American Dental Hygienists' Association Position on
Polishing Procedures
The American Dental Hygienists' Association (ADHA) takes the following
position regarding polishing procedures:
- Only a licensed dental hygienist or dentist is qualified to determine the
need for polishing procedures.
- Polishing should be performed only as needed and not be considered a
routine procedure.
Background
Historically, polishing has been a routine part of the
prophylaxis
appointment. It was believed to be important to have smooth, stain-free
tooth surfaces in order to impede the buildup of new plaque.
Patients/clients expected that their teeth be polished after scaling and
root planing to smooth the tooth surface and remove
stains. Recent
literature, however, has changed the way the polishing procedure is viewed.
Today, polishing is viewed as a cosmetic procedure with little therapeutic
benefit.(1,2) Unfortunately, many consumers do equate
polishing with the
oral prophylaxis. Nevertheless, polishing is not essential to the
prophylaxis, as once thought. In fact, it is considered poor oral health
care to provide polishing services only and have a patient/client believe
he/she is "getting their teeth cleaned." "Polishing"
involves making a
surface smooth; "cleaning" involves removing debris and extraneous
matter
from the teeth.(1) "Oral prophylaxis", then,
is defined by the
from the exposed and unexposed surfaces of the teeth by scaling and
polishing as a preventive measure for the control of local irritational
factors."(3) The prophylaxis procedure as stated here is performed on the
healthy mouth to prevent periodontal disease.
Recent literature shows that thorough brushing and flossing at home can
produce the same effect as polishing.(4) Therefore,
one can conclude that
polishing of coronal surfaces on a routine basis provides no additional
benefit to the patient/client. It is also argued in the literature that
continuous polishing can, over time,; cause morphological changes in the
teeth by abrading tooth structure away.(5) Additionally, the fluoride in the
outer layers of enamel is removed through polishing.(1) Thus, researchers
agree that polishing is no longer considered to be necessary on a routine
basis. The dental hygienist/dentist must assess each patient for the amount,
type, and location of stain present to determine the need for polishing.
Another reason polishing was considered important in the past was to remove
plaque and stain prior to a fluoride treatment to insure adequate uptake of
fluoride in the enamel. Research now shows that polishing does not improve
the uptake prior to a professionally applied fluoride treatment.(6,7)
Steele's and Tinanoff's studies in 1982 and 1974
respectively showed that
brushing and flossing were adequate methods of plaque removal prior to
fluoride treatments, and fluoride uptake was not adversely affected by lack
of a rubber cup polishing.
Polishing prior to sealant application is another area of recent debate.
Formerly, it was believed that it was necessary to polish tooth surfaces
prior to sealant placement to insure proper acid etching and sealant
penetration. However, several recent studies have shown other methods of
plaque removal to be equally efficient. They include use of an explorer and
forceful rinsing with water, tooth brushing with toothpaste, hydrogen
peroxide, and use of an air polisher.(8-11)
Air polishing was introduced in the 1980s and has been found to be
especially useful in certain instances. In addition to being used during the
prophylaxis, it has been found to be useful for orthodontic patients, root
detoxification during periodontal surgery, and sealant procedures.(11-13)
However, with any procedure, appropriate knowledge and technique are
important. The clinician must be aware of its limitations,
contraindications, and most importantly, its proper use. Generally, it is
indicated on patients with heavy amounts of stain, especially chlorhexidine.
There are numerous contraindications and other concerns, however, that
prohibit indiscriminate use of the air polisher in certain patient
groups.(14)
- Patients with restricted sodium diets - Patients with respiratory, renal,
or metabolic disease - Patients with infectious disease - Children -
Patients on diuretics or long-term steroid therapy - Patients with titanium
implants (Research is still needed in this area)
Air polishers also should not be used on patients/clients with exposed
cementum or dentin. A study by Galloway and Pashley in 1986 showed the air
polisher can cause clinically significant loss of tooth structure if used
excessively.(15) In addition, an air polisher should be avoided around most
types of restorative materials due to the possibility of scratching,
eroding, pitting, or margin leakage.(1)
Legislation
Currently, approximately 23 states allow dental assistants to perform
coronal polishing.(16) This raises a concern because only about half of
these states require education or examination in polishing for dental
assistants There is also a lack of standardization for education,
examination, or certification for dental assistants among states. Another
concern, to insurance companies as well as consumers, is the potential for
fraud by billings for a prophylaxis when only a polishing is performed.
Coupled with many states' legislative attempts to allow dental assistants to
perform supragingival scaling, this puts the
consumer's oral health at
serious risk. Incomplete removal of deposits from above and below the
gumline can lead to several problems: 1) If bacteria-laden deposits are not
completely removed, the bacteria continue to multiply and the disease
process is not stopped. 2) When deposits are not removed from the base of
the pocket, the tissue will shrink and tighten around the neck of the tooth,
and bacterial toxins are trapped in the pocket. This can result in a
periodontal abscess. 3) When healing and tissue shrinkage occur at the neck
of the tooth, the tissue becomes tighter, and it is more difficult to place
an instrument in the pocket for removal of remaining deposits.(17)
Conclusion
Polishing should not be considered a routine part of the oral prophylaxis.
The licensed dental hygienist or dentist is the best qualified to determine
the need for polishing. The ability to judge appropriately which
patients/clients should or shouldn't be polished is compromised if a
practitioner is not knowledgeable. ADHA believes that licensed dental
hygienists and dentists are the best qualified to perform polishing
procedures.
Notes
1. Woodall IR: _Comprehensive Dental Hygiene
Care", 4th edition. St. Louis,
Mosby-Year Book, Inc., 1993, pp. 648, 660.
2. Walsh MM, Heckman B. et al.: Effect of a rubber cup polish after scaling.
"Dental Hygiene" 1985;59(11):494-498.
3.
edition.
4. Waring MB, Horn ML, et al.: Plaque reaccumulation following engine
polishing or tooth brushing?a
90-day clinical trial. "Dental Hygiene"
1988;62:282-285.
5. Swan RW: Dimensional changes in a tooth root incident to various
polishing and root planing procedures. "Dental
Hygiene" 1979;53:17-19.
6. Steele RC, Waltner AW, Bawden
JW: The effect of tooth cleaning procedures
on fluoride uptake in enamel. "Pediatric Dentistry" 1982;4:228-233.
7. Tinanoff N, Wei SHY, Parkins FM: Effect of a pumice prophylaxis on
fLuoride uptake in tooth enamel. "Journal of the
American Dental
Association" 1974;88:384-389.
8. Donnan MF, Ball IA: A double-blind clinical trial
to determine the
importance of pumice prophylaxis on fissure sealant retention. "British
Dental Journal" 1988;165(8):283
9. Houpt M, Shey Z: The
effectiveness of a fissure sealant after six years.
"Pediatric Dentistry" 1983;5(2):104-106.
10. Christensen CJ: Fluoride made it: Why haven't sealants? "Journal of
the
American Dental Association" 1992;123(2):89-90.
11. Brocklehurst PR,
occlusal surfaces on the penetration of fissures by a
sealant.
"International Journal of Pediatric Dentistry" 1992;2:157-162.
12. Gerbo LR, Barnes CM, Leinfelder
KF: Applications of the air-powder
polisher in clinical orthodontics. "American Journal of Orthodontics and
Dentofacial Orthopedics" 1993:103(1):71-73.
13. Horning GM, Cobb CM,
on root surfaces in periodontal surgery. "Journal of Clinical
Periodontology" 1987;14:213.
14. Brown SM: A scientific foundation for the clinical use of air polishing
systems, Part II: Technique. "Practical Hygiene" 1995;4(6):14-19.
15. Galloway SE, Pashley DH: Rate of removal of root
structure by the use of
the prophyjet device. "Journal of
Periodontology" 1986;58(7):464-469.
16. American Dental Association: "Legal Provisions for Delegating
Functions
to Dental Assistants and Dental Hygienists". Chicago, American Dental
Association, 1993, p. 16.
17. O'Hehir TE: Gross scaling: An antiquated concept.
"Dental Hygiene News"
1994;7(1):19-20.American Dental Hygienists’
Association Position on
Polishing Procedures
キーワード
ポリッシング、PMTC
Copyrights(c) 2001 Hiroshi Miyashita DDS.
All rights reserved.