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Selective Polishing: An Approach to Comprehensive Polishing A Peer-Reviewed Publication Written by Trish Jones, RDH, BS

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AbstractPolishing has been an integral part of dental hygiene care since the beginning of the profession. As technology and services have evolved in dentistry, so has the approach to the polishing protocol. This course reviews the history of polishing, the current thinking on polishing, components of prophylaxis pastes, how prophylaxis pastes work, supplemental additives to prophylaxis pastes, and methods to educate patients on this topic.

Educational ObjectivesAt the conclusion of this course, participants should be able to:1. Identify the differences between polishing and

selective polishing, and identify criteria for selective polishing

2. Compare abrasives that are used for polishing3. Distinguish polishing variables that affect how

teeth are polished4. Review evidence-based information to

identify the best polishing agents for patients5. Educate patients using proper verbal skills in

order to build value in the polishing protocol

Author ProfileTrish Jones, RDH, BS has been passionate about dentistry for over 25 years. With degrees in Dental Hygiene and a Bachelor of Science in Health Care Management from Southern Illinois University in Car-bondale, she loves to speak and write about topics that have practical impact on dental offices. Trish is honored to be an Executive Coach with Fortune Management in San Antonio, Texas. She can be reached at gotrishjones@gmail.com

Author DisclosureTrish Jones, RDH, BS has no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course.

Publication date: July 2016 Expiration date: June 2019

This educational activity has been made possible through an unrestricted grant from Young.This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content.Requirements for Successful Completion: To obtain 3 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%.CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products or services discussed in this educational activity. Heather can be reached at hhodges@pennwell.comEducational Disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.Image Authenticity Statement: The images in this educational activity have not been altered.Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents the most current information available from evidence based dentistry. Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the data and information contained in reference section. The research data is extensive and provides direct benefit to the patient and improvements in oral health. Registration: The cost of this CE course is $59.00 for 3 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

PennWell designates this activity for 3 continuing educational credits.

Dental Board of California: Provider 4527, course registration number CA# 03-4527-15123 “This course meets the Dental Board of California’s requirements for 3 units of continuing education.”

The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to (10/31/2019) Provider ID# 320452.

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Educational ObjectivesAt the conclusion of this course, participants should be able to:1. Identify the differences between polishing and selective

polishing, and identify criteria for selective polishing2. Compare abrasives that are used for polishing3. Distinguish polishing variables that affect how teeth are

polished4. Review evidence-based information to identify the best

polishing agents for patients5. Educate patients using proper verbal skills in order to build

value in the polishing protocol

AbstractPolishing has been an integral part of dental hygiene care since the beginning of the profession. As technology and services have evolved in dentistry, so has the approach to the polishing protocol. This course reviews the history of polishing, the cur-rent thinking on polishing, components of prophylaxis pastes, how prophylaxis pastes work, supplemental additives to pro-phylaxis pastes, and methods to educate patients on this topic.

Polishing: The BasicsPolishing is part of oral prophylaxis code D1110 in the Ameri-can Dental Association’s (ADA) Code on Dental Procedures and Nomenclature (CDT-4). 18 It has become a routine procedure for hygiene appointments. Polishing produces smooth surfaces on teeth and restorations. These smooth surfaces reduce the ad-herence of dental biofilms and remove extrinsic stains. Rubber cup polishing entails polishing for every patient and polishing every tooth during an oral prophylaxis. However, this protocol has evolved based on evidence-based research.

Polishing is typically referred to using the phrase “cleaning and polishing”. The American Dental Hygienists’ Association (ADHA) has issued a position paper on polishing that defines these terms. “Cleaning” or “cleansing” is defined as “the removal of debris and extraneous matter from the teeth”, while “polishing” is defined as “making the tooth surface smooth and lustrous”. 1

Selective polishing only polishes teeth that have visible stains after scaling has been performed.2 From a patient’s per-spective, this can deviate from an expectation of having all the teeth polished during a hygiene visit. Polishing that is taught in dental hygiene schools, dental schools, and dental assisting schools entails selective polishing. There is however a differ-ence between the esthetic effect of polishing and health-based reasons for polishing.3

Using an evidence-based approach, which includes re-search, expertise, and judgment of the dental professional, the needs and values of patients are evaluated, aiding in the deci-sion of when to polish and with what agents.

The term “selective polishing” has been redefined in the 2012 edition of Clinical Practice of the Dental Hygienist 11th edition. 4 This term means the dental hygienist selects clean-ing or polishing agents according to the individual needs of the

patient.4 If all teeth are polished (whether they are stained or unstained) it is important to select the least abrasive polishing agent for the particular patient’s needs. This provides a cus-tomized approach to polishing that assists in preservation of enamel health. Tooth polishing within the oral prophylaxis is one of the most commonly performed procedures in dentistry,6

and patients have become conditioned to having this procedure performed during their appointment.

Selective PolishingSelective polishing is known as “extrinsic stain removal” or “selective stain removal” that is performed immediately follow-ing professional scaling. This term was introduced in Clinical Practice of the Dental Hygienists, written in 1976 by Esther M. Wilkins, DMD, RDH, BS.13 Selective polishing was a response to the concern regarding polishing abrasives. It was found that 4 µm of enamel were removed during a 30-second polishing procedure with a pumice-water slurry.19 That study has since been disputed because the sample size was small, uncontrolled variables affected the outcome, and the polishing method did not mirror realistic clinical techniques.7, 9 In any case, polishing for stain removal is not classified as a therapeutic procedure as stains on teeth are not etiologic factors for oral disease or destructive process. 14, 2, 4, 9 It should be understood that polishing for stain removal is done for esthetic reasons, not health based reasons.9, 14

The goal of the redefined term of selective polishing is to polish all teeth, stained or unstained, by using the least abrasive polishing agent to meet the individual patient’s needs.9 This customized approach to polishing helps to preserve enamel health and eliminate any dilemma of whether or not to polish every tooth. This type of selective polishing meets patients’ needs in terms of tissue health, caries risk, exposed dentin, ero-sion/abrasion, types of restorations present, oral health behav-iors of the patient, and type/amount of stain. This information determines the consideration of the additive or cleaning agent and/or the appropriate grit of the polish paste. By selecting the least abrasive polishing agent based on these factors, patient needs can be met.9, 15

Ingredients of Prophy Pastes: AbrasivesWhen prophy paste was introduced for chairside professional use, it was available in bulk jars, and dispensed onto a tray cover for application. This was once thought to be a less expensive delivery system. Today, single dose units are available as well as “2-in-1” dose packs that enhance the efficiency of applica-tion. The polishing pastes in these dose units are comprised of several ingredients, with an abrasive or grit as the primary component. These abrasives are available in a progression of grits,.7 ranging from fine, medium, coarse, and super coarse. The choice of abrasive type is important since these materi-als have the potential to remove millimicrons of fluoride-rich enamel layer, and can take up to three months to remineralize. The abrasive is made of particles (figure 1) that vary in hard-

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ness, size, and quantity. Hardness of an abrasive is ranked on the Mohs Hardness Scale. This scale is ranked on a value of 1 to 10. Talc, which is softest, ranks as a 1, and diamond, the hard-est, a 10. Enamel has a Moh hardness of 5 to 6.3

Figure 1: Abrasive Particles Found in Polishing Pastes

Flour of Pumice

Aluminum oxide (Alumina)

Silicon carbide

Aluminum silicate

Silicon dioxide

Carbon compounds

Garnet

Diamond

Zirconium silicate

Zirconium oxide

Boron

Calcium carbondate

Emery

Silica

Diatomaceous earth

Micro-fine white sapphire

Ingredients in Prophy Pastes: Binders, Humectants, etc…Commercially prepared polishing pastes combine ingredients such as binders, humectants, coloring agents, preservative, and flavoring agents along with the abrasive (figure 2). This is pro-prietary to each manufacturer, as they generally do not disclose the amount of each ingredient.8 Fluoride, another ingredient often found in pastes is not a replacement for topical fluoride treatment. The fluoride-rich enamel layer that may polished away can eventually be remineralized by salivary minerals, or by a topical fluoride treatment. If stain present on teeth is removed by coarse grit, it is important to follow up with a sepa-rate fluoride treatment such as full-mouth fluoride treatment or fluoride varnish for specific teeth. These actions will replace the fluoride layer removed from enamel during polishing.3, 13

Figure 2: Ingredients in Polishing Pastes

Abrasives

Binders

Humectants

Coloring agents

Preservatives

Flavoring agents

Fluoride

Ingredients in Prophy Pastes: Supplementals Manufacturers have added ingredients in pastes to assist with issues such as sensitivity, remineralization and bacterial control (figure 3). 11 It is important that these formulations be reviewed for their clinical efficacy, since as of this time, the Food and Drug Administration (FDA) does not regulate polishing pastes.7, 8

Figure 3: Supplemental Ingredients in Polishers

Desensitizers

- Potassium nitrate

- Arginine calcium

- Calcium sodium phosphosilicate

- Calcium phosphate

Bacterial Inhibitors

- Xylitol

Remineralizers

- Amphorhous calcium phosphate

- Casein phosphopetides amorphous

- Calcium phosphate nitrate

- Calcium sodium phosphosilicate

How Polishing WorksPolishing is a means of creating a smooth, glossy surface using abrasive grits that create progressively smaller scratches. Polish-ing pastes contain some sort of abrasive particle. Polishing agents produce scratches in the surface of the tooth or restoration by the friction that is created between the abrasive particle and the tooth or restorative surface.4, 11 Particle size is a factor that affects how abrasive a grit actually is. The smaller the grit, the smaller the scratches. This means the tooth surface will be shinier and reflect light more evenly. This is why using polishing grits in a progression of coarse to fine applications create a smooth, lustrous finish. Coarse grit pastes can create deep scratches. They can also roughen tooth surfaces, making them more susceptible to collect plaque biofilm and stain. Smooth surfaces reflect light and provide a surface that can resist adhesion of bacteria and stain. If coarse grit is utilized, it should be followed by fine grits, leaving the tooth surface as smooth as possible. Using a new polishing cup or brush for each sequentially smaller grit can also enhance successful pol-ishing. To avoid the problems associated with abrasives, cleaning pastes are a viable alternative to polishing pastes. These materials are free from abrasives and do not compromise the integrity of the tooth surface or restoration. Currently, the majority of polishing pastes purchased are coarse (80%), followed by medium (10%), and fine (10%). This tells us that a “one-paste-fits-all” approach is still the common polishing modality for patients.8

Polishing VariablesThere are variables that affect the properties and mechanisms of polishing paste (figure 4). The rate of polishing speed and pres-

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sure creates friction, generating heat against the tooth surface. To prevent excess heat production and ensure successful results, it is best to review the manufacturers’ product recommendations. Most manufacturers recommend operating the hand piece at 3,000 rpm.3, 8,12 Excessive pressure can contribute to increased abrasion against the surface being polished. Contact time should be limited per tooth, ideally between 1 to 2 seconds. Other fac-tors include the quality, size, shape and hardness of the abrasive particles.8, 12 Cup type can also contribute to the quality of the polishing procedure. The firmer a polishing cup, the more pres-sure must be applied to flare the cup against the tooth surface. The design of the cup also influences the amount of paste applied to the tooth. Webbed cups retain less paste than ribbed cups and reduce abrasiveness.15

Figure 4: Polishing Variables

Speed

Pressure

Contact time

Quality of paste applied

Shape of particle

Size of abrasive particles

Hardness of the abrasive particles (Mohs value)

Cup/brush type

Paste SelectionAs health-care providers, dental hygienists are responsible for understanding and educating themselves on the science and re-search that supports the dental materials utilized when treating patients.8 It is important to understand what kind of paste is be-ing used and why. Drawbacks in using a “one-size-fits-most” paste should be considered.9 Therefore, it is important to make an assessment of the patient’s primary issues and quantify the best polishing agent to use. Additional considerations when thinking critically about polishing practices are:- What brand names and angles are used in clinical practice?- What types of grit are available, and why are they being used?- What are the additives and their effects?- Can the dental sales representative/distributor be able to

provide additional information?There is a new product on the market that makes selective

poishing easier and more cost effective. SmartSelect Selective Polishing Paste by Young is the first 2-1 polishing system that includes two paste grits in a single unit cup. Each cup includes a coarser stain remover paste and a finer polishing paste that conveniently fit side-by-side in a custom made gripper. This makes choosing the least abrasive polishing agent more convenient because you have two different grit options available to use at your discretion without having to open multiple cups of paste.

Educating the PatientAs the dental health-care provider, it is important to let the pa-tient know the thought process behind selective polishing prior to performing the procedure.9 This in turn enhances the pa-tient’s experience, adding value to the procedure. This is called pre-framing, 17 a term used in the psychology of behavioral science. In this case, pre-framing involves explaining the pro-cedure to the patient before and after it is completed to ensure they have a complete understanding.16 (figure 5). For example, when the patient is in the chair, the hygienist can let the patient know the purpose of abrasive type pastes and cleansing pastes. These include why the paste is splatter-free, why it rinses very quickly and minimizes the gritty feel (flash rinsing), and how the product can remove stain so a beautiful smile can be main-tained. Patient concerns can also be addressed at this time.

Figure 5: Wording to Assist in Building Value of the Polishing Procedure

The following dialogue can begin at the start of the polishing process.

“In order to preserve the investment in your smile, we are going to use a specialized paste that not only removes stain, but also polishes the teeth to a lustrous shine.”

“Research has now shown us . . .”

“Because I know white teeth are important to you . . .”

“I know you love the feeling of smooth teeth and fresh breath . . .”

“So we can reduce the gritty feeling when I am done . . .”

“Because you told me your teeth are sensitive, I have a special technique . . .”

“Because I noticed this about your smile, I am implementing a procedure and have chosen a product just for you that will . . .”

ConclusionPolishing is now more important than ever as the average life expectancy of the human race has been increasing over the years, and people are keeping their natural teeth in their later years. A key factor to aid in the increased lifespan of the natural dentition is the method of selective polishing. Patient satisfaction is enhanced with awareness that all of their teeth have been polished. This is due to the common slick, smooth, and clean feeling they have come to expect. The hygienist is happy because a technique has been utilized that removes stain and cleanses the teeth, while at the same time preserving tooth structure. The teeth benefit because the customization of this protocol minimizes risk of damage and supports the longevity of the teeth that comprise the smile. The dental hygienist, who opts to use evidence-based options to meet the patient’s needs, has now provided optimal care.

References1. American Dental Hygienists’ Association Position Paper on the Oral

Prophylaxis. ADHA.org. https://www.adha.org/resources-docs/7115_Prophylaxis_Postion_Paper.pdf April 29, 1998. Accessed June 15, 2016.

2. Wilkins EM. Extrinsic Stain Removal. In Clinical Practice of the Dental Hygienist. 8th ed. Philadelphia: Lippincott William and Wilkins; 1999:603-611.

3. Darby M. An Evidence-Based Approach to Polishing Teeth. American

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Online CompletionUse this page to review the questions and answers. Return to www.ineedce.com and sign in. If you have not previously purchased the program select it from the “Online Courses” listing and complete the online

purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete all the program questions and submit your answers. An

immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for viewing and/or printing. Verification Forms can be viewed and/or printed anytime

in the future by returning to the site, sign in and return to your Archives Page.

Questions

1. Which of the following statements is true?a. The polishing process should begin with the ap-

plication of a fine abrasive to meet the patient’s needs followed by the application of medium and coarse abrasives

b. The polishing process should begin with evalu-ation of the patient's teeth in regards to stain for the best determination of application of paste abrasive level to meet the patient’s needs

c. The polishing process should begin with the application of a cleaning agent to meet the patient’s needs followed by the application of coarse abrasives

d. The polishing process should begin with the ap-plication of a grit abrasive to meet the patient’s needs followed by the application of cleaning agents

2. Which ingredients are commonly found in commercially prepared prophylaxis polishing pastes?a. Binders, Humectants, Chlorhexidine, Preserva-

tives and Flavoring agentsb. Binders, Humectants, Coloring Agents, Sodium

Bicarbonate, Flavoring agentsc. Binders, Humectants, Essential Oils, Coloring

Agents and Flavoring agentsd. Binders, Humectants, Coloring agents,

Preservatives and Flavoring agents

3. Which of the following statements is true?a. Cleaning agents, which have very fine to no

abrasive particles, are a viable alternative to abrasive polishing agents

b. Cleaning agents should be used prior to scaling c. Cleaning agents should not be used when

polishing teeth and restorationsd. Cleaning agents are not a viable alternative to

abrasive polishing agents

4. The redefined term of selective polishing principles are defined as:a. Polishing teeth by selecting a cleaning agent

and/or prophylaxis polishing agent according to the individual patient’s needs

b. Polishing teeth by selecting a cleaning agent and/or coarse prophylaxis polishing agent according to what’s available in the dental practice

c. Polishing teeth by selecting a prophylaxis polishing agent according to the individual patient’s needs

d. Polishing teeth by selecting a cleaning agent and/or prophylaxis polishing agent according in to what’s available in the dental practice

5. The clinical purpose of integrating polishing in hygiene services is to:a. Produce smooth surfaces on teeth and

restorations that reduce the adherence of dental biofilms and extrinsic stain

b. Produce smooth surfaces on teeth and restora-tions to prevent periodontal disease

c. Produce stain free surfaces on teeth and restorations so the patient will keep their hygiene appointment

d. Produce stain free surfaces on teeth and restora-tions to increase the adherence of dental biofilms and extrinsic stains

6. A polishing system that includes a cleaning agent and an abrasive grit promotes:a. Dentin health, preserving dental restorations and

customized care through rubber cup polishing principles

b. Enamel health, preserving dental restorations and customized care through selective polishing principles

c. Periodontal health, preserving dental restoration and customized care through polishing principles

d. Enamel health, preserving dental restorations and customized care through rubber cup polishing

Academy for Oral-Systemic Health website. https://aaosh.org/evidence-based-approach-cleansing-polishing-teeth/#!form/Connect. Published 2013. Accessed May 25, 2016

4. Barnes, CM. Polishing. In Clinical Practice of the Dental Hygienist. 11th ed. Philadelphia: Lippincott Williams and Wilkins: 2012.

5. Rhea M and Bettles C. Dental Hygiene at the Crossroads of Change. ADHA website. https://www.adha.org/resources-docs/7117_ADHA_Environmental_Scan.pdf. Published 2011. Accessed May 26, 2016.

6. Survey of Dental Hygienists in the United States, 2007: Executive Summary. Published by the American Dental Hygienists’ Association.

7. Vrbic V, Brudevold F, McCann HG. Acquisition of fluoride by enamel from fluoride pumice paste. J Dent Res. 1956;35:420.

8. Barnes, CM. The Science of Polishing. Dimensions of Dental Hygiene. 2009;(7)11:8–20,22.

9. Barnes, CM. Shining a New Light on Selective Polishing. Dimensions of Dental Hygiene. 2012;10(3):42,44.

10. Jurisdictional Update: Dental Prophylaxis Pastes with Drug Components. U.S. Food and Drug Administration website. http://www.fda.gov/CombinationProducts/JurisdictionalInformation/JurisdictionalUpdates/ucm106560.htm. Accessed June 12, 2016.

11. Dondiego L, Finnerty K. Factors in Coronal Polishing. Dental Aegis. http://www.dentalaegis.com/ida/2012/06/factors-in-coronal-polishing#sthash.XIY7ZZIM.dpuf. Published May 2012. Accessed May 26, 2016.

12. Wilkins EM. Clinical Practice of the Dental Hygienist. 10th ed. Philadelphia: Lippincott Williams and Wilkins; 2009:727-740.

13. Wilkins EM. Clinical Practice of the Dental Hygienist. 4th ed. St. Louis: Lea & Febiger, 1976.

14. Barnes, CM. To polish or not to polish. www.drbicuspid.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=306537#_=_. Published January 3, 2011. Accessed May 25, 2016.

15. Mossman S. Polishing Protocol. Dimensions of Dental Hygiene. 2016;14(03):38–40,42.

16. De Martino B, Kumaran D, et. al. Frames, Biases, and Rational Decision-Making in the Human Brain. Science. 2006;313(5787):684–687.

17. Changingminds.org Frame of Reference. http://changingminds.org/explanations/models/frame_of_reference.htm Accessed June 15, 2016.

18. American Dental Association’s (ADA) Code on Dental Procedures and Nomenclature (CDT-4). Edition 2016. Pg. 11.

19. Vrbic V. Brudevold F, McCann HG, Acquisition of fluoride by enamel from fluoride pumice paste. J Dent Res. 1956;35:420.

Author ProfileTrish Jones, RDH, BS has been passionate about dentistry for over 25 years. With degrees in Dental Hygiene and a Bachelor of Science in Health Care Management from Southern Illinois University in Car-bondale, she loves to speak and write about topics that have practical impact on dental offices. Trish is honored to be an Executive Coach with Fortune Management in San Antonio, Texas. She can be reached at gotrishjones@gmail.com

Author DisclosureTrish Jones, RDH, BS has no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course.

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7. Which polishing variables affect the level of abrasitivity during a polish-ing procedure?a. Speed, Pressure, Quality of paste, shape, size &

hardiness of the abrasive particleb. Speed, Pressure, shape, size & hardiness of the

abrasive particle, cup typec. Speed, Pressure, Quality of paste, shape &

hardiness of the abrasive particled. Speed, Pressure, Quality of paste, shape, size &

hardiness of the abrasive particle, cup type

8. The use of verbal frame of reference will enhance the patients polishing experience and create an increased value for the service, they may include:a. “Research now shows us that…”b. “In order to minimize the possibility of a gritty

feeling…”c. Both verbal pre-frames can be used to enhance

the patient experience d. Neither verbal pre-frame can be used to enhance

the patient’s experience

9. Which criteria should be considered when performing a pre-polishing assessment?a. Individual patient needs, disease of the tissue,

erosion, exposed dentition, grit of polishing paste, cleaning agent

b. Office’s purchasing history, health of the tissue, exposed dentition, amount and type of stain, grit of polishing paste

c. Individual patient needs, health of the tissue, erosion, exposed dentition, amount and type of stain, grit of polishing paste, cleaning agent

d. Office’s purchasing history, health of the tissue, erosion, exposed dentition, amount and type of stain, grit of polishing paste, cleaning agent

10. Selective polishing current research of abrasive science meets the patient’s expectations because:a. When stain is present, use a commercially

available coarse prophylaxis polishing paste. b. When stain is absent, use a commercially

available prophylaxis polishing paste and when stain is present, a cleaning agent.

c. When stain is present, use a commercially available prophylaxis polishing paste and when stain is absent, a cleaning agent.

d. When stain is absent, skip polishing.

11. Which statement is false?a. Tooth polishing is one of the most commonly

performed procedures in dentistryb. Rubber cup polishing entails polishing every

client and every toothc. Polishing with coarse grit has no effect on

enamel healthd. Selective polishing provides a customized

approach to polishing

12. Which statement is not true? a. Grits available in polishing pastes are available

in coarse, medium, fine and extra coarse gritb. Abrasives in pastes vary in size and hardnessc. The hardness of an abrasive is ranked on the

Mohs Hardness Scaled. Manufacturers disclose the amounts of

ingredients in polishing pastes

13. If a coarse grit is used, it should be followed by a fine grit to help minimize scratches and provide a smooth surface except in the follow-ing situation:a. The tooth has no stainb. The tooth has heavy stain from tobacco productsc. The patient has stain from coffee, tea or wine in

isolated areasd. The patient exhibits generalized staining and

plaque

14. Which statement is true?a. Fluoride found in pastes is an acceptable

replacement for a topical fluoride treatment.b. The enamel fluoride layer is not affected by

polishing for more than 5 seconds with coarse grit.

c. A topical fluoride treatment or selective varnish application is an acceptable modality to apply after polishing.

d. Polishing for stain removal is classified as a therapeutic procedure.

15. Which statement is true?a. The Food and Drug Administration (FDA) does

not regulate polishing pastes.b. Desensitizers in pastes include Potassium

nitrate, Argine Calcium, Calcium sodium phosphosilicate and Calcium phosphoric acid.

c. Xylitol is added to help re-mineralize the teeth.d. Re-mineralizers added to pastes prevent all

sensitivity.

16. Self-evaluation in regards to polishing includes asking all of the following questions, except:a. What brand names and angles are used in

clinical practice?b. What are the additives and their effects?c. What is the most abrasive toothbrush available? d. Can the dental sales representative/distributor

be able to provide additional information?

17. Which statement is false?a. It is acceptable to ask dental distributor

representative for additional information on a polishing paste.

b. Dental Hygienists are responsible for understanding and educating themselves on the science and research that support evidence based polishing.

c. It is acceptable to polish every patient with the coarsest paste available as “one size fits most” theory is advised.

d. Selective polishing is a customized approach to polishing that helps to preserve enamel health.

18. Selective polishing: a. Is a trend and will go away soon.b. Is a better way to meet the patient’s expectations

while maintaining enamel healthc. Is based on what patient’s want rather than

assessing what they need.d. Is time consuming and not necessary when

coarse grit is acceptable to use for full mouth polishing

19. Which one is not true?a. Life expectancy is increasing therefore more

people are living longer and keeping their natural teeth.

b. By selecting the least abrasive polishing agent, the patient’s needs can be met.

c. The extra fine paste or cleaning paste with no abrasive provides a smooth lustrous finish to teeth.

d. Only one polishing paste is needed for all teeth.

20. Educating the patient is important because:a. It is important to let them know the thought

process behind selective polishing.b. It enhances the patient’s experience and adds

value to the procedure.c. Both answers above are trued. None of the above are true

Questions (Continued)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Customer Service 800-633-1681

ANSWER SHEET

Selective Polishing: An Approach to Comprehensive PolishingName: Title: Specialty:

Address: E-mail:

City: State: ZIP: Country:

Telephone: Home ( ) Office ( )

Lic. Renewal Date: AGD Member ID:

Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 3 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 800-633-1681

Educational Objectives1. Identify the differences between polishing and selective polishing, and identify criteria for selective polishing

2. Compare abrasives that are used for polishing

3. Distinguish polishing variables that affect how teeth are polished

4. Review evidence-based information to identify the best polishing agents for patients

5. Educate patients using proper verbal skills in order to build value in the polishing protocol

Course Evaluation1. Were the individual course objectives met?

Objective #1: Yes No Objective #2: Yes No Objective #3: Yes No

Objective #4: Yes No Objective #5: Yes No

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0

3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0

7. Was the overall administration of the course effective? 5 4 3 2 1 0

8. Please rate the usefulness and clinical applicability of this course. 5 4 3 2 1 0

9. Please rate the usefulness of the supplemental webliography. 5 4 3 2 1 0

10. Do you feel that the references were adequate? Yes No

11. Would you participate in a similar program on a different topic? Yes No

12. If any of the continuing education questions were unclear or ambiguous, please list them. ________________________________________________________________

13. Was there any subject matter you found confusing? Please describe. _________________________________________________________________

14. How long did it take you to complete this course? _________________________________________________________________

15. What additional continuing dental education topics would you like to see?

_________________________________________________________________

For IMMEDIATE results, go to www.ineedce.com to take tests online.

Answer sheets can be faxed with credit card payment to 918-831-9804.

Payment of $59.00 is enclosed. (Checks and credit cards are accepted.)

If paying by credit card, please complete the following: MC Visa AmEx Discover

Acct. Number: ______________________________

Exp. Date: _____________________

Charges on your statement will show up as PennWell

If not taking online, mail completed answer sheet to PennWell Corp.

Attn: Dental Division, 1421 S. Sheridan Rd., Tulsa, OK, 74112

or fax to: 918-831-9804

AGD Code 149

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.

POLISH0816DIG

COURSE EVALUATION and PARTICIPANT FEEDBACKWe encourage participant feedback pertaining to all courses. Please be sure to complete the survey included with the course. Please e-mail all questions to: hhodges@pennwell.com.

INSTRUCTIONSAll questions should have only one answer. Grading of this examination is done manually. Participants will receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be mailed within two weeks after taking an examination.

COURSE CREDITS/COSTAll participants scoring at least 70% on the examination will receive a verification form verifying 3 CE credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact their state dental boards for continuing education requirements. PennWell is a California Provider. The California Provider number is 4527. The cost for courses ranges from $20.00 to $110.00.

PROVIDER INFORMATIONPennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, not does it imply acceptance of credit hours by boards of dentistry.

Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP ar www.ada.org/cotocerp/

The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to (10/31/2019) Provider ID# 320452

RECORD KEEPINGPennWell maintains records of your successful completion of any exam for a minimum of six years. Please contact our offices for a copy of your continuing education credits report. This report, which will list all credits earned to date, will be generated and mailed to you within five business days of receipt.

Completing a single continuing education course does not provide enough information to give the participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop skills and expertise.

CANCELLATION/REFUND POLICYAny participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

IMAGE AUTHENTICITYThe images provided and included in this course have not been altered.

© 2016 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell

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