Polishing pastes ... look good and taste great!
By Shannon Pace Brinker, CDA
Editor in Chief, Contemporary Product Solutions
It is estimated that dental hygienists perform approximately 200 million prophylaxis procedures annually. But many states are changing their practice act to allow expanded function dental assistants to perform some of these procedures, such as coronal polishing. These assistants are working alongside hygienists as hygiene treatment coordinators, helping to make this department even more functional and productive. In fact in the majority of dental offices, dental assistants are in charge of ordering supplies, choosing which products the hygiene department will use.
This article will help dental assistants understand the etiology for coronal polishing, its protocols and techniques, and product selections, including what to use and how to use it, as well as what not to use and why. Understanding these factors will help dental assistants better meet the doctors' and patients' expectations.
From the patient's perspective, it’s important to understand the four distinct objectives that must be met for patient satisfaction. First is the cosmetic aspect of “the cleaning” — stain removal. This is often the most significant element to patients simply because they like the look and feel of polished teeth. Equally as important to patients are the taste and smell sensations the taste bud receptors perceive. In other words, what you choose to use should taste good. The next issue is to understand what’s in the compound that could be considered both good and bad to special needs patients, such as aspartame, saccharin, or gluten. Lastly, the blend and texture of the formula should focus on splatter-free, thus eliminating prophy paste in the hair, on the glasses, etc.
These advanced technologies, along with innovative manufacturers, have given us amazing products that help us give patients the stunning smiles they want, and we’re happy to be able to exceed patients’ expectations.
What to choose
When choosing a prophy paste, flavor and aroma are as important as grit selection. Gone are the days of tasteless pastes, which have been replaced with products that have superior taste and smell.
When asking a patient for flavor preference, hygienists know that most adults choose either cherry or mint, and mint reminds them of their familiar flavored toothpaste. Then there are flavors targeted primarily to children, such as cotton candy and blue raspberry.
KOLORZ, the preventative line manufactured by DMG America, co-developed their products with gourmet food experts. Special attention was given to taste and smell, which satisfies two patient-pleasing factors. Sweetener selection also affects taste. KOLORZ contains no controversial sweeteners such as aspartame or saccharin. Instead it contains sucralose, which is commonly found in Splenda®, and xylitol, a natural sweetener found in fruits and berries. Studies are being conducted to see if the use of xylitol leads to a reduction in dental caries.
Another key factor in prophy paste development are the "specialty products" formulated for particular needs patients. For example, some patients are sensitive to wheat and wheat bi-products. They suffer from celiac disease, and selecting products that are gluten-free eliminates the chance of an allergic reaction. Unfortunately, gluten is found in many coloring and flavoring additives used in dentistry, so it is important to pay special attention to packages to see if they are labeled “gluten free.” Whenever there is a medical concern, products that are specifically made without flavoring, coloring, fluoride, or oils, such as Preventech's Nada, Denticator SureClean, or Whip Mix's Preppies, are good choices.
The impact of polishing
Some people view coronal polishing as a simple procedure with limited risk factors, but coronal polishing has the potential to abrade tooth structure and alter the surface characterization of esthetic restorations. Improper polishing techniques or an inappropriate cleaning or polishing compound can cause patient discomfort and create needless trauma to the soft tissue and pulp.
Cleaning and polishing agents: understanding the difference
There are differences in polishing pastes, such as grit size — fine, medium, coarse, and extra coarse. Some grits just clean or just polish, and many do both. The majority of prophy pastes are pumice-based, with particles that become smaller when they are used during the polishing procedures.
Cleaning agents do not contain abrasive particles, destroy tooth structure, or damage esthetic restorations. However, the majority of polishing pastes do contain abrasive particles that are usually harder than the surface being polished. Coarse paste removes stains but leaves a rougher tooth surface, which stains faster. However, medium grit prophy paste removes stain effectively and quickly with less abrasion to enamel or dentin. The finer the abrasive material, the finer the scratches, and the smoother and shinier the surface.
Manufacturers have produced specially formulated polishing compounds that protect the integrity of composite and ceramic restorations and improve luster. Typically, composites should be polished with aluminum oxide polishing pastes, while porcelain should be polished with diamond paste. These special polishing agents are designed to replenish and seal composite materials while restoring luster, but they are not designed to remove stains. These include Waterpik's Soft Shine, Ivoclar Vivadent’s Proxyt, and IC Care's CPR.
Traditional prophy paste is the most common material for stain removal. However, for patients with coronal staining it is important to identify the type of stain in order to determine which products to use.
Extrinsic stains vary in origin and color, and the protocols for removal vary as well. The most common external stains, yellow and orange, result from poor oral hygiene and can be easily removed with light polishing. Another common stain, the green staining often seen in children with very poor oral hygiene, indicates demineralized enamel. It is important to prevent further loss of tooth structure in these situations, so coronal polishing is contraindicated. The impact of prophy pastes on demineralization is noteworthy: not only will prophy paste remove the majority of the fluoride ion remaining on the surface, it may also damage the enamel so much that it is difficult to remineralize.
Brown stains are caused from pigmented beverages and foods, tobacco use, or chlorhexidine, and are a bigger challenge to remove. However, black-line stain is calculus-like and forms along the gingival third of the tooth near the gingival margin. Black line stain firmly attaches to the teeth and requires moderate instrumentation to be removed.
While removing stain with a prophy cup and paste, it is imperative to decrease the pressure applied to the tooth surface. As we know, root surface is much softer than enamel, and more tooth structure is lost when polishing exposed root as compared to enamel.
According to dental distributors, “The majority all prophy paste sold in this country is coarse or extra-coarse; fine prophy pastes only account for a small percentage of sales.” It is true that coarse pastes remove stain faster, but there is a price, especially to the root structure. Remember that more patients are being scheduled on a more frequent basis for periodontal maintenance, doubling the risk of potential damage.
For safe, effective polishing, it is important to remember that after polishing, a topical fluoride is recommended to replace what was removed during the polishing procedure. The much needed fluoride therapy helps reduce the solubility of the enamel surface by replacing the apatite with fluorapatite, thus reducing further breakdown.
Shannon L. Pace-Brinker, CDA and a 1994 graduate of the Dental Assisting Program at Bowman Gray School of Medicine, works with Dr. John Cranham in his private practice in Chesapeake, Va. She has been a dental assistant for more than 20 years. Shannon is the past president of the Metrolina Dental Assistants Society in Charlotte. She is also on the advisory board for the dental assistant program at Central Piedmont Community College. She is a member of the AACD and serves on its New Member Committee. She is also on The Journal of Cosmetic Dentistry’s editorial board. Shannon is the first auxiliary to sit on the AACD Executive Board. She is an evaluator for Dental Advisor and consultant for many dental manufacturers.
To visit her new venture, Contemporary Product Solutions, click here. On her CPS site, Shannon will provide editorial that combines product review for the whole team — dentists, assistants, hygienists, front desk associates, and dental laboratory personnel. This full-service publication will inform the dental team of the latest comprehensive clinical product information.