officer evaluate the tissue condition if any questions exist.

Tooth polishing removes plaque or stains remaining on the teeth after thorough scaling. Improper use of a prophy cup and abrasive paste can have harmful effects on the teeth including: loss of tooth structure, removal of fluoride-rich surface enamel, thermal injury to the pulp, and trauma to soft tissues.

Materials and Equipment

A typical tooth polishing setup (fig. 3-25) includes a mouth mirror, slow-speed handpiece with a prophylaxis angle attachment, rubber polishing cup, tapered bristle brush, dental floss, and prophylaxis paste.

Many different types of prophylaxis (sometimes abbreviated as "prophy") angle attachments are available. Disposable or single-use prophy angles are recommended; however, sterilizable prophy angles are equally effective, can be more economical, and are widely used in the Navy. There are latch and screw- type rubber polishing cups. Ensure that the prophy angle and the type of rubber cup you select are compatible. Follow the manufacturer's instructions for use and maintenance of handpiece and prophy attachments.

The use of single-unit prophylaxis paste prevents waste and cross contamination. Commercially prepared pastes containing fluoride are commonly used in the Navy and are available in popular flavors. Pastes are also available in fine, medium, coarse, and coarse grits. Select the abrasiveness appropriate for removal of the stains present. A fine paste will not efficiently remove heavy stain. A coarse paste will

Figure 3-25. - Tooth polishing setup.

needlessly remove enamel when treating fine stains. A tapered bristle brush may be used to polish the occlusal surfaces of the teeth.

Precautions

You must be careful when you use the handpiece and prophylaxis attachment. Neither a polishing cup nor bristle brush should contact soft tissue. Such contact could injure the tissue. Only use the bristle brush on occlusal surfaces of teeth, well away from the soft tissue.

You must also be careful to avoid friction between the cup or brush and the tooth. Friction causes heat, and heat can harm the tooth pulp and cause pain to the patient. For this reason, always run the handpiece at the slowest of the slow speeds. The speed of the handpiece is controlled by a foot-operated rheostat. Use firm pressure when applying the rubber cup to the surface that needs polishing. You will know that you have applied sufficient pressure when you see the cup's edge flare slightly. Don't bounce the cup on and off the tooth. Keep the cup in constant motion while in contact with the tooth. To avoid splattering paste, bring the cup almost in contact with the tooth before the cup starts turning. Follow all safety precautions. You should always wear protective gloves, glasses, and mask. Drape the patient to protect his or her clothing.

Polishing Routine

You should polish the patient's teeth according to a definite sequence. A typical sequence would start with the maxillary arch and polish the teeth as follows:

All facial surfaces - from the right quadrant to the left quadrant.

All lingual surfaces - from the left quadrant to the right quadrant.

All occlusal surfaces - from the right quadrant to the left quadrant.

As you polish, begin at the gingival margin of the tooth and work toward the occlusal or incisal edge, using vertical or oblique pulling strokes. Rinse the working area with water from the three-way syringe as needed and have the patient use the saliva ejector to remove the debris from the mouth.

You may not be able to reach all of the interproximal areas with the polishing cup. To polish these areas, place the polishing paste in the facial and