I would ask my patients to float their tongue across those freshly finished surfaces and proudly tell them that this is how your teeth should feel all the time following proper tooth brushing. I had spent countless hours perfecting my technique; I excelled at coronal polishing. However, it was beyond frustrating to have less than optimum results, since my gratification came from seeing stain-free dentition. That was an unattainable goal with too many patients, but I gave it my all nonetheless. Selective polishing was a concept (or passing fad) that I did not seriously consider for many years. Forget about esthetically unpleasing to the patient, those stained tooth surfaces were unpleasing to the perfectionist in me!
?Back in the day? without benefit of an air polisher or a powered scaler, I used coarse prophy paste to muscle off stubborn extrinsic staining - resorting to extra coarse paste for the tobacco users. I considered the bristle brush my go-to for any stain resisting my efforts and would often use scissors to transform a flat brush into a tapered one more suited to the task at hand. No exposed tooth surface with remaining stain was off limits for the bristle brush (yes, yes I am ashamed of myself too). I used a medium polish as the standard grit. For patients with hypersensitivity, a topical fluoride gel mixed with fine flour pumice in a glass dappen dish seemed to do the trick. Those patients came to request the ?custom? polishing paste, perceiving it as something extra special just for them. For the kids who protested the use of a gritty paste, a dollop of child-friendly toothpaste was and still is an acceptable substitute. I did and do floss with paste in place to help remove interproximal staining and dental plaque.
At some point, for patients presenting with moderate to heavy plaque/biofilm, I began to initiate deposit removal with coronal polishing instead of scaling. I pondered the following questions. Why scale plaque/biofilm? Why sweep when you can vacuum? Why eat jello with a fork when you have a spoon handy? In other words, without benefit of an ultrasonic to de-plaque tooth surfaces, why not polish first to emulsify the plaque and get it out of the way? How can I do a decent job of probing or doing a dental exam with all that debris clinging to the teeth? Hey, why not?!
I realized after reading a dental hygiene journal article some time later that I was of the same mindset of at least one other person and felt my version of selective polishing was validated. However, I was still working under a misconception as to what the term ?selective polishing? actually meant; I was still putting my clinician motivated needs ahead of ?evidence-based? patient needs. I still find polishing first to be a prudent approach with some patients. However, my thought process (read rationalization) is more in tune with providing a clear field for the periodontal and dental examinations and therefore a more accurate assessment of the patient?s oral needs. Lest I leave the door open for criticism of not educating the patient first in self-care instruction with the plaque/biofilm in place, I would, in fact, address that with the patient prior to implementing the polishing.
The concept of selective polishing came to the forefront for me when I became responsible for teaching others why, when and how to coronal polish. I needed then to re-read the Extrinsic Stain Removal chapter in Dr. Esther Wilkins? ?Clinical Practice of the Dental Hygienist.? And oh, do things make more sense when read from the perspective of a seasoned clinician as opposed to a floundering dental hygiene student.
Of course a couple of decades had passed between the 3rd edition of my youth and the 9th edition that I acquired at the onset of my teaching assignment. With the passage of time, coronal polishing was a point of debate within the dental hygiene community. There was strong support for its use as a limited adjunctive service, only for the removal of extrinsic stain that the patient found esthetically displeasing barring that no medical or dental condition prohibited it.
Even though polishing was/is not considered therapeutic by definition, I still polished the majority of my patients since I was not convinced that coronal polishing was without any redeeming qualities. I did, however, become more discriminating with prophy paste grit, was less inclined to apply a bristle brush to tobacco stained root surfaces, and in general would not touch a stain-free surface provided the plaque/biofilm had also been removed during either ultrasonic or hand-scaling. Having to teach polishing to others, I now understood better myself that the potential for inadvertent removal of microns of tooth structure, and therefore iatrogenic hypersensitivity, were outcomes of polishing every tooth, every re-care visit without regard for product applied and technique implemented.
With the advent of modern prophy pastes that provide the tooth surface with bio-available minerals, I believe that coronal polishing will be making an about-face and come to be deemed as a therapeutic intervention for those patients at risk for caries and/or with complaints of hypersensitivity when these products are applied. Selective polishing will now be the rule rather than the exception, and clinicians should be actively educating themselves as to the plethora of products on the market specifically designed to remineralize acid-damaged tooth surfaces. I?m excited to be able to offer a significantly improved polishing experience for my patients, which has a decidedly positive spin on it (pun intended). Perhaps it?s time to create a new term for coronal polishing when utilizing the cutting edge technology which now embodies its therapeutic potential.
I think ?enhanced polishing? has a nice ring to it. What do you think?
Denise M Heater, RDH, MSEd, is a full-time faculty member in the SUNY Canton Dental Hygiene Program located in Rome, New York, as the lead freshmen pre-clinical and clinical instructor. She also works clinically in a private practice in Syracuse, New York.