Teeth Polishing

Article Author:
Sujata Tungare
Article Editor:
Arati Paranjpe
Updated:
4/30/2019 11:18:42 PM
PubMed Link:
Teeth Polishing

Introduction

Tooth polishing is an important part of dental procedures, especially as a part of cleaning. Polishing involves the smoothening of the tooth surface and reduces the deposition of plaque, hence maintaining healthy periodontal health. Polishing is termed as a prophylactic procedure, but overzealous polishing may cause wear of the superficial tooth structure leading to an increase in the number of deposits; therefore, dental professionals prefer to polish the teeth dependant on the patients’ needs and not as a routine procedure.

Anatomy

According to the American Academy of Periodontology, tooth polishing is the elimination of plaque, calculus, and stains from exposed and unexposed tooth surfaces through scaling and polishing as a preventive measure to control local irritation.

Indications

Polishing can remove exogenous stains caused by various dietary and environmental factors. Generally, intrinsic stains are not removed by polishing, but furcation areas, root proximities, near restorations, orthodontic brackets, among others can be polished using different types of devices suited to individual needs.

Contraindications

Polishing is contraindicated in:

  • Endogenous stains caused by developmental defects, drugs, enamel hypoplasia or other factors
  • Acute diseases of the gingiva 
  • Aesthetic restorations
  • Allergy to paste ingredients
  • Dental caries
  • Decalcification
  • Enamel hypoplasia
  • Hypomineralization
  • Newly erupted teeth
  • Gingival Recessions
  • Sensitive teeth
  • Xerostomia

Equipment

Abrasive agents are used for polishing to help to make the teeth lustrous and give smooth, shiny surfaces. Abrasive agents are used in dentifrices and polishing pastes. The latter contain agents with bigger particle size. Polishing pastes also contain binders, humectants, and flavoring agents, coloring agents, and preservatives to increase patient motivation. They are available in various sizes, for example, coarse, large-sized particles, medium particles, and fine particles that are smooth and small.

Pastes with small particle size will increase the smoothness and cleanliness of teeth making them more resistant to plaque accumulation. A polishing agent should be selected in such a way that its hardness is less than the hardness of the surface to be polished.

Commonly-Used Pastes

  • Feldspar: Used on tooth and restorations
  • Pumice: Polishing of tooth enamel, gold foil, amalgam; acrylic resins are siliceous material. The disadvantage of pumice is its significant abrasive depth and average polishing capacity as compared to other polishing agents.
  • Calcium carbonate: Less abrasive than pumice, produces minimum scratches and a highly reflective surface
  • Perlite: Fluoride-containing abrasive
  • Aluminum silicate: Excellent stain remover, great taste, easy to rinse-off, excellent polishing capacity, fluoride releasing
  • Amorphous calcium phosphate: Tooth surface smoothness improvement 
  • Xylitol-containing products: Help in saliva production and reduce dry mouth thus helping to reduce decay, acid and biofilm production in the mouth. Can be used in kids and available in various sizes
  • Novamin containing products: Reduce the sensitivity and help in stain removal
  • Zirconium silicate: Used on discs and strips, prophylactic polishing pastes

Polishing Devices

  • Manual: Handheld devices 
  • Engine-driven: Require handpieces

Preparation

Care should be taken while polishing.

  • Proper technique should be used to minimize abrasion to the tooth surfaces with the appropriate amount of force, pressure, time and speed.
  • The least abrasive polishing agent must be used but must be effective enough to remove the stains and plaque.
  • Restorations must be polished with an agent that is softer than the restoration itself.

Technique

Manual devices

Porte Polisher

A porte polisher rubs the abrasive agent against the tooth surface with a wedge-shaped, tapered, orange-wooden point.

Advantages

Its noiseless with minimum aerosol production, portable, accessible on various aspects of the teeth and hence can be used on malpositioned teeth as well, generates minimal heat.

Disadvantages

Time-consuming and more force is required.

Polishing Strips

These are for interproximal regions and line angles of teeth. Since they are very abrasive, soft tissue in the interproximal areas must be protected. They come in various colors and sizes of abrasive agents.

Engine-Driven Devices

These are widely used and need either a straight or a contra-angled handpiece. A polishing brush or a rubber cup is attached to the handpiece used at an rpm of 2500 to 3000 rpm. The rubber cups or the polishing brushes are either autoclavable or disposable. The motion used for polishing in clinical practice is patting motion, and the handpiece should be a slow speed handpiece always rotated at the lowest rpm. Most of the tooth surfaces require 2 to 5 seconds to get polished with the rubber cup contacting the tooth for 4.5 seconds. The pressure needed to be applied 20 psi since too much pressure generates heat.

Indications

Used most frequently in clinical practice since its patient-friendly

Contraindications

Patients having allergies to latex or fluorides

Air-Powder Polishers

These are generally used for supragingival plaque removal as they reach the inaccessible areas where the rotary devices cannot reach like furcations, flutings, close root proximities. They use a slurry of water and sodium bicarbonate under air and water pressure along with certain abrasive agents like aluminium trihydroxide, calcium sodium phosphosilicate, calcium carbonate, and glycine.

The air powder polisher can also be used with an ultrasonic scaler or directly with the air/water connector or also is available separately. A foot control controls it. The nozzle of the handpiece has to be held 3 to 4 mm from the tooth as it propels the slurry of water and sodium bicarbonate on the tooth. The motion used in air powder polishers is a paintbrush motion at an angle of 60 degrees for anterior teeth, 80-degree angle for posterior teeth and 90-degree occlusal surfaces. It should be directed at the middle thirds of the tooth in a circular motion with an air pressure of 40 to 100 psi and inlet water pressure 20 to 60 psi. Adjusting the water flow and the distance between the instrument and the tooth helps to adjust abrasive forces. They are generally safe for exogenous stains removal except for exposed dentin or cementum regions which can be damaged because of the abrasives in the air-powder polishers.

Advantages

The main advantage of air-powder polishers is their ability to efficiently remove biofilm, without harming the periodontal soft tissues and the hard tissue structures. It is a faster method. Patient comfort is greater.

  1. It saves time and hence, it can prevent patient and operator fatigue.
  2. It is very effective.
  3. It can be used in orthodontically bracketed teeth as it does not physically damage and disturb the bands and the wires and also does not disturb the bonding cement.
  4. It reduces dentinal sensitivity by blocking the tubular opening with bicarbonate crystals.
  5. It reaches the inaccessible areas that cannot be reached by rotary devices.

Disadvantages

Since they use sodium bicarbonate in the slurry, it should be cautiously used in patients with restricted sodium diets. Non-sodium prophy powder can be used which contains aluminium trihydroxide in such cases.

  1. It should be carefully used in patients with respiratory, renal, or metabolic disease, diuretics or long-term steroid therapy, those having titanium implants, or with children and in patients with infectious diseases.
  2. Infection control is a problem with these devices since they produce aerosols. Hence, pretreatment washes are recommended.
  3. There is a risk of subcutaneous emphysema intraorally. It is important to follow the manufacturer's instructions to avoid such mishaps in the dental office.

Air polishers are generally used supragingivally, but recently, glycine powder air polishers are used for removing sub-gingival biofilm that results in less erosion of the soft tissues and 80% reduction in abrasion of the root surface as compared to hand instrumentation or sodium bicarbonate air polishing.

Vector System

They use a polishing fluid. It causes minimum damage to the cementum surface. Polishing fluid contains hydroxyapatite or an abrasive fluid containing silicon carbide with a resonating device that deflects the forces directed toward the tooth and hence protects the tooth. The plaque is removed by fluid dynamics and gives effective control of inflammation.

Complications

The complications of manual devices are that they are time-consuming and there is no control over the force applied. Also, they require more patient compliance. On the other hand, engine-driven polishers are useful; however, they have a risk of aerosol production, heat generation, and damage to the soft tissue if not attended properly. Nevertheless, they are faster and easier to use.

Clinical Significance

Tooth polishing is an elective procedure. Within a few minutes, even the polished teeth are again covered with plaque and debris. Hence, only teeth that have stains that are not removed by scaling are polished. Generalized polishing is avoided since it causes the removal of the outer enamel which takes around 3 months to remineralize.

The tooth polishing devices are selected according to each case, and treatment plans are selectively designed taking into account the patients' needs and with concern about minimal damage to the teeth and general periodontal health.


References

[1] Heintze SD,Reinhardt M,Müller F,Peschke A, Press-on force during polishing of resin composite restorations. Dental materials : official publication of the Academy of Dental Materials. 2019 Apr 17;     [PubMed PMID: 31005330]
[2] Kaizer MR,Bano S,Borba M,Garg V,Dos Santos MBF,Zhang Y, Wear Behavior of Graded Glass/Zirconia Crowns and Their Antagonists. Journal of dental research. 2019 Apr;     [PubMed PMID: 30744472]
[3] Miličević A,Goršeta K,van Duinen RN,Glavina D, Surface Roughness of Glass Ionomer Cements after Application of Different Polishing Techniques. Acta stomatologica Croatica. 2018 Dec;     [PubMed PMID: 30666062]
[4] Ng E,Byun R,Spahr A,Divnic-Resnik T, The efficacy of air polishing devices in supportive periodontal therapy: A systematic review and meta-analysis. Quintessence international (Berlin, Germany : 1985). 2018;     [PubMed PMID: 29700503]
[5] Priyadarsini S,Mukherjee S,Mishra M, Nanoparticles used in dentistry: A review. Journal of oral biology and craniofacial research. 2018 Jan-Apr;     [PubMed PMID: 29556466]
[6] Deutscher H,Derman S,Barbe AG,Seemann R,Noack MJ, The effect of professional tooth cleaning or non-surgical periodontal therapy on oral halitosis in patients with periodontal diseases. A systematic review. International journal of dental hygiene. 2018 Feb;     [PubMed PMID: 28836329]
[7] Worthington HV,Clarkson JE,Bryan G,Beirne PV, Routine scale and polish for periodontal health in adults. The Cochrane database of systematic reviews. 2013 Nov 7;     [PubMed PMID: 24197669]
[8] Cobb CM,Daubert DM,Davis K,Deming J,Flemmig TF,Pattison A,Roulet JF,Stambaugh RV, Consensus Conference Findings on Supragingival and Subgingival Air Polishing. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995). 2017 Feb;     [PubMed PMID: 28156118]
[9] Sawai MA,Bhardwaj A,Jafri Z,Sultan N,Daing A, Tooth polishing: The current status. Journal of Indian Society of Periodontology. 2015 Jul-Aug;     [PubMed PMID: 26392683]
[10] Bühler J,Amato M,Weiger R,Walter C, A systematic review on the effects of air polishing devices on oral tissues. International journal of dental hygiene. 2016 Feb;     [PubMed PMID: 25690301]