Coronal Polishing
Chapter 58
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 58
Lesson 58.1
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
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Pronounce, define, and spell the Key Terms.
Explain the difference between prophylaxis
and coronal polishing.
Explain the indications for and
contraindications to coronal polishing.
Name and describe the types of extrinsic
stains.
Name and describe the two categories of
intrinsic stains.
Describe types of abrasives used for
polishing the teeth.
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Introduction
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Coronal polishing is a technique used to remove
plaque and stains from the coronal surfaces of the
teeth. Polishing the crowns
of the teeth is considered mainly cosmetic, but there
are instances in which coronal polishing has
therapeutic value as well.
In some states, coronal polishing is delegated to
registered or expanded-function dental assistants
who have had special training in this procedure.
Coronal polishing is strictly limited to the clinical
crowns of the teeth. Coronal polishing is not a
substitute for oral prophylaxis.
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Selective Polishing
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Selective polishing is a procedure in which
only those teeth or surfaces with stain are
polished.
The purpose of selective polishing is to avoid
removing even small amounts of surface
enamel unnecessarily.
In some individuals, stain removal may cause
dentinal hypersensitivity during and after the
appointment.
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Coronal Polishing and Fluoride
Application
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Historically teeth were polished to remove all
soft deposits and stains before the application
of fluoride because it was believed that there
would be greater uptake of the fluoride into
the enamel.
As scientific knowledge has evolved, it has
been shown that polishing does not improve
the uptake of professionally applied fluoride.
Therefore polishing is no longer necessary
before fluoride application.
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Benefits of Coronal Polishing
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Polishing prepares the teeth for the
placement of dental sealants.
Smooth tooth surfaces are easier for the
patient to keep clean.
The formation of new deposits is slowed.
Patients appreciate the smooth feeling and
clean appearance.
Polishing prepares the teeth for the
placement of orthodontic brackets and bands.
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Dental Stains
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Stains of the teeth occur in three
basic ways:
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A stain adheres directly to the surface of the tooth.
A stain is embedded in calculus and plaque
deposits.
A stain is incorporated into the
tooth’s structure.
It is important to distinguish between the
types of stains before coronal polishing is
undertaken to remove them.
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Dental Stains
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Stains are primarily an aesthetic problem.
Some types of stains can be removed, and
others cannot. It is important for the dental
assistant to be able to correctly identify
stains.
There are other treatment options for patients
with stains that cannot be removed.
These include professional and at-home
bleaching procedures, enamel microabrasion,
and cosmetic restorative procedures such as
laminate veneers and composite restorations.
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Types of Dental Stains
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Dental stains are categorized as either
endogenous or exogenous:
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Endogenous stains originate within the tooth as a
result of developmental and systemic
disturbances.
Exogenous stains originate outside the tooth in
response to environmental agents.
Exogenous stains are those stains caused by
an environmental source:

They are subdivided even further as extrinsic or
intrinsic stains, depending on whether the stain
can be removed.
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Extrinsic and Intrinsic Stains
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Extrinsic stains are stains on the exterior of the tooth
that can be removed. Examples include staining from
food, drink, and tobacco. The source of the stain is
external and the stain may be removed.
Intrinsic stains are caused by an environmental
source but cannot be removed because the stain has
become incorporated into the structure of the tooth.
Examples are tobacco stain from smoking, chewing,
or dipping and stains from dental amalgam that has
become incorporated into the tooth’s structure.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 58-2 Endogenous developmental stain: tetracycline.
(Courtesy of Santa Rosa Junior College, Santa Rosa, Calif.)
Notice how the stained area corresponds to the period of tooth development
and the time at which the drug was taken.
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Fig. 58-3 Endogenous developmental stain:
enamel hypoplasia.
(From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and
competencies, ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 58-4 Endogenous developmental stain:
dental fluorosis.
(From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and
competencies, ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 58-5 Endogenous developmental stain: secondary caries.
(From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and
competencies, ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 58- 6 Endogenous stain: amalgam restoration.
(From Daniel SJ, Harfst SA, Wilder R: Mosby’s dental hygiene: concepts, cases and
competencies, ed 2, St Louis, 2008, Mosby. Courtesy of Dr. George Taybos, Jackson, Miss.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Methods of Removing Plaque and
Stain
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Air-powder polishing
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The air-powder polishing technique involves the
use of a specially designed handpiece with a
nozzle that delivers a high-pressure stream of
warm water and sodium bicarbonate.
Rubber-cup polishing
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This is the most common technique for removing
stains and plaque and polishing the teeth.
A rubber polishing cup is rotated slowly and
carefully by means of a prophylactic angle
attached to the slow-speed handpiece.
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Rotary Equipment for Coronal
Polishing
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Polishing cups
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Soft webbed polishing cups are used to clean and
polish the smooth surfaces of the teeth. The
polishing cup is attached to the reusable
prophylaxis angle by means of a snap-on or
screw-on attachment.
Prophylaxis angle

Commonly called a prophy angle, this tool
attaches to the slow-speed handpiece.
 The reusable prophy angle must be properly
cleaned and sterilized after each use.
 A disposable angle is discarded after a single use.
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Fig. 58-1 Bristle brush (top) rubber polishing cup (bottom),
sterilizable prophy angle (center), and disposable prophy
angle (right).
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Bristle Brushes
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Bristle brushes, made of natural or synthetic
materials, may be used to remove stains from
deep pits and fissures of the enamel
surfaces.
Bristle brushes can cause severe gingival
lacerations and must be used with special
care.
Brushes are not recommended for use on
exposed cementum or dentin because these
surfaces are soft and are easily grooved.
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Abrasives
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Dental abrasives (polishing materials) are used to
remove stain and to polish natural teeth, prosthetic
appliances, restorations, and castings.
They are available in extra coarse, coarse, medium,
fine, and extra fine grits. The coarser the agent, the
more abrasive the surface.
Even a fine-grit agent removes small amounts of the
enamel’s surface.
The goal is to always use the abrasive agent that will
produce the least amount of abrasion to the tooth
surface.
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Factors That Influence the Rate of
Abrasion
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The more agent used, the greater the degree
of abrasion.
The lighter the pressure, the less abrasion.
The slower the rotation of the cup, the less
abrasion.
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Chapter 58
Lesson 58.2
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Learning Objectives
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Describe the types of abrasives used for porcelain
aesthetic restorations.
Name materials to avoid when polishing aesthetic
restorations.
Describe the technique for polishing aesthetic
restorations.
Demonstrate the handpiece grasp and positioning for
the prophy angle.
Demonstrate the fulcrum or finger rest used in each
quadrant during a coronal polishing procedure.
(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
(Cont’d)
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Demonstrate the proper seating positions for the
operator and the assistant during a coronal polishing
procedure.
Demonstrate safety precautions to be taken during
coronal polishing.
In states where it is legal, demonstrate coronal
polishing technique.
Complete coronal polishing without causing tissue
trauma.
Be able to determine that the teeth are free of stains
and plaque.
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Polishing Esthetic Type Restorations
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Many patients have crown and bridge restorations
and are having cosmetic resin, composite, bonding,
and veneers placed to enhance their smiles.
Improper oral care can quickly damage many of
these types of restorations.
Coarse polishing paste, use of acidulated phosphate
fluorides, and even hard brushing with abrasive
toothpaste can be destructive to the surfaces of
restorative materials.
A diamond, aluminum oxide, or low-abrasion
toothpaste should be used for these restorations.
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Fig. 58-8 A, It can be difficult to detect esthetic restorations.
Two of these teeth have crowns.
(Courtesy of Dr. Peter Pang, Sonoma, Calif.)
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Polishing Strokes
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Fill the polishing cup with the polishing agent and
spread it over several teeth in the areas to be
polished.
Establish a finger rest and place the cup almost in
contact with the tooth.
The stroke should reach from the gingival third to the
incisal third of the tooth.
Using the slowest speed, lightly apply the revolving
cup to the tooth surface for 1 or 2 seconds.
Use light pressure to make the edges of the polishing
cup flare slightly.
Use a patting, wiping motion and an overlapping
stroke.
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Fig. 58-9 Close-up of hand with handpiece and proper grip.
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Fig. 58-10 Use overlapping strokes to ensure
complete coverage of the tooth.
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Fig. 58-11 Stroke from the gingival third with
just enough pressure to cause the cup to flare.
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Positioning the Patient
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Adjust the dental chair so that the patient is
approximately parallel to the floor with the
back of the chair raised slightly.
Adjust the headrest for patient comfort and
operator visibility.
For the mandibular arch, position the patient's
head with the chin down. When the mouth is
open, the lower jaw should be parallel to the
floor.
For access to the maxillary arch, position the
patient's head with the chin up.
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Fig. 58-12 For the mandibular arch, the patient’s head is
positioned so that the lower jaw is parallel to the floor when
the mouth is open.
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Fig. 58-13 For access to the maxillary arch, position the
patient’s head with the chin up.
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Fig. 58-14 The right-handed operator is seated
at the 9 o’clock position.
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The Handpiece Grasp
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The handpiece and prophylaxis angle are
held in a pen grasp with the handle resting in
the V-shaped area of the hand between the
thumb and index finger.
Proper grasp is important because if the
grasp is not secure and comfortable, the
weight and balance of the handpiece can
cause hand and wrist fatigue.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 58-9 Handpiece grasp.
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Handpiece Operation
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The rheostat (foot pedal) controls the speed
(revolutions per minute) of the handpiece.
The toe is used to activate the rheostat. The
sole remains flat on the floor.
Apply a steady pressure with the toe on the
rheostat to produce a slow, even speed.
Use a low-speed handpiece that operates to
a maximum of 20,000 rpm.
Release the rheostat to prevent debris from
splattering when the handpiece is removed
from the tooth for more than a moment.
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The Fulcrum/Finger Rest
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The fulcrum provides stability for the operator
and must be placed in such a way as to allow
for movement of the wrist and forearm.
The fulcrum is repositioned throughout the
procedure as necessary.
The fulcrum may be either intraoral or
extraoral, depending on a variety of
circumstances such as:
• The presence or absence of teeth
• The area of the mouth being polished
• How wide the patient can open his or her mouth
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Positioning of the Operator
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The operator should keep his or her feet flat on the
floor and the thighs parallel to the floor.
The operator's arms should be at waist level and
even with the patient’s mouth.
When performing a coronal polish procedure, the
right-handed operator generally begins by seating
himself or herself in an 8 to 9 o’clock position.
When performing a coronal polish procedure, the lefthanded operator generally begins by seating himself
or herself in the 3 to 4 o’clock position.
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The Sequence of Polishing
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Full mouth coronal polishing must be performed in a
predetermined sequence to be certain that no area is
missed.
The best sequence is based on the operator's
preference and the individual needs of the patient.
Aesthetic and porcelain restorations should be
polished first, after which the remaining teeth may be
polished with the use of the appropriate methods for
any stain that is present. This reduces the possibility
that a coarse abrasive will remain in the rubber cup
when aesthetic restorations are being polished.
The positions and fulcrums described in the following
slides are for a right-handed operator.
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Setup for Coronal Polishing
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Patient Preparation
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Check the patient's medical history for any
contraindications to the coronal polishing procedure.
Seat the patient and and him or her with a waterproof
napkin. Ask the patient to remove any dental
prosthetic appliances he or she may be wearing.
Provide the patient with protective eyewear.
Explain the procedure to the patient and answer any
questions.
Inspect oral cavity for lesions, missing teeth, tori, and
so on.
Apply a disclosing agent to identify areas of plaque.
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Application of a Disclosing Agent
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Maxillary Right Posterior
Quadrant, Buccal Aspect
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Sit in the 8 to 9 o’clock position.
Have the patient tilt his head up and turn
slightly away from you.
Hold the dental mirror in your left hand. Use it
to retract the cheek or for indirect vision of the
more posterior teeth.
Establish a fulcrum on the maxillary right
incisors.
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Polishing the Buccal Surfaces of
the Maxillary Right Quadrant
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Maxillary Right Posterior
Quadrant, Lingual Aspect
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Remain seated in the 8 to 9 o’clock position.
Have the patient turn his head up and toward
you.
Hold the dental mirror in your left hand. Direct
vision in this position and the mirror provides
a view of the distal surfaces.
Establish a fulcrum on the lower incisors and
reach up to polish the lingual surfaces.
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Maxillary Anterior Teeth, Facial
Aspect
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Remain in the 8 to 9 o’clock position.
Position the patient’s head tipped up slightly
and facing straight ahead. Make necessary
adjustments by turning the patient's head
slightly either toward or away from you.
Use direct vision in this area.
Establish a fulcrum on the incisal edge of the
teeth adjacent to the ones being polished.
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Polishing the Facial Surfaces of
the Maxillary Anterior Teeth
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Maxillary Anterior Teeth, Lingual
Aspect
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Remain in the 8 to 9 o’clock position or move
to the 11 to 12 o’clock position.
Position the patient’s head so that it is tipped
slightly upward.
Use the mouth mirror for indirect vision and to
reflect light on the area.
Establish a fulcrum on the incisal edge of the
teeth adjacent to the ones being polished.
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Polishing the Lingual Surfaces
of the Maxillary Anterior Teeth
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Maxillary Left Posterior
Quadrant, Buccal Aspect
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Sit in the 9 o’clock position.
Tip the patient's head upward and turn it
slightly toward you to improve visibility.
Use the mirror to retract the cheek and for
indirect vision.
Rest your fulcrum finger on the buccal
occlusal surface of the teeth toward the front
of the quadrant.
Alternative: Rest your fulcrum finger on the
lower premolars and reach up to the maxillary
posterior teeth.
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Maxillary Left Posterior
Quadrant, Lingual Aspect
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Remain in the 8 to 9 o’clock position.
Have the patient turn his or her head away
from you.
Use direct vision in this position. Hold the
mirror in your left hand and use for a
combination of retraction and reflecting light.
Establish a fulcrum on the buccal surfaces of
the maxillary left posterior teeth or on the
occlusal surfaces of the mandibular left teeth.
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Mandibular Left Posterior
Quadrant, Buccal Aspect
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Sit in the 8 to 9 o’clock position.
Have the patient turn his or her head slightly
toward you.
Use the mirror to retract the cheek and for
indirect vision of distal and buccal surfaces.
Establish a fulcrum on the incisal surfaces of
the mandibular left anterior teeth and reach
back to the posterior teeth.
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Mandibular Left Posterior
Quadrant, Lingual Aspect
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Remain in the 9 o’clock position.
Have the patient turn his or her head slightly
away from you.
For direct vision, use the mirror to retract the
tongue and reflect more light to the working
area.
Establish a fulcrum on the mandibular
anterior teeth and reach back to the posterior
teeth.
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Polishing the Lingual Surfaces
of the Mandibular Left Quadrant
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Mandibular Anterior Teeth,
Facial Aspect
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Sit in either the 8 to 9 o’clock position or in
the 11 to 12 o’clock position.
As necessary, instruct the patient to make
adjustments in head position by turning either
toward or away from you or by tilting his head
up or down.
Use your left index finger to retract the lower
lip. Both direct and indirect vision can be
used in this area.
Establish a fulcrum on the incisal edges of the
teeth adjacent to the ones being polished.
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Mandibular Anterior Teeth,
Lingual Aspect
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Sit in either the 8 to 9 o’clock position or at the 11 to
12 o’clock position.
As necessary, instruct the patient to make
adjustments in head position by turning either toward
or away from you or by tilting the head up or down.
Use the mirror for indirect vision, to retract the
tongue, and to reflect light onto the teeth. Direct
vision is often used in this area when the operator is
seated in the 12 o’clock position, but indirect vision
can also be helpful.
Establish a fulcrum on the mandibular cuspid incisal
area.
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Polishing the Lingual Surfaces
of the Mandibular Anterior Teeth
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Mandibular Right Quadrant,
Buccal Aspect
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Sit in the 8 o’clock position.
Have the patient turn his or her head slightly
away from you.
Use the mirror to retract tissue and reflect
light. The mirror may also be used to view the
distal surfaces in this area.
Establish a fulcrum on the lower incisors.
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Polishing the Mandibular Right
Quadrant, Buccal Aspect
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Mandibular Right Quadrant,
Lingual Aspect
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Remain in the 8 o’clock position.
Have the patient turn his or her head slightly
toward you.
Retract the tongue with the use of the mirror.
Establish a fulcrum on the lower incisors.
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Flossing After Coronal Polishing
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Dental floss and tape have two purposes after
coronal polishing.
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The first is to polish the interproximal
tooth surfaces.
The second is to remove any abrasive agent or debris that
may be lodged in the contact area.
Place abrasive on the contact area between the teeth
and work the floss
or tape through the contact area, using a back-andforth motion.
A floss threader can be used to pass the floss under
any fixed bridgework to gain access to the abutment
teeth.
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Evaluation of Polishing
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There is no remaining disclosing agent on
any of the tooth surfaces.
The teeth are glossy and reflect light from the
mirror uniformly.
There is no evidence of trauma to the gingival
margins or any other soft tissues in the
mouth.
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Patient Instructions
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Most patients are self-conscious about stains
on their teeth and appreciate any tips you can
give them on how to keep their teeth as white
as possible.
It is important to educate patients about the
causes of stains.
When stains are intrinsic, the dentist may
want you to discuss possible cosmetic dental
care options to satisfy their desire for
attractive and stain-free teeth.
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