POLISHING CONSIDERATIONS*

Careful consideration of patient conditions must occur to achieve the full benefits of rubber cup and air-powder polishing.
The benefits of cleaning and polishing include stain and biofilm removal for enhanced patient satisfaction. As with any patient
Young Dentals
care procedure, both risks and benefits must be weighed.

Rubber Cup Polishing

Guide to Polishing
Allergies to the cleaning and polishing paste
Stain-free areas ingredients
Newly erupted teeth, especially primary teeth Air-Powder Polishing
Areas of decalcification, hypocalcification, hypoplasia, Areas of gingival recession (exposed cementum or
demineralization dentin)
Areas of gingival recession Acute gingival or periodontal inflammation
(exposed cementum or Restored tooth surfaces: composite, veneers, glass
dentin) ionomer, cements, porcelain, gold, titanium (unless
Dentin abrades 20-25 special polishing agents or devices are used for these
times faster than enamel materials)
Cementum abrades 30-35 Patients who have:
times faster than enamel Rampant or early childhood caries
Acute gingival or periodontal inflammation Dentinal hypersensitivity
Immediately after deep scaling, root planing, or extensive Xerostomia
periodontal debridement Communicable disease that could be spread via

Restored tooth surfaces: composite, veneers, glass contaminated aerosols

ionomer, porcelain, gold, titanium (unless special A compromised immune system and are susceptible
polishing agents or devices are used for these materials) to infection
Implants (specially-designed ultrasonic and sonic tips High risk of adverse effects from infective endocarditis
can remove soft and hard deposits safely) if not premedicated
Patients who have: Respiratory problems which may be further

Rampant or early childhood caries compromised by contaminated aerosol, e.g., asthma,

emphysema, cystic fibrosis, chronic bronchitis, lung
Dentinal hypersensitivity cancer and persons who carry oxygen
Xerostomia
Allergies to the air-powder ingredients
Respiratory problems which may be further
End-stage renal disease, Addisons disease, Cushings
compromised by contaminated aerosols, e.g., asthma, syndrome or metabolic alkalosis
emphysema, chronic bronchitis, cystic fibrosis, lung
Sodium-restricted diets (use sodium-free polishing
cancer and persons who carry oxygen

powder such as aluminum trihydroxide and calcium

Communicable disease that could be spread via
carbonate, or calcium sodium phosphosilicate)
contaminated aerosols
Conditions in which they must take potassium, anti- Rubber cup and air-powder polishing are professional services performed by dental hygienists during preventive,
High risk of adverse effects from infective endocarditis
diuretics, or steroid-therapy
if not premedicated therapeutic, or maintenance care appointments. The primary goal of the polishing procedure is selective stain
*Considerations may vary with the assessed needs of the patients and the removal on coronal tooth surfaces. Secondary benefits of polishing include plaque biofilm removal and a smooth
materials and devices used.
surface that reduces future adherence of plaque biofilm and extrinsic stain. After dental scaling and debridement,
selective stain removal leaves the teeth stain-free, lustrous, and feeling clean and smooth.
REFERENCES FOR GUIDE:
This guide reviews information that every dental hygienist should know in order to clean and polish tooth enamel
American Dental Hygienists Association. Position paper on polishing procedures. Available at: www.adha.org/profissues/polishingpaper.htm. Accessed October 24, 2011.
Barnes, C, Polishing Esthetic Restorative Materials. Dimensions of Dental Hygiene. Web. 28 Nov. 2011. http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=6894. and dental restorations safely and effectively, and to teach patients about the value and limitations of polishing.
Barnes, C, The Science of Polishing. Dimensions of Dental Hygiene. Nov 2009; 7(11): 18-20, 22. It should be used in conjunction with knowledge of evolving evidence-based research literature, professional
Barnes, C, Watanabe, Hidehiko and Johnson, Effects of a Paste-free Prophylaxis Polishing Cup and Various Prophylaxis Polishing Pastes on Tooth Enamel and Restorative
Materials. Academy of General Dentistry (2011). Web. 21 Nov. 2011. http://www.agd.org/publications/articles/?ArtID=10179.
judgement, and an understanding of the patients values.
Bird, D, Robinson, D and Torres, H, Torres and Ehrlich. Modern Dental Assisting. St. Louis, MO: Saunders Elsevier, 2009. 941. Print.
Darby M, Walsh MM. Dental Hygiene Theory and Practice. 3rd ed. St. Louis: Saunders; 2010: 511-528.
PROPHY 0112

Darby, M, Comprehensive Review of Dental Hygiene. 7th ed. St. Louis, Elsevier; 2012.
Gladwin, M, and Bagby, M, Clinical Aspects of Dental Materials: Theory, Practice, and Cases. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. 202-206.
Jones, T. Polishing Techniques for Beauty and Longevity Dentistry Today. Oct. 2009. Web. 30 July 2010. http://www.dentistrytoday.com/aesthetics/aestheticsrestorative.maintenance/
113-polishingtechniquesforbeauty-and-longevity.
Schroeder-Drucks, C, Selective Polishing. Inside Dental Assisting (Nov/Dec 2009) Web. 30 Jan 2012. http://www.dentalaegis.com/ida/2009/12/selective-polishing.
2012 Young Dental Manufacturing I, LLC

Wilkins, E. Clinical Practice of The Dental Hygienist. 11 ed. Baltimore: Lippincott Williams & Williams: 2013; 689-708.

Elite and ProphyPal are trademarks owned by Young Dental Manufacturing I, LLC and its related companies. All other trademarks and trade names are the property of their respective owners.
This guide was reviewed and edited by: Michele Darby, RDH, MS, Chairperson, Gene W. Hirschfeld School of Dental Hygiene, Old Dominion University
and Pamela Brilowski, RDH, MS, Director, Waukesha County Technical College Dental Hygiene Program

Young Dental Manufacturing 13705 Shoreline Court East Earth City, MO 63045

4
DEFINITIONS
Abrasive Agent A material composed of particles of
sufficient hardness and sharpness to cut or scratch a softer
material. Known to clean away stains, plaque biofilm and
polish substrates.
Air-Powder Polishing The process of cleaning and
polishing the dentition and some dental restorations using a
device that mixes air and water pressure with a powder such
as sodium bicarbonate, aluminum trihydroxide, glycine,
calcium sodium phosphosilicate, or calcium carbonate to
remove remaining plaque biofilm and extrinsic stain after
scaling.
Cleaning The process of removing plaque biofilm and
extrinsic stain from tooth surfaces after scaling using a
latex-free cup and/or bristle brush on a prophylaxis angle
attached to a low-speed handpiece; accomplished with an
appropriate grit abrasive agent. Selection of grit coarseness
depends on the severity and type of stain as well as the
assessed patients needs.
Coronal Polishing Polishing crowns of teeth to remove
visible extrinsic stains. Does not include scaling to remove
calculus.
Dental Biofilm Non-mineralized mass of structured
communities of microorganisms bound together by an
intermicrobial enclosed matrix that is interwoven with
channels that deliver nutrients to the microorganism.
Grit Term used to reference the particle size of different
abrasive agents. Fine, medium, and coarse refer to particle
size.
TYPES OF DENTAL STAINS
Extrinsic Stain
Occurs on the external
tooth surfaces and calculus
Examples: tobacco, red
wine, chlorohexidine,
tea, coffee
Controlled with proper oral self-care, rubber cup
polishing, hand, sonic, or ultrasonic scaling and
air-powder polishing
Intrinsic Stain
Occurs on the internal
tooth structure
Examples: fluorosis,
tetracycline stains,
hypoplasia, trauma
discoloration
Cannot be removed with oral self-care, rubber cup
polishing, hand, sonic, or ultrasonic scaling or
air-powder polishing
Managed by dental restorations or tooth whitening
2 3
Oral Prophylaxis Prevention of plaque biofilm and stain
accumulation by professional cleaning and polishing the
teeth. Ultrasonic, sonic, and/or hand scaling is included in
the oral prophylaxis procedure.
Polishing (also known as cosmetic polishing) The process
of achieving a smooth, mirror-like enamel or material surface
that reflects light and is characterized as having a high
luster; accomplished with a finer grit abrasive agent. May
also encompass cleaning.
R.P.M. Acronym for revolutions per minute. Used when
discussing the speed of prophy cup rotation during
polishing.
Selective Stain Removal (also known as rubber cup
polishing and extrinsic stain removal) The process of
cleaning and polishing tooth surfaces to remove extrinsic
stains that may remain after scaling using a latex-free cup
and/or bristle brush on a prophylaxis angle attached to
a low-speed handpiece, and an appropriately selected
abrasive agent.
Selective Polishing The polishing method supported by and
term used by the American Dental Hygienists Association.
Polishing is omitted on surfaces that are stain-free and on
restorative materials.
Substrate A surface material to be cleaned and polished,
e.g., tooth structure or a dental restoration.
FIVE IMPORTANT POLISHING VARIABLES
Prophylaxis Paste Abrasiveness
Select the least abrasive agent to accomplish stain
removal. Use of medium and coarse prophylaxis
paste is rarely needed
Abrasive Quantity in Polishing/Cleaning Agent
The concentration of abrasive particles in a paste is
directly correlated with its abrasiveness
Use wet agents because drier agents increase abrasion
For air-powder polishing, the ratio of particles to water
should be the lowest required
Cup & Brush Contact Time on the Substrate
Use short, intermittent pressure between rubber cup
and the tooth or restorative materials
Heat and tooth structure loss increase with
contact time
For air-powder polishing, keep air powder spray
moving and nozzle at 3-4 mm off the substrate
Cup or Brush Rotation Speed
Use low speeds to reduce abrasion and heat build-up
3000 r.p.m. is the maximum speed recommended
Applied Force on the Substrate
Use a light, intermittent polishing technique to avoid
excessive heat and abrasion. For air-powder
polishing, the high air pressure setting is more
abrasive than the low setting
RUBBER CUP POLISHING TOOLS
Elite designs
Cleaning and Polishing Agents Prophylaxis Cup
Agents used to remove debris and extrinsic stain (clean) A soft, flexible, latex-free cup is preferable
and then impart luster on teeth (polish). Abrasives Must flare and flex to contours of teeth, hold adequate
may be loose, coated or impregnated in a device, or amount of paste, and aid in selective stain removal
in a paste Cup designs
Commercial pastes exist for cleaning and polishing Interior webbing for holding prophylaxis paste and
specific dental materials and enamel creating friction for stain removal
(see Dental Substrate Polishing Chart on insert) Exterior ridges for interproximal stain removal
Available in different flavor and grit options and splatter control
- Young Dentals exclusive Elite Series prophylaxis
- Fine, medium, coarse and extra coarse grits
cups have exterior ridges
- Dry powders and pumice available in
Length options Petite, Junior, and Long
F, FF and FFF (increasing fineness)
Rubber density options soft vs. firm
All cups should be disposed after usage and when
Common ingredients in prophylaxis paste:
changing to abrasive agents with smaller grit
Abrasives
Clean and polish dental substrates
Screw or snap cups on prophylaxis angle head
Screw-type cup reduces vibration during polishing
Binders
Hold abrasive particles together
Humectants
Promote the retention of water and help to keep Bristle Brush
prophy paste moist and pliable Flat and tapered designs
Preservatives
For stain removal on occlusal and interproximal
Prevent undesired chemical changes or microbial surfaces, in fossa
growth Around orthodontic appliances
Coloring and Flavoring Agents Used to polish before sealant procedure
All should be disposed of after usage and when
Supplemental ingredients*: changing to abrasive agents with smaller grit
Bristles soften in hot water
1.23% fluoride ion
Desensitizers such as potassium nitrate, arginine
bicarbonate, or calcium sodium phosphosilicate
Remineralizers such as fluoride, amorphous calcium
Prophylaxis Angle
Disposable or metal device that attaches to
phosphate, casein phosphopeptides-amorphous
calcium phosphate and calcium sodium low-speed handpiece; holds the rubber
phosphosilicate cup or bristle brush
Bacterial inhibitors such as xylitol
Disposable prophy angle designs include:
Youngs Classic Straight Angle
Youngs Contra Angle:
- Ergonomically designed with a proprietary
17 degree bend to enhance access to
posterior teeth and reduce muscle fatigue
and repetitive wrist motion
Hygiene Handpiece
Air-driven, low-speed handpiece connects to
the prophylaxis angle
Choose light weight and ergonomically
*Note that research on the clinical effectiveness of some of these ingredients
balanced designs to reduce muscle fatigue
is ongoing. Prophylaxis paste manufacturers have not completed clinical
studies to show that these additives have therapeutic benefits when used and strain
biannually during dental prophylaxis. Supplemental ingredients used in
Youngs disposable Contra prophylaxis angle on
prophylaxis paste will not substitute for professional fluoride therapy.
Denticators Prophy Pal low-speed handpiece
 Dental Substrate Polishing Chart
This chart is intended to serve as a reference for selection of the appropriate abrasive agents and products to clean and polish different dental
substrates. Several examples of different products, their abrasives, and the abrasives Mohs hardness value are shown below. The Mohs Hardness
Scale measures the hardness of a material. To prevent damage to the substrate while still achieving an effective cleaning, the Mohs hardness
value of the abrasive agent should be less than or equal to the Mohs value of the surface being cleaned. To polish effectively, the abrasive agent
should be 1-2 Mohs units harder than the substrate. Please note that particle size, shape and strength should all be considered in addition to
particle hardness before use. In addition, although it is not generally recommended to polish exposed dentin or cementum, some air-powder
polishing products and gentle polishing agents are compatible with these softer tissues. See the box below for more information on the additional
characteristics of abrasive agents.

Acrylic Resin Dentin and Gold Amalgam Enamel Glass Ionomer Composite Resins Ceramic
Common Cementum Cements (macrofilled, microfilled, (porcelain)
Dental Materials* hybrid, flowable, pit &

= known
compatability Common Temporary Posterior Posterior Restorations, sealants,
fissure sealants, packable)
Anterior/posterior Veneers, onlays,
Clinical Uses crowns, dental restorations, restorations cavity liners and luting restorations inlays, crowns,
appliances onlay, inlay agent for onlays, sealants, veneers common CAD/
inlays, veneers, crowns CAM material
Mohs Hardness Examples of Polishing & Mohs Hardness Values of Common Dental Materials
Value of Cleaning Products &
Abrasive Agent their Abrasive Agent** 2 to 3 2 to 4 2.5 to 4 4 to 5 5 to 6 5 to 6 5 to 7 6 to 7
Cleaning
Cavitron Prophy-Jet


2.5 to 3 Air Polishing Powder
(Sodium Bicarbonate)

Cavitron JET-Fresh


2.5 to 4 Air Polishing Powder
(Aluminum Trihydroxide)

Proxyt Prophy Paste

6 to 7 Fine Grit
(Silicon Dioxide)

Cleaning & Polishing
PROPHYpearls


3 Air Polishing Powder
(Calcium Carbonate)


5.5 to 7
Clinpro Prophy Paste
(Perlite) ~
~
~
~

D-Lish Prophy Paste

6 to 7 Fine, Medium & Coarse Grits
(Flour of Pumice)

Soft Shine Polishing Paste
9
(Micro-Fine White Sapphire)
Polishing
6 to 7 Tin Oxide/Putty Powder

Zircon-F Paste
6.5 to 7.5
(Zirconium Silicate)
Shimmer Polishing Paste

9 (Micro-Fine Aluminum Oxide)

Topex Brillance
10

Micrograin Polishing Paste
(Diamond particles)

*Restorations should be polished with agents recommended by the materials manufacturer. When uncertain, a dentifrice with low abrasivity or a non-abrasive agent should be used as the cleaning and
polishing agent.
**The recommendations in the chart are based on the product manufacturers recommendations. In many cases, the product mentioned is safe to use on specific materials because of the specialized
formula, reduced particle size, etc. Please contact the product manufacturers with specific questions about any of the products referenced in the guide.

Some margins must be avoided to prevent removal of the luting agent.

~Perlite will break down from coarse to fine grit within seconds of use. Avoid using fresh Clinpro coarse paste on areas that could easily abrade.

Fine grit should be used on porcelain.

KEY CHARACTERISTICS OF THE ABRASIVE AGENT

HARDNESS
Ability of a substrate to resist abrasion to fine, based on the size of the holes in a standard
sieve through which particles pass
Assessed using the Mohs Hardness Scale:
Ranges from 1 (softest material, talc) to 10 (hardest The larger the particle size, the more abrasive the agent
material, diamond) BODY STRENGTH
The harder the agent, the greater the abrasion Particles that fracture could result in smaller, sharper
particles that are more abrasive than particles that
PARTICLE SHAPE wear down and become dull
An irregular shape or a particle with jagged edges is ATTRITION RESISTANCE
more abrasive than a particle with rounder edges
The greater the resistance of the abrasive, the faster
the abrasion
PARTICLE SIZE (GRIT)
Abrasive agents are graded from coarse The less resistant the substrate, the faster its abrasion
 BASIC CUP POLISHING TECHNIQUE

1. Before polishing, provide safety glasses for patient 8. Use light pressure so that
and wear personal protective equipment. Assess the cup slightly flares and
patients health, dental, slips slightly into the sulcus.
and pharmacologic history. Make sure not to flatten
Evaluate for extrinsic the lip of the cup entirely
stain, exposed dentin because that can create
or cementum, aesthetic damaging heat
and other restorative and abrasion
materials, and areas of
9. Move cup to adjacent area on tooth surface, using an
demineralization, etc.
intermittent patting motion
2. Have patient complete a preprocedural rinse with an
10. Turn and/or lift handpiece to adapt rubber cup to
antimicrobial mouthrinse
targeted tooths surface, including proximal surfaces
3. Explain purpose and limitations of procedure to the
11. Start with the distal surface of the most posterior tooth
patient
of a quadrant and move toward the anterior
4. If needed, the aesthetic restorations should be polished
12. Work from the gingival third to the incisal third of the
first. Special polishing agents need to be used on
tooth
aesthetic restorations to preserve the integrity and
longevity of the material (see Dental Substrate Polishing 13. Move to next tooth and wipe cup with gauze if needed.
Chart) Replenish cleaning and polishing agent
5. Fill rubber cup with appropriate polishing agent and 14. If using more than one type of abrasive, be sure to switch
apply it to the tooth surface or material to be cleaned and to a separate rubber cup for each finer grit agent
polished. Polish teeth and restorations that require 15. Follow up with professionally-administered fluoride
selective cleaning and stain removal therapy
6. Establish finger rest and 16. Educate patient about oral biofilm and extrinsic stain
bring filled cup to contact control
the tooth surface
17. Document service in the patients record
7. Apply revolving cup lightly
to the tooth surface using
a low speed

CHART REFERENCES
Barnes C, Air Apparent. Mentor. Feb. 2012: 24-27.
Barnes C, An In-Depth Look at Air Polishing. Dimensions of Dental Hygiene. Mar. 2010; 8(3): 32, 34-36, 40.
Barnes C, The Science of Polishing. Dimensions of Dental Hygiene. Nov. 2009; 7(11):18-20, 22.
Barnes C, Covey D, Johnson W, Watanabe, H. Effects of a paste-free prophylaxis polishing cup and various prophylaxis polishing pastes on tooth enamel and restorative materials. General
Dentistry. November 2011; page 466-473.
Cavitron DENTSPLY Professional. Web. 11 June 2012. http://www.prevent.dentsply.com/cavitron/products.cfm.
Clinpro Prophy Paste and Disposable Prophy Angle Technical Product Profile. 3M. Web. 11 June 2012. http.//solutions.3m.com.
Dais J, Polishing Procedures. Dimensions of Dental Hygiene. June 2006; 4(6): 22, 24.
Darby M, Walsh MM. Dental Hygiene Theory and Practice. 3rd. Ed. St. Louis: Saunders; 2010: 511-528.
Darby, M, Comprehensive Review of Dental Hygiene. 7th ed. St. Louis, Elsevier; 2012.
Gemstone Characteristics Table Web. http://www.csgnetwork.com/gemchar.html. Accessed January 2012.
Jefferies J, Abrasive Finishing and Polishing in Restorative Dentistry: A State-of-the-Art Review Dental Clinics of North America. April 2007; 51 (2); 379-397.
Jones T, Polishing Techniques for Beauty and Longevity Dentistry Today. Oct. 2009. Web. 30 July 2010. http://www.dentistrytoday.com/aesthetics/aesthetic-restorative-maintenance/113-
polishing-techniques-for-beauty-and-longevity.
Pendleton A, Anderson P, The Dental Assistant. 7th Ed. Delmar Thomson Learning 2001, 119.
PROPHYpearls. Kavo, Web. 11 Jun 2012. http://www.kavousa.com/US/Hygiene/PROPHYflex-3/PROPHYpearls.aspx.
Proxyt Scientific Documentation. Ivoclar Vivodent. Web. 11 June 2012. http://www.ivoclarvivadent.us/en-us/dental-professional/products/products/prevention-care/professional-tooth-cleaning/
proxyt.
Terracciano-Mortilla L, Effective Implant Care. Dimensions of Dental Hygiene. Sept. 2010; 8 (9): 30-32, 34.
Topex Polishing Pastes. Sultan Materials Catalog. Sultan Healthcare. Page 33.
Wilkins EM. Clinical Practice of The Dental Hygienist. 11 ed. Baltimore: Lippincott Williams & Williams: 2013; 689-708.
Waterpik Soft Shine Prophy Paste. Waterpik. Web. 11 Jun 2012. http://professional.waterpik.com/in-office-products/prophy-products/.

REFERENCES
2012 Young Dental Manufacturing I, LLC

D-Lish, Elite and ProphyPal are trademarks owned by Young Dental Manufacturing I, LLC and its related companies. All other trademarks and trade names are the property of their
respective owners.

Young Dental Manufacturing 13705 Shoreline Court East Earth City, MO 63045