Tooth polishing is the smoothing of all exposed tooth surfaces with a rubber cup, a brush, or by an air polisher driven by a slow-speed hand piece or water unit.
Purpose
According to the Journal of Periodontology an oral prophylaxis is the removal of plaque, calculus, and stains from the exposed and unexposed surfaces of the teeth by scaling and polishing as a means to prevent periodontal disease. A cleaning involves removing debris and extraneous matter from the teeth. Polishing makes the surfaces of teeth smooth. As a result of these procedures, the teeth are smooth and clean at the end of treatment.
Precautions
Historically polishing has been part of the oral prophylaxis appointment. Dental polishing was considered important for the removal of plaque and stain prior to a fluoride treatment to insure adequate uptake of fluoride in the enamel. Recent research by the American Dental Association has shown that polishing does not improve the uptake prior to a professionally applied fluoride treatment. Polishing prior to a sealant application has also been considered important, but recent research by the ADA again has shown that other methods of plaque removal are equally efficient.
The American Dental Hygienist Association (ADHA) considers that polishing of the teeth is a cosmetic procedure with little therapeutic benefit. Some have argued that continuous polishing over time can cause morphological changes in the teeth by abrading tooth structure and removing fluoride in the outer layers of the enamel. In some cases, polishing is required where there is heavy staining that cleaning with hand instruments will not take care of, but polishing should not be considered a routine part of the oral prophylaxis and the dentist and dental hygienist must assess each patient for the amount, type, and location of stain present to determine the need for polishing.
Air polishing was introduced in the mid-1980s. It is a technique for cleaning tooth surfaces efficiently removing stain and soft tissue deposits. The technique consists of directing a stream of air, water, and sodium bicarbonate particles at the tooth surface to be cleaned. Compared with conventional polishing methods using a rotating rubber cup or brush, together with a polishing paste, air polishing is less abrasive on the teeth, more efficient, faster, and allows better access to difficult-to-reach areas. Concerns over airborne pathogens associated with the air polisher have arisen causing the ADA to study data on the matter. Data suggests that an aerosol reduction device attached to the air polishing unit is effective in reducing the number of aerosol microorganisms generated during air polishing and that the air polisher is a safe unit to use.
Description
Dental polishing, or more commonly called coronal polishing, is performed when scaling has removed the hardened tartar buildup. The patient is assessed by the dentist and hygienist to determine whether coronal polishing is necessary. If it is deemed necessary, a coronal polishing will remove any stain build up not removed by the scaling procedure. The duration of a polishing appointment can vary, depending on the amount of plaque and tartar build up. Commonly, prophylaxis is scheduled for 45 minutes of the hygienist's time and 10 minutes of the dentist's time. The coronal polishing is billed as part of the oral prophylaxis and is considered a preventive measure, most commonly covered by major insurance companies at 100%.
Preparation
Premedication with antibiotics prior to the polishing treatment is required for those patients with heart disease or a history of rheumatic fever. This is a preventive measure, since toxins released during the cleaning and polishing may enter the blood stream and travel to the heart. Premedication prescriptions can be written by the dentist or obtained from the patient's medical doctor.
Aftercare
The patient is advised not to eat or drink for 30 minutes following a cleaning/polishing appointment, to allow sufficient time for fluoride uptake.
Complications
There are usually no complications associated with coronal polishing.
Results
The results of coronal polishing are smooth teeth free of tartar and plaque build up. The results with the air polisher are smooth teeth, above and below the gum tissue.
Health care team roles
Licensed dental hygienists and dentists are best qualified to perform polishing procedures. Currently, 23 states in the U.S. allow dental assistants to perform coronal polishing. This raises concerns by the ADA and the ADHA because only half of these states require education or an examination in polishing for dental assistants. There is also a lack of standardization for education, examination, or certification for dental assistants among states. The ability to judge appropriately which patients should or should not be polished, is compromised if the practitioner is not knowledgeable about the procedure.
Air polishing should only be performed by a dental hygienist or dentist, as the direct flow and the exact amount of water used is crucial, depending on how much staining and tartar buildup is present.
Patients need to be made aware that coronal polishing research has changed today's procedures. Patients expecting to have their teeth polished after scaling might feel neglected and unsatisfied with the treatment. Patient education with literature and pamphlets relating to the research and the effects of coronal polishing, will help alleviate any concerns and greatly improve patient relationships.
PERIODICALS
Chava, Vijay K. "An Evaluation of the Efficacy of a Curved Bristle and Conventional Toothbrush. A Comparative Clinical Study." Journal of Periodontology 71 (May 2000). <http://www.electronicipc.com/JournalEZ/detail.cfm?code=02250010710514>.
Muzzin, Kathleen B. "Assessing the Clinical Effectiveness of an Aerosol Reduction Device for the Air Polisher." JADA: Journal Of The American Dental Association (September 1999): 1354. <http://www.ada.org/prof/pubs/jada/9909/ab-8.html>.
ORGANIZATIONS
American Dental Association. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2500. <http://www.ada.org>.
American Dental Hygienist Association. 444 North Michigan Avenue, Suite 3400, Chicago, IL 60611. <http://www.adha.org>.
Deldent Ltd. (2000) Air Polishers. <http://www.deldent.com/air%20polisher.htm>.
KEY TERMS
Abrade—To rub off or wear away by friction.
Enamel—Outer most layer or coat of a tooth.
Pathogen—An agent such as bacteria that causes disease.
Registered dental assistant (RDA)—An individual trained for the specific purpose of assisting the dentist in dental procedures.
Registered dental hygienist (RDH)—An individual trained for the specific purpose of oral hygiene who performs teeth cleanings and gives home care instructions.
Scaling—The removal of food and debris from the portion of the tooth above the gum line.
Sealant—A clear coating placed over permanent premolars and molars to guard against tooth decay.
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