Instrumentation & Tools
Name three common prophylaxis angle attachments and give one typical use for each.
Disposable right‑angled prophylaxis angle with rubber cup (polishing facial surfaces of anterior teeth); contra‑angled disposable prophylaxis angle with rubber cup impregnated with abrasive particles (general polishing around the mouth); sterilizable stainless steel prophylaxis angle with a polishing brush mandrel (cleaning or polishing removable prostheses or adjunctive polishing).
Define two‑body and three‑body abrasion in the context of dental polishing
Two‑body abrasion: abrasive particles are fixed to an applicator (abrasive attached to medium) and abrade the surface without separate paste; three‑body abrasion: loose abrasive particles (e.g., in prophy paste) form a slurry between the tooth and the applicator, allowing the abrasive particles to move between surfaces.
State three absolute or common indications for selective stain removal.
Presence of extrinsic stain on tooth surfaces or restorations; patient desire for cosmetic stain removal; assessment reveals stain localized to accessible surfaces amenable to polishing.
Name two primary advantages of air‑powder polishing over conventional rubber cup/paste polishing.
Faster stain and biofilm removal from broad surfaces and difficult‑to‑reach areas (e.g., furcations, orthodontic appliances); effective stain removal on certain surfaces with less mechanical contact.
List the items that must be documented in the patient record after selective stain removal/polishing.
Medical history updates, clinical findings (intraoral, extraoral, periodontal, dental), dental charting including restorative materials present, procedures performed (type of polishing, materials/pastes/powders used), areas treated, any adverse events or patient complaints, oral hygiene instructions given.
Describe the recommended handpiece speed/pressure strategy and rubber cup orientation for selective stain removal to minimize heat and abrasion.
Use a slow‑speed handpiece, the lightest pressure necessary, minimal heat production, and position a soft rubber cup at approximately 90° to the tooth surface with intermittent light applications.
List three factors that affect the abrasive action of polishing agents.
Characteristics of abrasive particles (hardness, size/particle shape/grit), pressure and speed of application, and the medium/slurry consistency; also contact time and lubrication/heat dissipation.
List at least four contraindications for coronal polishing.
No visible extrinsic stain, respiratory problems (e.g., asthma, COPD) where aerosols pose risk, areas of demineralization, extremely thin enamel or exposed cementum/dentin, patients with certain restorative materials that might be damaged by abrasion.
Identify three patient or clinical situations in which air‑powder polishing is contraindicated or used with caution.
Patients with respiratory conditions (e.g., COPD, asthma), those on sodium‑restricted diets if sodium bicarbonate powder is used, presence of soft tissue lesions or communicable diseases, immunocompromised patients, patients with exposed root surfaces or certain restorative materials sensitive to abrasive powders.
Explain why identification of dental restorative materials in the chart influences polishing agent choice. Describe two ways to identify restorative materials clinically.
Different restorative materials vary in hardness and susceptibility to abrasion; knowing materials prevents selection of abrasives that could scratch or damage restorations. Identification can be done via radiographs (radiopacity patterns) and intraoral dental charting/visual inspection (color, texture, marginal integrity), and patient record of materials used.
Explain when a Dixon bristle brush (type C, soft) would be preferred over a rubber cup.
Dixon bristle brushes are preferred for polishing removable dentures or other prostheses and for cleaning areas where a small brush better accesses irregular surfaces; they are useful when a cup cannot reach narrow or concave surfaces.
Given that Mohs hardness is used to compare abrasives, explain why understanding Mohs hardness is important when selecting a polishing agent around restorative materials.
Mohs hardness indicates relative scratch resistance; selecting an abrasive with hardness greater than a restorative material risks scratching or dulling it. Understanding Mohs hardness prevents damage to softer restorative surfaces (e.g., composite, glass ionomer) while ensuring enamel stain removal.
Describe precautions when polishing teeth that have areas of demineralization or thin enamel.
Avoid abrasive polishing; use cleaning agents or very fine, least‑abrasive grit; minimize pressure and time; avoid heat production; consider postponing polishing and recommend remineralization therapy first.
Describe the principle of air‑powder polishing and the role of specially formulated powders.
Air‑powder polishing propels a mixture of compressed air, water, and fine powder at the tooth surface to remove stain and biofilm by abrasive action. Specially formulated powders (glycine, erythritol, sodium bicarbonate variants) are designed to balance efficacy and reduce tissue/restoration damage—smaller, softer particles reduce abrasion and are appropriate near restorations and root surfaces.
Create an example concise progress note entry (one or two sentences) documenting selective polishing of a patient who had generalized extrinsic tobacco stain on enamel and composite restorations where only enamel surfaces were polished.
Example note: "Performed selective coronal polishing: removed generalized extrinsic tobacco stain from natural enamel using fine‑grit prophy paste and soft rubber cup at low speed/pressure; avoided polishing composite restorations; no adverse events. Home care and selective polishing contraindications reviewed."
For a prophy setup, list components you would select for polishing a patient with moderate extrinsic stain on natural enamel but with several composite restorations.
Select a soft rubber cup (nonabrasive), low‑abrasive prophy paste or cleaning agent (least abrasive grit possible), slow‑speed handpiece/prophylaxis angle (preferably disposable right or contra angle), protective measures to limit aerosol, and avoid coarse prophylaxis paste on composite restorations—use nonabrasive cleaning agents near restorations.
Explain the primary difference in intended effect between cleaning agents and polishing agents and give an example clinical scenario where a cleaning agent is preferable.
Cleaning agents are round, flat, nonabrasive particles that do not scratch but increase luster—used when there is no visible extrinsic stain to avoid abrasion; polishing agents are abrasive and intended for stain removal. Cleaning agent preferable for a patient with no visible extrinsic stain but who expects a “clean” feel, or for patients with hypersensitivity or demineralization.
Explain why inappropriate selection of prophy paste can worsen dentinal hypersensitivity.
Coarse abrasives or excessive polishing pressure can remove enamel or smear layers, exposing dentin tubules, increasing sensitivity. Aggressive polishing on cementum/dentin exacerbates hypersensitivity.
For a patient with a fixed partial denture requiring cleaning of the gingival surface of the prosthesis and proximal stain, outline the technique choices including use of dental tape, floss, and polishing methods.
Use interdental cleaning (tape or specialized floss for prosthesis) to remove proximal deposits; for gingival surface cleaning, consider polishing with nonabrasive agents and gentle interdental polishing tools (wood points, tape with paste) to avoid damaging margins. If using air‑powder, select low‑abrasive powder and keep nozzle angulation and distance per recommendations; otherwise, use rubber cup with fine paste and minimal pressure around prosthesis margins.
Describe key patient teaching points you would cover after stain removal regarding stain recurrence, home care, and selective polishing concepts.
Explain how extrinsic stains form and the role of biofilm/calculus; emphasize that polishing and stain removal do not prevent reaccumulation—biofilm must be removed by patient brushing/flossing 2–3 times daily; review selective polishing and contraindications and instruct on appropriate oral care products and dietary modifications to reduce stain; schedule maintenance appointments.
Compare and contrast the design differences and clinical implications between a disposable rubber cup impregnated with abrasive particles and a rubber cup used with prophy paste.
A rubber cup impregnated with abrasive particles contains fixed abrasives within the cup medium (two‑body abrasion) and may abrade surfaces differently with potentially greater localized wear; a plain rubber cup used with prophy paste relies on loose abrasive particles forming a slurry (three‑body abrasion), which generally allows for more controlled polishing and reduced direct abrasive contact—selection affects surface wear, restoration safety, and desired luster.
Describe how particle size, shape, and concentration in a prophy paste influence both efficacy and risk of surface wear. Include implications for enamel, cementum, and composite restorations.
Larger, angular particles increase cutting action and stain removal efficacy but raise risk of surface abrasion and roughness; smaller, round particles are less aggressive and produce higher luster with less wear. Higher concentration increases abrasive action; prolonged contact/time increases material loss. Enamel can tolerate more abrasion than cementum/dentin or resin composites—so choose finer abrasives near root surfaces/restorations to minimize irreversible wear.
You identify a patient with extensive subgingival calculus, generalized extrinsic stain, a history of COPD, and multiple porcelain restorations. Formulate a selective stain removal plan explaining choices and avoided procedures.
Avoid air‑powder polishing due to COPD and aerosols; avoid coarse prophy pastes near porcelains to prevent abrasion—use minimal or nonabrasive cleaning agents on porcelain and fine abrasives or mechanical scaling where needed. For extrinsic stain on accessible enamel, use a soft rubber cup with fine polishing paste at low pressure. Emphasize mechanical debridement (scaling) for subgingival calculus and postpone cosmetic polishing in sensitive areas; provide home care instruction and fluoride remineralization as needed.
Compare clinical indications, mechanism, and restorative considerations among sodium bicarbonate, glycine, and erythritol powders used for air‑polishing. Recommend one for a patient with composite restorations and exposed root surfaces, justifying your choice
Sodium bicarbonate is effective but more abrasive and not recommended near root surfaces or some restorations; glycine is less abrasive and biocompatible, suitable for subgingival use and around restorations; erythritol has very fine particles, is minimally abrasive and suitable for sensitive areas and subgingival biofilm removal. For a patient with composite restorations and exposed root surfaces, erythritol (or glycine if erythritol unavailable) is recommended due to minimal abrasion and safer profile for restorations and soft tissues.
Draft a brief patient education handout paragraph (3–4 sentences) explaining selective polishing, why it might not be performed at every appointment, and recommendations to minimize recurrence of extrinsic stains.
Selective polishing means we remove only visible extrinsic stains where this is safe for your teeth and restorations, using the least abrasive methods necessary. We do not polish every appointment because polishing can remove small amounts of tooth structure or damage restorations when not needed, and some medical conditions limit its use. To minimize stain recurrence, brush twice daily with appropriate toothpaste, floss daily, avoid or reduce stain‑causing substances (tobacco, dark beverages), and return for regular maintenance and professional cleaning as recommended.