one of the main aspects of oral hygiene.

Scaling and 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 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 etiologic 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 Cleaning the mouth by brushing the teeth and cleaning in between the teeth.

Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems by regular brushing of the teeth and cleaning between the teeth. 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.

Remineralisation of teeth

Tooth remineralisation 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. Remineralisation can contribute towards restoring strength and function within tooth structure.

Tooth pathology

Tooth pathology is any condition of the teeth that can be congenital or acquired. Sometimes a congenital tooth diseases are called tooth abnormalities. 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

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 a both a mechanical and chemical procedure.

References

  1. 1 2 3 4 Jones, Trish (July 2016). "Selective Polishing: An Approach to Comprehensive Polishing" (PDF). www.rdhmag.com. PennWell Publications. Retrieved November 25, 2016.
  2. 1 2 Stewart, Marcia; Bagby, Michael (2013). Clinical Aspects of Dental Materials: Theory, Practice, and Cases. Philadelphia: Lippincott Williams & Wilkins. pp. 205–222. ISBN   978-1-60913-965-0.
  3. "American Dental Hygienists' Association Position Paper on the Oral Prophylaxis" (PDF). www.adha.org. American Dental Hygienists' Association. April 29, 1998. Retrieved November 25, 2016.
  4. Sawai, Madhuri Alankar; Bhardwaj, Ashu; Jafri, Zeba; Sultan, Nishat; Daing, Anika (2015). "Tooth Polishing: The Current Status". Journal of Indian Society of Periodontology. 19 (4): 375–380. doi:10.4103/0972-124X.154170. PMC   4555792 . PMID   26392683.
  5. 1 2 3 4 5 6 7 8 9 10 Darby, Michele; Walsh, Margaret (2010). Dental Hygiene: Theory and Practice. St. Louis, Missouri: Saunders/Elsevier. pp. 516–533. ISBN   978-1-4557-4548-7.
  6. Graumann, Sarah; Sensat, Michelle; Stoltenberg, Joe (2013). "Air Polishing: A Review of Current Literature". Journal of Dental Hygiene. 87 (4): 173–180. PMID   23986410.