By Nancy Dukes, BA, RDH
Whether or not hygienists should polish a patient's teeth following instrumentation has long been a dilemma clinicians face. Most were taught in dental hygiene school that polishing should be selective at most. While that was presented as the ideal, most experienced hygienists now understand that we rarely practice in an ideal world but, instead, in a very esthetic-driven world.
We recognize the reasons why we were taught not to polish: removal of tooth structure, increased tooth and restoration roughness, damage to demineralized areas, removal of fluoride-rich enamel surfaces, heat production with possible pulp damage over time, trauma to free gingiva especially when inflamed, exposure of clinician and patient to biologically contaminated aerosols and splatter, increased tooth sensitivity, damage to incompletely mineralized newly erupted teeth, etc. The list and arguments go on, as does the concern for any hygienist in caring for his or her patients.
With that extensive list of complications, why are we so driven to polish routinely? The answer lies in the fact that we strive to balance pleasing the esthetic desires of the patient with gaining commitment from our perfectly cared for patients. We must please our patients by providing excellent care and service without possible harm. This is a vital component in our quest to build the relationship that ultimately will allow us to motivate the patient to achieve oral health.
So, while this "to polish or not to polish" issue has no black and white answer, the solution lies in professional judgment of the necessity for stain removal and comprehensive patient education, based on individual dental and medical histories and the patient's current oral situation. When and if polishing is appropriate can only be decided following comprehensive evaluation of each patient and the necessary treatment to be provided. The key (and, therefore, the answer) lies in individualized patient care and education. I believe there can be no right or wrong answer that applies to everyone, because no mouth is the same. Selective polishing, special clinical techniques, and individualized patient home care to reduce or eliminate stains can solve this dilemma, helping us achieve the goals we all strive to reach.
If your team is struggling with the issue of polishing, create a list of questions to ask yourselves during a comprehensive oral evaluation to help determine when and where polishing would be appropriate. Remember, hygienists must keep their patients' best interests in mind. As their health-care provider, your patients trust you to recommend what's best for them and rely on you to educate them appropriately. You must help them understand — through education — what they need and how that fits into what they want. Your responsibility is great as a dental professional. But you can meet this challenge and do what you know is best for each patient on a case-by-case basis with systems that support you efficiently and effectively along the way.
Nancy Dukes, BA, RDH, is director of clinical consulting for Jameson Management, Inc., an international dental practice management consulting firm. Visit www.jamesonmanagement.com and call (877) 369-5558 for more information.
