Transcript Chapter 58 Coronal Polish Copyright 2003, Elsevier Science (USA). All rights reserved. No part of this product may be reproduced or transmitted in.

Chapter 58
Coronal Polish
Copyright 2003, Elsevier Science (USA).
All rights reserved. No part of this product may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including input into or storage in any
information system, without permission in writing from the publisher.
PowerPoint® presentation slides may be displayed and may be reproduced in print
form for instructional purposes only, provided a proper copyright notice appears on
the last page of each print-out.
Produced in the United States of America
ISBN 0-7216-9770-4
Introduction
A technique used to remove plaque and stains from
the coronal surfaces of the teeth. A dental
handpiece, a rubber cup, and an abrasive agent are
used.
In some states, coronal polishing is delegated to
registered or expanded-function dental assistants
who have had special training in this procedure.
Coronal polishing is strictly limited to the clinical
crowns of the teeth. A coronal polish is NOT a
substitute for an oral prophylaxis.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Selective Polishing
 Selective polishing is a procedure in which only
those teeth or surfaces with stain are polished.
 The purpose of selective polishing is to avoid
removing even small amounts of the surface
enamel unnecessarily.
 For some individuals, stain removal may cause
dentinal hypersensitivity during and after the
appointment.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Benefits of Coronal Polishing
Fluoride is better accepted into the enamel.
Polishing prepares the teeth for placement of dental
sealants.
Smooth tooth surfaces are easier for the patient to keep
clean.
Formation of new deposits is slowed.
Patients appreciate the smooth feeling and clean
appearance.
Polishing prepares the teeth for placement of orthodontic
brackets and/or bands.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Dental Stains
 Stains of the teeth occur in three basic ways:
• Stain adheres directly to the surface of the tooth.
• Stain can be embedded in calculus and plaque
deposits.
• Stain is incorporated within the tooth structure.
 Before coronal polishing is undertaken to remove
stains, it is important to distinguish between extrinsic
and intrinsic stains.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Extrinsic Stains
 Occur on the external surfaces of the teeth and
may be removed by scaling and/or polishing.
 Extrinsic stains are caused by certain substances
such as tobacco, coffee, tea, red wine, certain
drugs, and chromogenic (color-producing)
bacteria.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-1 A, Yellow and brown stain and marginal plaque.
Fig. 58-1 A
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-1 B, Moderate tobacco stain on the lingual surfaces.
Fig. 58-1 B
Copyright 2003, Elsevier Science (USA). All rights reserved.
Intrinsic Stains
 An internal discoloration of the tooth that may
be caused by exposure to medicine (e.g.,
tetracycline or excessive fluoride ingestion), or
other causes during tooth development.
 The dental assistant must be able to recognize
these conditions because these stains cannot be
removed by polishing or scaling.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-2 Intrinsic discoloration.
Fig. 58-2
Copyright 2003, Elsevier Science (USA). All rights reserved.
Methods of Removing Plaque and Stain
 Air-powder polishing
• The air-powder polishing technique uses a specially
designed handpiece with a nozzle that delivers a highpressure stream of warm water and sodium bicarbonate.
 Rubber cup polishing
• The most common technique for removing stains and
plaque and polishing the teeth.
• A rubber polishing cup is rotated slowly and carefully
by a prophy angle attached to the slow-speed handpiece.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Rotary Equipment for Coronal Polishing
 Polishing cups
• Soft, webbed polishing cups are used to clean and
polish the smooth surfaces of the teeth. The polishing
cup attaches to the reusable prophy angle by either a
snap-on or screw-on attachment.
 Prophylaxis angle
• Commonly called a prophy angle, attaches to the
slow-speed handpiece.
• The reusable prophy angle must be properly cleaned
and sterilized after each use.
• A disposable angle is discarded after a single use.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Bristle Brushes
 Bristle brushes are made from either natural or
synthetic materials and may be used to remove
stains from deep pits and fissures of the enamel
surfaces.
 Bristle brushes can cause severe gingival lacerations
and must be used with special care.
 Brushes are not recommended for use on exposed
cementum or dentin because these surfaces are soft
and are easily grooved.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Abrasives
 Dental abrasives (polishing materials) are used to
remove stain and to polish natural teeth, prosthetic
appliances, restorations, and castings.
 Abrasives are available in extra coarse, coarse,
medium, fine, and extra fine. The coarser the agent,
the more abrasive the surface.
 Even a fine-grit agent removes small amounts of the
enamel surface.
 The goal is to always use the abrasive agent that will
produce the least amount of abrasion to the tooth
surface.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Factors That Influence Rate of Abrasion
 The more agent used, the greater the degree
of abrasion.
 The lighter the pressure, the less abrasion.
 The slower the rotation of the cup, the less
abrasion.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Polishing Strokes
 Fill the polishing cup with the polishing agent and





spread it over several teeth in the areas to be
polished.
Establish a finger rest, and place the cup almost in
contact with the tooth.
The stroke should be from the gingival third toward
the incisal third of the tooth.
Use the slowest speed, and then apply the revolving
cup lightly to the tooth surface for 1 to 2 seconds.
Use light pressure to make the edges of the polishing
cup flare slightly.
Use a patting, wiping motion and an overlapping
stroke.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-5 Use overlapping strokes to ensure complete coverage of the tooth.
Fig. 58-5
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-6 Stroke from the gingival third with just sufficient pressure to make
the cup flare.
Fig. 58-6
Copyright 2003, Elsevier Science (USA). All rights reserved.
Positioning the Patient
 Adjust the dental chair so that the patient is approximately
parallel to the floor with the back of the chair raised
slightly.
 Adjust the headrest for patient comfort and operator
visibility.
 For the mandibular arch, position the patient's head with
the chin down. When the mouth is open, the lower jaw
should be parallel to the floor.
 For access to the maxillary arch, position the patient's
head with the chin up.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-3 Disposable handpiece.
Fig. 58-3
Copyright 2003, Elsevier Science (USA). All rights reserved.
The Handpiece Grasp
 The handpiece and prophylaxis angle are held in
a pen grasp with the handle resting in the Vshaped area of the hand between the thumb and
index finger.
 A proper grasp is important because if the grasp
is not secure and comfortable, the weight and
balance of the handpiece can cause hand and
wrist fatigue.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-4 Handpiece grasp.
Fig. 58-4
Copyright 2003, Elsevier Science (USA). All rights reserved.
Handpiece Operation
 The rheostat (foot pedal) controls the speed (rpm)
of the handpiece.
 The toe of the foot is used to activate the rheostat.
The sole of the foot remains flat on the floor.
 Apply a steady pressure with the toe on the rheostat
to produce a slow, even speed.
 Use a low-speed handpiece that operates to a
maximum of 20,000 rpm.
 Release the rheostat to prevent debris from
splattering when the handpiece is removed from the
tooth for more than a moment.
Copyright 2003, Elsevier Science (USA). All rights reserved.
The Fulcrum/Finger Rest
 The fulcrum provides stability for the operator and
must be placed in such a way as to allow for
movement of the wrist and forearm.
 The fulcrum is repositioned throughout the procedure
as necessary.
 The fulcrum may be either intraoral or extraoral,
depending on a variety of circumstances such as:
•
The presence or absence of teeth.
•
The area of the mouth being polished.
•
How wide the patient can open the mouth.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Positioning of the Operator
 The operator's feet should be flat on the floor with the
thighs parallel to the floor.
 The operator's arms should be at waist level and even
with the patient's mouth.
 When performing a coronal polish procedure, the right-
handed operator generally begins by being seated at the
8 to 9 o'clock position.
 When performing a coronal polish procedure, the left-
handed operator generally begins by being seated at the
3 to 4 o'clock position.
Copyright 2003, Elsevier Science (USA). All rights reserved.
The Sequence of Polishing
 The full mouth coronal polishing must be done in
a predetermined sequence to be certain that no
area is missed.
 The best sequence is based on the operator's
preference and the individual needs of the
patient.
 The positions and fulcrums described in the
following slides are for a right-handed operator.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-7 Setup for coronal polishing.
Fig. 58-7
Copyright 2003, Elsevier Science (USA). All rights reserved.
Patient Preparation
 Check the patient's medical history for any
contraindications to the coronal polish procedure.
 Seat and drape the patient with a waterproof napkin.
Ask the patient to remove any dental prosthetic
appliance he or she may be wearing. Provide the
patient with protective eyewear.
 Explain the procedure to the patient and answer any
questions.
 Inspect oral cavity for lesions, missing teeth, tori,
and so on.
 Apply a disclosing agent to identify areas of plaque.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-8 Application of disclosing agent.
Fig. 58-8
Copyright 2003, Elsevier Science (USA). All rights reserved.
Maxillary Right Posterior Quadrant,
Buccal Aspect
 Sit in the 8 to 9 o'clock position.
 Have the patient tilt his head up and turn slightly
away from you.
 Hold the dental mirror in your left hand. Use it to
retract the cheek or for indirect vision of the
more posterior teeth.
 Establish a fulcrum on the maxillary right
incisors.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-9 Polishing the buccal surfaces of the maxillary right quadrant.
Fig. 58-9
Copyright 2003, Elsevier Science (USA). All rights reserved.
Maxillary Right Posterior Quadrant,
Lingual Aspect
 Remain seated in the 8 to 9 o'clock position.
 Have the patient turn his head up and toward
you.
 Hold the dental mirror in your left hand. Direct
vision in this position and the mirror provides a
view of the distal surfaces.
 Establish a fulcrum on the lower incisors and
reach up to polish the lingual surfaces.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Maxillary Anterior Teeth, Facial Aspect
 Remain in the 8 to 9 o'clock position.
 Position the patient's head tipped up slightly and
facing straight-ahead. Make necessary
adjustments by turning the patient's head
slightly either toward or away from you.
 Use direct vision in this area.
 Establish a fulcrum on the incisal edge of the
teeth adjacent to the ones being polished.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-10 Polishing the facial surfaces of the maxillary anterior teeth.
Fig. 58-10
Copyright 2003, Elsevier Science (USA). All rights reserved.
Maxillary Anterior Teeth, Lingual Aspect
 Remain in the 8 to 9 o'clock position or move to
the 11 to 12 o'clock position.
 Position the patient's head so it is tipped slightly
upward.
 Use the mouth mirror for indirect vision and to
reflect light on the area.
 Establish a fulcrum on the incisal edge of the
teeth adjacent to the ones being polished.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-11 Polishing the lingual surfaces of the maxillary anterior teeth.
Fig. 58-11
Copyright 2003, Elsevier Science (USA). All rights reserved.
Maxillary Left Posterior Quadrant,
Buccal Aspect
 Sit in the 9 o'clock position.
 Position the patient's head tipped upward and turned
slightly toward you to improve visibility.
 Use the mirror to retract the cheek and for indirect
vision.
 Rest your fulcrum finger on the buccal occlusal surface
of the teeth toward the front of the quadrant.
 Alternative: Rest your fulcrum finger on the lower
premolars and reach up to the maxillary posterior teeth.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Maxillary Left Posterior Quadrant,
Lingual Aspect
 Remain in the 8 to 9 o'clock position.
 Have the patient turn his head away from you.
 Use direct vision in this position. Hold the mirror
in your left hand and use for a combination of
retraction and reflecting light.
 Establish a fulcrum on the buccal surfaces of the
maxillary left posterior teeth or on the occlusal
surfaces of the mandibular left teeth.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Mandibular Left Posterior Quadrant,
Buccal Aspect
 Sit in the 8 to 9 o'clock position.
 Have the patient turn his head slightly toward
you.
 Use the mirror to retract the cheek and for
indirect vision of distal and buccal surfaces.
 Establish a fulcrum on the incisal surfaces of the
mandibular left anterior teeth and reach back to
the posterior teeth.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Mandibular Left Posterior Quadrant,
Lingual Aspect
 Remain in the 9 o'clock position.
 Have the patient turn his head slightly away
from you.
 For direct vision, use the mirror to retract the
tongue and reflect more light to the working
area.
 Establish a fulcrum on the mandibular anterior
teeth and reach back to the posterior teeth.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-12 Polishing the lingual surfaces of the mandibular left quadrant.
Fig. 58-12
Copyright 2003, Elsevier Science (USA). All rights reserved.
Mandibular Anterior Teeth, Facial
Aspect
 Sit in either the 8 to 9 o'clock position or in the 11 to 12
o'clock position.
 As necessary, instruct the patient to make adjustments
in his head position by turning either toward or away
from you or by tilting his head up or down.
 Use your left index finger to retract the lower lip. Both
direct and indirect vision can be used in this area.
 Establish a fulcrum on the incisal edges of the teeth
adjacent to the ones being polished.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Mandibular Anterior Teeth, Lingual
Aspect
 Sit in either the 8 to 9 o'clock position or at the 11 to
12 o'clock position.
 As necessary, instruct the patient to make
adjustments in his head position by turning either
toward or away from you or by tilting his head up or
down.
 Use the mirror for indirect vision, to retract the
tongue, and to reflect light onto the teeth. Direct
vision is often used in this area when the operator is
seated in the 12 o’clock position, but indirect vision
can also be helpful.
 Establish a fulcrum on the mandibular cuspid incisal
area.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-13 Polishing the lingual surfaces of the mandibular anterior teeth.
Fig. 58-13
Copyright 2003, Elsevier Science (USA). All rights reserved.
Mandibular Right Quadrant, Buccal
Aspect
 Sit in the 8 o'clock position.
 Have the patient turn his head slightly away from
you .
 Use the mirror to retract tissue and reflect light.
The mirror may also be used to view the distal
surfaces in this area.
 Establish a fulcrum on the lower incisors.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Fig. 58-14 Polishing the mandibular right quadrant, buccal aspect.
Fig. 58-14
Copyright 2003, Elsevier Science (USA). All rights reserved.
Mandibular Right Quadrant, Lingual
Aspect
 Remain in the 8 o'clock position.
 Have the patient turn his head slightly toward
you.
 Retract the tongue with the mirror.
 Establish a fulcrum on the lower incisors.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Flossing After Coronal Polishing
 Dental floss and tape have two purposes after coronal
polishing.
• The first is to polish the interproximal tooth surfaces.
• The second is to remove any abrasive agent or
debris that may be lodged in the contact area.
 Place abrasive on the contact area between the teeth,
and work the floss or tape through the contact area with
a back-and-forth motion.
 A floss threader can be used to pass the floss under any
fixed bridgework to gain access to the abutment teeth.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Evaluation of Polishing
 There is no remaining disclosing agent on any
of the tooth surfaces.
 The teeth are glossy and reflect light from the
mirror uniformly.
 There is no evidence of trauma to the gingival
margins or any other soft tissues in the mouth.
Copyright 2003, Elsevier Science (USA). All rights reserved.
Patient Instructions
 Most patients are self-conscious about stains on
their teeth and appreciate any tips you can give
them as to how to they can keep their teeth as
white as possible.
 It is important to educate patients about the
cause of stains.
 When the stains are intrinsic, the dentist may
want you to discuss possible cosmetic dental
care options to satisfy their desire for attractive
and stain-free teeth.
Copyright 2003, Elsevier Science (USA). All rights reserved.