coronal polishing chapter 58 copyright © 2009, 2006 by saunders, an imprint of elsevier inc. all...

Coronal PolishingCoronal Polishing

Chapter 58Chapter 58

Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.


Lesson 58.1Lesson 58.1


Learning ObjectivesLearning Objectives

Pronounce, define, and spell the Key Terms.Pronounce, define, and spell the Key Terms. Explain the difference between prophylaxis and Explain the difference between prophylaxis and

coronal polishing.coronal polishing. Explain the indications for and contraindications Explain the indications for and contraindications

to coronal polishing.to coronal polishing. Name and describe the types of extrinsic stains.Name and describe the types of extrinsic stains. Name and describe the two categories of intrinsic Name and describe the two categories of intrinsic

stains.stains. Describe types of abrasives used for polishing the Describe types of abrasives used for polishing the

teeth.teeth.


IntroductionIntroduction

Coronal polishing is a technique used to remove Coronal polishing is a technique used to remove plaque and stains from the coronal surfaces of the plaque and stains from the coronal surfaces of the teeth. Polishing the crowns teeth. Polishing the crowns of the teeth is considered mainly cosmetic, but there of the teeth is considered mainly cosmetic, but there are instances in which coronal polishing has are instances in which coronal polishing has therapeutic value as well. therapeutic value as well.

In some states, coronal polishing is delegated to In some states, coronal polishing is delegated to registered or expanded-function dental assistants registered or expanded-function dental assistants who have had special training in this procedure. who have had special training in this procedure. Coronal polishing is strictly limited to the clinical Coronal polishing is strictly limited to the clinical crowns of the teeth. Coronal polishing is not a crowns of the teeth. Coronal polishing is not a substitute for oral prophylaxis.substitute for oral prophylaxis.


Selective PolishingSelective Polishing

Selective polishing is a procedure in which Selective polishing is a procedure in which only those teeth or surfaces with stain are only those teeth or surfaces with stain are polished. polished.

The purpose of selective polishing is to avoid The purpose of selective polishing is to avoid removing even small amounts of surface removing even small amounts of surface enamel unnecessarily.enamel unnecessarily.

In some individuals, stain removal may cause In some individuals, stain removal may cause dentinal hypersensitivity during and after the dentinal hypersensitivity during and after the appointment. appointment.


Coronal Polishing and Fluoride Coronal Polishing and Fluoride ApplicationApplication

Historically teeth were polished to remove all Historically teeth were polished to remove all soft deposits and stains before the application soft deposits and stains before the application of fluoride because it was believed that there of fluoride because it was believed that there would be greater uptake of the fluoride into would be greater uptake of the fluoride into the enamel. the enamel.

As scientific knowledge has evolved, it has As scientific knowledge has evolved, it has been shown that polishing does not improve been shown that polishing does not improve the uptake of professionally applied fluoride. the uptake of professionally applied fluoride.

Therefore polishing is no longer necessary Therefore polishing is no longer necessary before fluoride application. before fluoride application.


Benefits of Coronal PolishingBenefits of Coronal Polishing

Polishing prepares the teeth for the Polishing prepares the teeth for the placement of dental sealants. placement of dental sealants.

Smooth tooth surfaces are easier for the Smooth tooth surfaces are easier for the patient to keep clean.patient to keep clean.

The formation of new deposits is slowed.The formation of new deposits is slowed. Patients appreciate the smooth feeling and Patients appreciate the smooth feeling and

clean appearance.clean appearance. Polishing prepares the teeth for the Polishing prepares the teeth for the

placement of orthodontic brackets and bands.placement of orthodontic brackets and bands.


Dental StainsDental Stains

Stains of the teeth occur in three Stains of the teeth occur in three basic ways:basic ways: A stain adheres directly to the surface of the tooth.A stain adheres directly to the surface of the tooth. A stain is embedded in calculus and plaque A stain is embedded in calculus and plaque

deposits.deposits. A stain is incorporated into the A stain is incorporated into the

tooth’s structure.tooth’s structure. It is important to distinguish between the It is important to distinguish between the

types of stains before coronal polishing is types of stains before coronal polishing is undertaken to remove them.undertaken to remove them.


Dental StainsDental Stains

Stains are primarily an aesthetic problem. Stains are primarily an aesthetic problem. Some types of stains can be removed, and Some types of stains can be removed, and

others cannot. It is important for the dental others cannot. It is important for the dental assistant to be able to correctly identify stains. assistant to be able to correctly identify stains.

There are other treatment options for patients There are other treatment options for patients with stains that cannot be removed. with stains that cannot be removed.

These include professional and at-home These include professional and at-home bleaching procedures, enamel microabrasion, bleaching procedures, enamel microabrasion, and cosmetic restorative procedures such as and cosmetic restorative procedures such as laminate veneers and composite restorations.laminate veneers and composite restorations.


Types of Dental StainsTypes of Dental Stains

Dental stains are categorized as either Dental stains are categorized as either endogenous or exogenous: endogenous or exogenous: Endogenous stains originate within the tooth as a Endogenous stains originate within the tooth as a

result of developmental and systemic disturbances.result of developmental and systemic disturbances. Exogenous stains originate outside the tooth in Exogenous stains originate outside the tooth in

response to environmental agents.response to environmental agents. Exogenous stains are those stains caused by an Exogenous stains are those stains caused by an

environmental source:environmental source: They are subdivided even further as extrinsic or They are subdivided even further as extrinsic or

intrinsic stains, depending on whether the stain can intrinsic stains, depending on whether the stain can be removed. be removed.


Extrinsic and Intrinsic StainsExtrinsic and Intrinsic Stains

Extrinsic stains are stains on the exterior of the tooth Extrinsic stains are stains on the exterior of the tooth that can be removed. Examples include staining from that can be removed. Examples include staining from food, drink, and tobacco. The source of the stain is food, drink, and tobacco. The source of the stain is external and the stain may be removed. external and the stain may be removed.

Intrinsic stains are caused by an environmental Intrinsic stains are caused by an environmental source but cannot be removed because the stain has source but cannot be removed because the stain has become incorporated into the structure of the tooth. become incorporated into the structure of the tooth. Examples are tobacco stain from smoking, chewing, Examples are tobacco stain from smoking, chewing, or dipping and stains from dental amalgam that has or dipping and stains from dental amalgam that has become incorporated into the tooth’s structure. become incorporated into the tooth’s structure.


Fig. 58-2 Endogenous developmental stain: tetracycline. Fig. 58-2 Endogenous developmental stain: tetracycline. (Courtesy of Santa Rosa Junior College, Santa Rosa, Calif.) (Courtesy of Santa Rosa Junior College, Santa Rosa, Calif.)

Notice how the stained area corresponds to the period of tooth development Notice how the stained area corresponds to the period of tooth development and the time at which the drug was taken.and the time at which the drug was taken.


Fig. 58-3 Endogenous developmental stain: Fig. 58-3 Endogenous developmental stain: enamel hypoplasia. enamel hypoplasia.

(From Daniel SJ, Harfst SA, Wilder R: (From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and Mosby’s dental hygiene: concepts, cases and competenciescompetencies, ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.), ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.)


Fig. 58-4 Endogenous developmental stain: Fig. 58-4 Endogenous developmental stain: dental fluorosis. dental fluorosis.

(From Daniel SJ, Harfst SA, Wilder R: (From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and Mosby’s dental hygiene: concepts, cases and

competenciescompetencies, ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.), ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.)


Fig. 58-5 Endogenous developmental stain: secondary caries. Fig. 58-5 Endogenous developmental stain: secondary caries. (From Daniel SJ, Harfst SA, Wilder R: (From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and Mosby’s dental hygiene: concepts, cases and



Fig. 58- 6 Endogenous stain: amalgam restoration.Fig. 58- 6 Endogenous stain: amalgam restoration. (From Daniel SJ, Harfst SA, Wilder R: (From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and Mosby’s dental hygiene: concepts, cases and



Methods of Removing Plaque and Methods of Removing Plaque and StainStain

Air-powder polishingAir-powder polishing The air-powder polishing technique involves the The air-powder polishing technique involves the

use of a specially designed handpiece with a use of a specially designed handpiece with a nozzle that delivers a high-pressure stream of nozzle that delivers a high-pressure stream of warm water and sodium bicarbonate. warm water and sodium bicarbonate.

Rubber-cup polishingRubber-cup polishing This is the most common technique for removing This is the most common technique for removing

stains and plaque and polishing the teeth.stains and plaque and polishing the teeth. A rubber polishing cup is rotated slowly and A rubber polishing cup is rotated slowly and

carefully by means of a prophylactic angle carefully by means of a prophylactic angle attached to the slow-speed handpiece.attached to the slow-speed handpiece.


Rotary Equipment for Coronal Rotary Equipment for Coronal PolishingPolishing

Polishing cups Polishing cups Soft webbed polishing cups are used to clean and Soft webbed polishing cups are used to clean and

polish the smooth surfaces of the teeth. The polishing polish the smooth surfaces of the teeth. The polishing cup is attached to the reusable prophylaxis angle by cup is attached to the reusable prophylaxis angle by means of a snap-on or screw-on attachment.means of a snap-on or screw-on attachment.

Prophylaxis angle Prophylaxis angle Commonly called a prophy angle, this tool attaches Commonly called a prophy angle, this tool attaches

to the slow-speed handpiece. to the slow-speed handpiece. The reusable prophy angle must be properly cleaned The reusable prophy angle must be properly cleaned

and sterilized after each use.and sterilized after each use. A disposable angle is discarded after a single use.A disposable angle is discarded after a single use.


Fig. 58-1 Bristle brush (Fig. 58-1 Bristle brush (toptop) rubber polishing cup () rubber polishing cup (bottombottom), ), sterilizable prophy angle (sterilizable prophy angle (centercenter), and disposable prophy ), and disposable prophy

angle (angle (rightright).).


Bristle BrushesBristle Brushes

Bristle brushes, made of natural or synthetic Bristle brushes, made of natural or synthetic materials, may be used to remove stains from materials, may be used to remove stains from deep pits and fissures of the enamel deep pits and fissures of the enamel surfaces.surfaces.

Bristle brushes can cause severe gingival Bristle brushes can cause severe gingival lacerations and must be used with special lacerations and must be used with special care. care.

Brushes are not recommended for use on Brushes are not recommended for use on exposed cementum or dentin because these exposed cementum or dentin because these surfaces are soft and are easily grooved.surfaces are soft and are easily grooved.


Abrasives Abrasives

Dental abrasives (polishing materials) are used to Dental abrasives (polishing materials) are used to remove stain and to polish natural teeth, prosthetic remove stain and to polish natural teeth, prosthetic appliances, restorations, and castings.appliances, restorations, and castings.

They are available in extra coarse, coarse, medium, They are available in extra coarse, coarse, medium, fine, and extra fine grits. The coarser the agent, the fine, and extra fine grits. The coarser the agent, the more abrasive the surface. more abrasive the surface.

Even a fine-grit agent removes small amounts of the Even a fine-grit agent removes small amounts of the enamel’s surface. enamel’s surface.

The goal is to always use the abrasive agent that will The goal is to always use the abrasive agent that will produce the least amount of abrasion to the tooth produce the least amount of abrasion to the tooth surface. surface.


Factors That Influence the Rate of Factors That Influence the Rate of AbrasionAbrasion

The more agent used, the greater the degree The more agent used, the greater the degree of abrasion.of abrasion.

The lighter the pressure, the less abrasion.The lighter the pressure, the less abrasion. The slower the rotation of the cup, the less The slower the rotation of the cup, the less

abrasion. abrasion.



Lesson 58.2Lesson 58.2



Describe the types of abrasives used for porcelain Describe the types of abrasives used for porcelain aesthetic restorations.aesthetic restorations.

Name materials to avoid when polishing aesthetic Name materials to avoid when polishing aesthetic restorations.restorations.

Describe the technique for polishing aesthetic Describe the technique for polishing aesthetic restorations.restorations.

Demonstrate the handpiece grasp and positioning for Demonstrate the handpiece grasp and positioning for the prophy angle.the prophy angle.

Demonstrate the fulcrum or finger rest used in each Demonstrate the fulcrum or finger rest used in each quadrant during a coronal polishing procedure.quadrant during a coronal polishing procedure.

(Cont’d)(Cont’d)



(Cont’d)(Cont’d)

Demonstrate the proper seating positions for the Demonstrate the proper seating positions for the operator and the assistant during a coronal polishing operator and the assistant during a coronal polishing procedure.procedure.

Demonstrate safety precautions to be taken during Demonstrate safety precautions to be taken during coronal polishing.coronal polishing.

In states where it is legal, demonstrate coronal In states where it is legal, demonstrate coronal polishing technique.polishing technique.

Complete coronal polishing without causing tissue Complete coronal polishing without causing tissue trauma.trauma.

Be able to determine that the teeth are free of stains Be able to determine that the teeth are free of stains and plaque.and plaque.


Polishing Esthetic Type RestorationsPolishing Esthetic Type Restorations

Many patients have crown and bridge restorations Many patients have crown and bridge restorations and are having cosmetic resin, composite, bonding, and are having cosmetic resin, composite, bonding, and veneers placed to enhance their smiles.and veneers placed to enhance their smiles.

Improper oral care can quickly damage many of Improper oral care can quickly damage many of these types of restorations. these types of restorations.

Coarse polishing paste, use of acidulated phosphate Coarse polishing paste, use of acidulated phosphate fluorides, and even hard brushing with abrasive fluorides, and even hard brushing with abrasive toothpaste can be destructive to the surfaces of toothpaste can be destructive to the surfaces of restorative materials. restorative materials.

A diamond, aluminum oxide, or low-abrasion A diamond, aluminum oxide, or low-abrasion toothpaste should be used for these restorations.toothpaste should be used for these restorations.


Fig. 58-8 A, It can be difficult to detect esthetic restorations. Fig. 58-8 A, It can be difficult to detect esthetic restorations. Two of these teeth have crowns. Two of these teeth have crowns.

(Courtesy of Dr. Peter Pang, Sonoma, Calif.)(Courtesy of Dr. Peter Pang, Sonoma, Calif.)


Polishing StrokesPolishing Strokes

Fill the polishing cup with the polishing agent and Fill the polishing cup with the polishing agent and spread it over several teeth in the areas to be polished.spread it over several teeth in the areas to be polished.

Establish a finger rest and place the cup almost in Establish a finger rest and place the cup almost in contact with the tooth. contact with the tooth.

The stroke should reach from the gingival third to the The stroke should reach from the gingival third to the incisal third of the tooth.incisal third of the tooth.

Using the slowest speed, lightly apply the revolving cup Using the slowest speed, lightly apply the revolving cup to the tooth surface for 1 or 2 seconds. to the tooth surface for 1 or 2 seconds.

Use light pressure to make the edges of the polishing Use light pressure to make the edges of the polishing cup flare slightly.cup flare slightly.

Use a patting, wiping motion and an overlapping stroke. Use a patting, wiping motion and an overlapping stroke.


Fig. 58-9 Close-up of hand with handpiece and proper grip.Fig. 58-9 Close-up of hand with handpiece and proper grip.


Fig. 58-10 Fig. 58-10 Use overlapping strokes to ensure Use overlapping strokes to ensure complete coverage of the tooth.complete coverage of the tooth.


Fig. 58-11 Fig. 58-11 Stroke from the gingival third with Stroke from the gingival third with just enough pressure to cause the cup to flare.just enough pressure to cause the cup to flare.


Positioning the PatientPositioning the Patient

Adjust the dental chair so that the patient is Adjust the dental chair so that the patient is approximately parallel to the floor with the back of approximately parallel to the floor with the back of the chair raised slightly.the chair raised slightly.

Adjust the headrest for patient comfort and Adjust the headrest for patient comfort and operator visibility. operator visibility.

For the mandibular arch, position the patient's For the mandibular arch, position the patient's head with the chin down. When the mouth is open, head with the chin down. When the mouth is open, the lower jaw should be parallel to the floor.the lower jaw should be parallel to the floor.

For access to the maxillary arch, position the For access to the maxillary arch, position the patient's head with the chin up.patient's head with the chin up.


Fig. 58-12 For the mandibular arch, the patient’s head is Fig. 58-12 For the mandibular arch, the patient’s head is positioned so that the lower jaw is parallel to the floor when positioned so that the lower jaw is parallel to the floor when

the mouth is open.the mouth is open.


Fig. 58-13 For access to the maxillary arch, position the Fig. 58-13 For access to the maxillary arch, position the patient’s head with the chin up.patient’s head with the chin up.


Fig. 58-14 The right-handed operator is seated Fig. 58-14 The right-handed operator is seated at the 9 o’clock position.at the 9 o’clock position.


The Handpiece GraspThe Handpiece Grasp

The handpiece and prophylaxis angle are The handpiece and prophylaxis angle are held in a pen grasp with the handle resting in held in a pen grasp with the handle resting in the V-shaped area of the hand between the the V-shaped area of the hand between the thumb and index finger. thumb and index finger.

Proper grasp is important because if the Proper grasp is important because if the grasp is not secure and comfortable, the grasp is not secure and comfortable, the weight and balance of the handpiece can weight and balance of the handpiece can cause hand and wrist fatigue.cause hand and wrist fatigue.


Fig. 58-9 Handpiece grasp.Fig. 58-9 Handpiece grasp.


Handpiece OperationHandpiece Operation

The rheostat (foot pedal) controls the speed The rheostat (foot pedal) controls the speed (revolutions per minute) of the handpiece.(revolutions per minute) of the handpiece.

The toe is used to activate the rheostat. The sole The toe is used to activate the rheostat. The sole remains flat on the floor.remains flat on the floor.

Apply a steady pressure with the toe on the Apply a steady pressure with the toe on the rheostat to produce a slow, even speed.rheostat to produce a slow, even speed.

Use a low-speed handpiece that operates to a Use a low-speed handpiece that operates to a maximum of 20,000 rpm. maximum of 20,000 rpm.

Release the rheostat to prevent debris from Release the rheostat to prevent debris from splattering when the handpiece is removed from splattering when the handpiece is removed from the tooth for more than a moment.the tooth for more than a moment.


The Fulcrum/Finger RestThe Fulcrum/Finger Rest

The fulcrum provides stability for the operator The fulcrum provides stability for the operator and must be placed in such a way as to allow and must be placed in such a way as to allow for movement of the wrist and forearm. for movement of the wrist and forearm.

The fulcrum is repositioned throughout the The fulcrum is repositioned throughout the procedure as necessary.procedure as necessary.

The fulcrum may be either intraoral or extraoral, The fulcrum may be either intraoral or extraoral, depending on a variety of circumstances such depending on a variety of circumstances such as:as:

• The presence or absence of teethThe presence or absence of teeth

• The area of the mouth being polishedThe area of the mouth being polished

• How wide the patient can open his or her mouthHow wide the patient can open his or her mouth


Positioning of the OperatorPositioning of the Operator

The operator should keep his or her feet flat on the The operator should keep his or her feet flat on the floor and the thighs parallel to the floor. floor and the thighs parallel to the floor.

The operator's arms should be at waist level and The operator's arms should be at waist level and even with the patient’s mouth. even with the patient’s mouth.

When performing a coronal polish procedure, the When performing a coronal polish procedure, the right-handed operator generally begins by seating right-handed operator generally begins by seating himself or herself in an 8 to 9 o’clock position. himself or herself in an 8 to 9 o’clock position.

When performing a coronal polish procedure, the left-When performing a coronal polish procedure, the left-handed operator generally begins by seating himself handed operator generally begins by seating himself or herself in the 3 to 4 o’clock position.or herself in the 3 to 4 o’clock position.


The Sequence of PolishingThe Sequence of Polishing

Full mouth coronal polishing must be performed in a Full mouth coronal polishing must be performed in a predetermined sequence to be certain that no area is predetermined sequence to be certain that no area is missed.missed.

The best sequence is based on the operator's preference The best sequence is based on the operator's preference and the individual needs of the patient.and the individual needs of the patient.

Aesthetic and porcelain restorations should be polished Aesthetic and porcelain restorations should be polished first, after which the remaining teeth may be polished with first, after which the remaining teeth may be polished with the use of the appropriate methods for any stain that is the use of the appropriate methods for any stain that is present. This reduces the possibility that a coarse abrasive present. This reduces the possibility that a coarse abrasive will remain in the rubber cup when aesthetic restorations will remain in the rubber cup when aesthetic restorations are being polished.are being polished.

The positions and fulcrums described in the following The positions and fulcrums described in the following slides are for a right-handed operator. slides are for a right-handed operator.


Setup for Coronal PolishingSetup for Coronal Polishing


Patient PreparationPatient Preparation

Check the patient's medical history for any Check the patient's medical history for any contraindications to the coronal polishing procedure.contraindications to the coronal polishing procedure.

Seat the patient and and him or her with a waterproof Seat the patient and and him or her with a waterproof napkin. Ask the patient to remove any dental napkin. Ask the patient to remove any dental prosthetic appliances he or she may be wearing. prosthetic appliances he or she may be wearing. Provide the patient with protective eyewear.Provide the patient with protective eyewear.

Explain the procedure to the patient and answer any Explain the procedure to the patient and answer any questions.questions.

Inspect oral cavity for lesions, missing teeth, tori, and Inspect oral cavity for lesions, missing teeth, tori, and so on.so on.

Apply a disclosing agent to identify areas of plaque.Apply a disclosing agent to identify areas of plaque.


Application of a Disclosing AgentApplication of a Disclosing Agent


Maxillary Right Posterior Maxillary Right Posterior Quadrant, Buccal Aspect Quadrant, Buccal Aspect

Sit in the 8 to 9 o’clock position. Sit in the 8 to 9 o’clock position. Have the patient tilt his head up and turn Have the patient tilt his head up and turn

slightly away from you.slightly away from you. Hold the dental mirror in your left hand. Use it Hold the dental mirror in your left hand. Use it

to retract the cheek or for indirect vision of the to retract the cheek or for indirect vision of the more posterior teeth.more posterior teeth.

Establish a fulcrum on the maxillary right Establish a fulcrum on the maxillary right incisors. incisors.


Polishing the Buccal Surfaces of Polishing the Buccal Surfaces of the Maxillary Right Quadrantthe Maxillary Right Quadrant


Maxillary Right Posterior Maxillary Right Posterior Quadrant, Lingual Aspect Quadrant, Lingual Aspect

Remain seated in the 8 to 9 o’clock position. Remain seated in the 8 to 9 o’clock position. Have the patient turn his head up and toward Have the patient turn his head up and toward

you.you. Hold the dental mirror in your left hand. Direct Hold the dental mirror in your left hand. Direct

vision in this position and the mirror provides vision in this position and the mirror provides a view of the distal surfaces. a view of the distal surfaces.

Establish a fulcrum on the lower incisors and Establish a fulcrum on the lower incisors and reach up to polish the lingual surfaces. reach up to polish the lingual surfaces.


Maxillary Anterior Teeth, Facial Maxillary Anterior Teeth, Facial Aspect Aspect

Remain in the 8 to 9 o’clock position. Remain in the 8 to 9 o’clock position. Position the patient’s head tipped up slightly Position the patient’s head tipped up slightly

and facing straight ahead. Make necessary and facing straight ahead. Make necessary adjustments by turning the patient's head adjustments by turning the patient's head slightly either toward or away from you.slightly either toward or away from you.

Use direct vision in this area. Use direct vision in this area. Establish a fulcrum on the incisal edge of the Establish a fulcrum on the incisal edge of the

teeth adjacent to the ones being polished. teeth adjacent to the ones being polished.


Polishing the Facial Surfaces of Polishing the Facial Surfaces of the Maxillary Anterior Teeththe Maxillary Anterior Teeth


Maxillary Anterior Teeth, Lingual Maxillary Anterior Teeth, Lingual Aspect Aspect

Remain in the 8 to 9 o’clock position or move Remain in the 8 to 9 o’clock position or move to the 11 to 12 o’clock position.to the 11 to 12 o’clock position.

Position the patient’s head so that it is tipped Position the patient’s head so that it is tipped slightly upward.slightly upward.

Use the mouth mirror for indirect vision and to Use the mouth mirror for indirect vision and to reflect light on the area. reflect light on the area.

Establish a fulcrum on the incisal edge of the Establish a fulcrum on the incisal edge of the teeth adjacent to the ones being polished. teeth adjacent to the ones being polished.


Polishing the Lingual Surfaces Polishing the Lingual Surfaces of the Maxillary Anterior Teethof the Maxillary Anterior Teeth


Maxillary Left Posterior Maxillary Left Posterior Quadrant, Buccal AspectQuadrant, Buccal Aspect

Sit in the 9 o’clock position. Sit in the 9 o’clock position. Tip the patient's head upward and turn it slightly Tip the patient's head upward and turn it slightly

toward you to improve visibility.toward you to improve visibility. Use the mirror to retract the cheek and for indirect Use the mirror to retract the cheek and for indirect

vision.vision. Rest your fulcrum finger on the buccal occlusal Rest your fulcrum finger on the buccal occlusal

surface of the teeth toward the front of the surface of the teeth toward the front of the quadrant. quadrant.

Alternative: Rest your fulcrum finger on the lower Alternative: Rest your fulcrum finger on the lower premolars and reach up to the maxillary posterior premolars and reach up to the maxillary posterior teeth.teeth.


Maxillary Left Posterior Maxillary Left Posterior Quadrant, Lingual AspectQuadrant, Lingual Aspect

Remain in the 8 to 9 o’clock position. Remain in the 8 to 9 o’clock position. Have the patient turn his or her head away Have the patient turn his or her head away

from you. from you. Use direct vision in this position. Hold the Use direct vision in this position. Hold the

mirror in your left hand and use for a mirror in your left hand and use for a combination of retraction and reflecting light.combination of retraction and reflecting light.

Establish a fulcrum on the buccal surfaces of Establish a fulcrum on the buccal surfaces of the maxillary left posterior teeth or on the the maxillary left posterior teeth or on the occlusal surfaces of the mandibular left teeth.occlusal surfaces of the mandibular left teeth.


Mandibular Left Posterior Mandibular Left Posterior Quadrant, Buccal Aspect Quadrant, Buccal Aspect

Sit in the 8 to 9 o’clock position. Sit in the 8 to 9 o’clock position. Have the patient turn his or her head slightly Have the patient turn his or her head slightly

toward you. toward you. Use the mirror to retract the cheek and for Use the mirror to retract the cheek and for

indirect vision of distal and buccal surfaces. indirect vision of distal and buccal surfaces. Establish a fulcrum on the incisal surfaces of Establish a fulcrum on the incisal surfaces of

the mandibular left anterior teeth and reach the mandibular left anterior teeth and reach back to the posterior teeth. back to the posterior teeth.


Mandibular Left Posterior Mandibular Left Posterior Quadrant, Lingual Aspect Quadrant, Lingual Aspect

Remain in the 9 o’clock position.Remain in the 9 o’clock position. Have the patient turn his or her head slightly Have the patient turn his or her head slightly

away from you.away from you. For direct vision, use the mirror to retract the For direct vision, use the mirror to retract the

tongue and reflect more light to the working tongue and reflect more light to the working area. area.

Establish a fulcrum on the mandibular Establish a fulcrum on the mandibular anterior teeth and reach back to the posterior anterior teeth and reach back to the posterior teeth.teeth.


Polishing the Lingual Surfaces Polishing the Lingual Surfaces of the Mandibular Left Quadrantof the Mandibular Left Quadrant


Mandibular Anterior Teeth, Mandibular Anterior Teeth, Facial Aspect Facial Aspect

Sit in either the 8 to 9 o’clock position or in the 11 Sit in either the 8 to 9 o’clock position or in the 11 to 12 o’clock position. to 12 o’clock position.

As necessary, instruct the patient to make As necessary, instruct the patient to make adjustments in head position by turning either adjustments in head position by turning either toward or away from you or by tilting his head up toward or away from you or by tilting his head up or down. or down.

Use your left index finger to retract the lower lip. Use your left index finger to retract the lower lip. Both direct and indirect vision can be used in this Both direct and indirect vision can be used in this area.area.

Establish a fulcrum on the incisal edges of the Establish a fulcrum on the incisal edges of the teeth adjacent to the ones being polished. teeth adjacent to the ones being polished.


Mandibular Anterior Teeth, Mandibular Anterior Teeth, Lingual Aspect Lingual Aspect

Sit in either the 8 to 9 o’clock position or at the 11 to 12 Sit in either the 8 to 9 o’clock position or at the 11 to 12 o’clock position. o’clock position.

As necessary, instruct the patient to make adjustments As necessary, instruct the patient to make adjustments in head position by turning either toward or away from in head position by turning either toward or away from you or by tilting the head up or down.you or by tilting the head up or down.

Use the mirror for indirect vision, to retract the tongue, Use the mirror for indirect vision, to retract the tongue, and to reflect light onto the teeth. Direct vision is often and to reflect light onto the teeth. Direct vision is often used in this area when the operator is seated in the 12 used in this area when the operator is seated in the 12 o’clock position, but indirect vision can also be helpful. o’clock position, but indirect vision can also be helpful.

Establish a fulcrum on the mandibular cuspid incisal Establish a fulcrum on the mandibular cuspid incisal area.area.


Polishing the Lingual Surfaces Polishing the Lingual Surfaces of the Mandibular Anterior Teethof the Mandibular Anterior Teeth


Mandibular Right Quadrant, Mandibular Right Quadrant, Buccal AspectBuccal Aspect

Sit in the 8 o’clock position.Sit in the 8 o’clock position. Have the patient turn his or her head slightly Have the patient turn his or her head slightly

away from you.away from you. Use the mirror to retract tissue and reflect Use the mirror to retract tissue and reflect

light. The mirror may also be used to view the light. The mirror may also be used to view the distal surfaces in this area. distal surfaces in this area.

Establish a fulcrum on the lower incisors.Establish a fulcrum on the lower incisors.


Polishing the Polishing the Mandibular Right Mandibular Right Quadrant, Buccal AspectQuadrant, Buccal Aspect


Mandibular Right Quadrant, Mandibular Right Quadrant, Lingual AspectLingual Aspect

Remain in the 8 o’clock position.Remain in the 8 o’clock position. Have the patient turn his or her head slightly Have the patient turn his or her head slightly

toward you. toward you. Retract the tongue with the use of the mirror. Retract the tongue with the use of the mirror. Establish a fulcrum on the lower incisors. Establish a fulcrum on the lower incisors.


Flossing After Coronal PolishingFlossing After Coronal Polishing

Dental floss and tape have two purposes after coronal Dental floss and tape have two purposes after coronal polishing. polishing. The first is to polish the interproximal The first is to polish the interproximal

tooth surfaces. tooth surfaces. The second is to remove any abrasive agent or debris that may The second is to remove any abrasive agent or debris that may

be lodged in the contact area.be lodged in the contact area. Place abrasive on the contact area between the teeth Place abrasive on the contact area between the teeth

and work the floss and work the floss or tape through the contact area, using a back-and-forth or tape through the contact area, using a back-and-forth motion.motion.

A floss threader can be used to pass the floss under any A floss threader can be used to pass the floss under any fixed bridgework to gain access to the abutment teeth.fixed bridgework to gain access to the abutment teeth.


Evaluation of PolishingEvaluation of Polishing

There is no remaining disclosing agent on There is no remaining disclosing agent on any of the tooth surfaces. any of the tooth surfaces.

The teeth are glossy and reflect light from the The teeth are glossy and reflect light from the mirror uniformly. mirror uniformly.

There is no evidence of trauma to the gingival There is no evidence of trauma to the gingival margins or any other soft tissues in the margins or any other soft tissues in the mouth. mouth.


Patient InstructionsPatient Instructions

Most patients are self-conscious about stains Most patients are self-conscious about stains on their teeth and appreciate any tips you can on their teeth and appreciate any tips you can give them on how to keep their teeth as white give them on how to keep their teeth as white as possible. as possible.

It is important to educate patients about the It is important to educate patients about the causes of stains.causes of stains.

When stains are intrinsic, the dentist may When stains are intrinsic, the dentist may want you to discuss possible cosmetic dental want you to discuss possible cosmetic dental care options to satisfy their desire for care options to satisfy their desire for attractive and stain-free teeth.attractive and stain-free teeth.


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introductioncoronal

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coronal surfaces

purpose of selective

coronal polishingchapter

types of stains

types of extrinsic stains

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