To polish, or not to polish?

March 31, 2006
We have a difference of opinion in our office as to whether we should polish teeth or not. What do you think?

Dear RDH eVillage:

We have a difference of opinion in our office as to whether we should polish teeth or not. What do you think?

Reply from Nancy Dukes, BA, RDH:

Whether or not hygienists should polish a patient's teeth following instrumentation has long been a dilemma clinicians face. Most were taught in dental hygiene school that polishing should be selective, at most. While that was presented as the ideal, most experienced hygienists now understand that we rarely practice in an ideal world but, instead, in a very consumer/esthetic-driven world.

We recognize the reasons why we were taught not to polish: removal of tooth structure, increased tooth and restoration roughness, damage to demineralized areas, removal of fluoride-rich enamel surfaces, heat production with possible pulp damage over time, trauma to free gingiva especially when inflamed, exposure of clinician and patient to biologically contaminated aerosols and splatter, increased tooth sensitivity, damage to incompletely mineralized newly erupted teeth, etc. The list and arguments go on, as does the concern of any hygienist caring for his/her patients.

So, with that extensive list of complications, why are we so driven to polish routinely? The answer lies in the fact that we are striving to balance pleasing the esthetic desires of the patient with gaining commitment from our perfectly cared for patients. We must please our patient by providing excellent care and service without possible harm. This is a vital component in our quest to build the relationship that will ultimately allow us to motivate the patient to achieve oral health.

So, while this "to polish or not to polish" issue has no black and white answer, the solution lies in professional judgment of necessity for stain removal and comprehensive patient education, based on the individual patient's dental and medical histories and the current oral situation. When and if polishing is appropriate can only be decided following comprehensive evaluation of the patient and necessary treatment to be provided. The key, and therefore the answer, lies in individualized patient care and patient education. I believe there is no right or wrong answer, because no mouth is the same. Selective polishing, special clinical techniques, and individualized patient home care to reduce or eliminate stains can solve this dilemma, therefore achieving the goals we all strive to reach.

In summary, if your team is struggling with this issue, create a model of questions to ask yourselves during a comprehensive oral evaluation to determine when and where polishing would be appropriate. Remember, each hygienist must keep in mind what is in the patient's best interest. You are the patient's health-care provider; your patients trust you to recommend what is best for them and educate them appropriately. You must help them understand, through education, what they need and how that fits into what they want. Your responsibility is great as a dental professional. You can meet this challenge and do what you know to be best for the patient on a case-by-case basis with systems supporting you efficiently and effectively along the way.

Nancy Dukes, BA, RDH, is director of clinical consulting for Jameson Management, Inc., an international dental practice-management consulting firm. Visit or call (877) 369.5558 for more information.