Indications and Contraindications for Coronal Polishing.
What is coronal polishing?
Coronal polishing is defined as the procedure that removes plaque and stain from the coronal surfaces of teeth. It gives the patient the “clean and sparkly” feeling and concludes many dental appointments. As much as the patient may love having their teeth polished, beware that there are rules to follow (if you are aiming to be that amazing dental hygienist).
And see the word “Coronal” in “Coronal polishing.” That means you are supposed to only polish the crown part of the tooth, not the roots. This is because the root is much weaker than the crown. As you may know, the enamel is one of the hardest parts of the body.
Do I need to learn about coronal polishing for the dental hygiene National Boards?
For the NBDHE and NDHCE National Boards exams, it is important to understand the concept of coronal polishing because this may come up in your case study about how to treat a patient. Coronal polishing is part of the full treatment plan and it is our job as dental hygienists to see if we have to provide coronal polishing or if we have to say no. Most likely you will see at least one question in your dental hygiene National Boards about this topic.
Why do we perform coronal polishing?
Let’s start with why coronal polishing is part of dental treatment. Polishing can:
- Create a smooth tooth surface that is less likely to retain plaque, calculus, and stain.
- Remove extrinsic stain.
- Enhance fluoride absorption and discourages the buildup of new deposits.
- Prepare teeth for various dental procedures.
One important point to mention is that coronal polishing is NOT a substitution for dental prophylaxis. Coronal polishing does not remove calculus. Only thorough dental prophylaxis (also known as a “cleaning” by a dental hygienist) can remove the calculus.
Indications for coronal polishing
Now, when do you say yes or no to coronal polishing? Here are the indications for coronal polishing:
- Removal of light stain.
- Removal of light plaque.
- Placement of sealants.
- Placement of dental dam.
- Placement of orthodontic bands and brackets.
- Placement of crowns and bridges.
- Removal of temporary cement residues.
- Surface cleaning before the selection of a tooth shade guide.
Contraindication for coronal polishing
Now, here are the contraindications for coronal polishing:
- Absence of stain.
- Patient has demineralized spots.
- Patient has root caries.
- Gold, composite, acrylic veneers, porcelain restorations.
- Immediately after SRP and NSPT to avoid reintroduction of bacteria. Polishing can be done at succeeding appointments.
- Patients with hypertension, Addison’s disease, Cushing’s syndrome, and metabolic alkalosis, as pumice, can contain sodium.
- Patients with respiratory and infectious diseases, as polishing creates aerosols.
- Patients with periodontitis/gingivitis - unhealthy, spongy, edematous tissue.
- Intrinsic stain.
- Recession with tooth sensitivity.
- Demineralized areas or thin enamel as in amelogenesis imperfecta. Decalcified or demineralized areas appear chalky white.
- Newly erupted teeth as the surfaces have not been fully mineralized yet.
- Teeth with large pulp chambers, such as primary teeth.
- Areas of exposed cementum and dentin.
One of the most common mistakes the dental professionals make is to polish all the teeth regardless of the patient’s condition. If you look at the list above, you may realize that you provided polishing to the pediatric patient when he/she had demineralized spots that needed the dentist’s attention first. Or, maybe you polished the patient’s teeth without checking if the patient had a medical condition that can spread through aerosol. You may also have done all the right things!
Take a moment to look back at your previous experience. The goal is to enhance our knowledge and become the dental professional everyone can trust!
Did you know that StudentRDH has a great National Boards Review course? Click here if you are interested!
Let’s try a few questions and practice the scenarios.
Q1: Coronal polishing is indicated when:
A. The patient has tuberculosis
B. The stain is extrinsic
C. Gingivitis is present
D. The temporary crown came off
Q2: Which of the following is a contraindication for coronal polishing?
A. Dental dam
Q3: Which of the following is a contraindication for coronal polishing?
A. Removal of cement
B. Placement of orthodontic bands
C. No obvious stain
D. Placement of bridge
Answers: B, C, C
Now that you have mastered when to and not to provide coronal polishing, l would like to explain one more concept. Have you heard of the term “selective polishing”? This word is extremely important if you are taking the NBDHE and NDHCE National Boards exams.
In brief, selective polishing means that you must carefully choose the cases and teeth for coronal polishing. If we continue with the example of the decalcified tooth, with selective polishing, you could work on the other teeth and skip the ones with decalcification. Or you could polish the teeth that have an only visible extrinsic stain.
The judgment made by the dental hygienist when polishing teeth can directly affect the patient’s oral health. If you know your indications and contraindications, you will provide better care. And occasionally, you may have a patient that “wants polishing at all costs.” If that happens, you are now armed with the proper knowledge to justify your decisions.
Have a wonderful time polishing! Remember that you are a key player in the dental office, so your knowledge and action matter. #DHstrong
Author: Claire Jeong is an educator and entrepreneur. She founded StudentRDH and SmarterDA – which offer dental hygiene and dental assisting exam prep courses. The online platform delivers content of the highest quality through the latest e-learning technology. According to some students, studying is now “addicting.” Claire was invited on various podcasts to speak about memory techniques and learning efficacy; topics she also promotes through articles, speeches, e-books, and blogs.
Claire has a Master’s Degree in Administration from Boston University and a Dental Hygiene Degree from Forsyth School of Dental Hygiene in Boston. Prior to her career in the dental field, she has been mentoring students for 15 years and was an education specialist at Boston Children’s Museum.
Related article: [Embriology] How to Remember the Stages of Tooth Development