To polish or not to polish

It's an interesting question and one worth investigating

by Dr. Susan Maples

We have all grown up with the experience of having our teeth polished at the cleaning appointment. We leave with nice smooth teeth for about an hour, until the protein layer of protection (called the biofilm or pellicle) forms again.

It turns out polishing teeth is not so good for them. For years we have had studies proving that polishing teeth with a rubber cup and professional paste causes micro-abrasion and should be performed selectively, for unsightly stain only.

Why? Picture your teeth under a microscope. Enamel is like a massive stack of glass tubules (like straws) that suck up whatever moisture it touches. Maybe it’s saliva, which is perfect, or maybe its juice/soda/diet soda/sports or energy drinks which are highly acidic. Add to that the acid from sugar-eatingbacteria in the plaque and bang, the enamel tubules begin to dissolve.

Topical fluoride to the rescue! Picture the fluoride molecule as glue, clogging the glass-like tubules and protecting the tooth from absorbing these harmful acids. Fluoride must be continually reapplied to reinforce its protective power. Here’s the rub: polishing teeth with abrasive paste, removes the biofilm, and the fluoride protected layer of enamel. Abrasion is even more harmful to kids, where the enamel on baby teeth is far thinner.

But wait, it gets worse. It turns out that polishing off the biofilm makes the fluoride varnish less effective. The data shows the intact biofilm acts as a scaffold to hold the fluoride on the enamel surface longer; actually increasing its penetration and effectiveness for cavity protection.

Incidentally, fluoride varnish leaves the teeth feeling rough for a half-hour, like fine-grit sandpaper. This should be our new feel of health after your dental visit, not smooth, shiny teeth.

Is this new evidence? No! Dental/ hygiene schools have, for years, taught selective polishing for stain alone. But it’s hard for us to change our practices, mostly because we are worried about disappointing patients.

Instead of polishing, I recommend dental professionals take that time to work with each person (especially children) on individual skill-building, for a lifetime of good home care and health.

It is up to all of us to know this information and request “No polish, please.” In addition, if you are even slightly cavity prone, insist on a fluoride varnish protection at each and every cleaning appointment!