Dentals... to polish or not to polish...?

Re: Dentals... to polish or not to polish...?

Pynadath George — Fri, 19 Oct 2012 15:55:33 GMT

You mentioned you were polishing subgingivally. At the cementoenamel junction. So dentine will be present.

Re: Dentals... to polish or not to polish...?

Evelyn Barbour-Hill — Fri, 19 Oct 2012 13:48:28 GMT

[quote user="Pynadath George"]Actually I said you should polish really only for stain removal. I presumed you were polishing purely for this as that's what the dental profession polish for ( but rarely for other reasons too such as restorations etc). You then explained it was for micro scratches at the surface subgingivally and to decrease plaque maturation. I said this was like to cause damage to o enamel, cementum, dentine and the gingivae. And it's unlikely to have much of a difference on decreasing plaque maturation.[/quote]

Well at least we're clear now.

I beg to differ on both your points of objection until some conclusive evidence or reasoning is presented.

It's an odd suggestion that cementum and dentine are likely to be damaged, when polishing is only done on enamel. The gingiva could be damaged if the polishing is done badly, yes.

This discussion has come to an end, I feel.

Re: Dentals... to polish or not to polish...?

Pynadath George — Fri, 19 Oct 2012 07:28:28 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Pynadath George"] I tried to send you links of human dentistry (as it was human dentistry evidence that you were shown originally) on the new standpoint showing polishing to be of little value whether subgingival or supragingivally. [/quote]

You sent me three links to somewhat simplistic education material asserting that polishing was of little value. Some of the important reasons given for not polishing were utterly irrelevant .

I say subgingival polishing is important. You say it isn't. You say this is because you only use polishing to remove stain and there is no stain subgingival. I say I don't use polishing for the purpose of removing stain. You say I do, therefore I shouldn't polish subgingivally. This could go on for ever.

[quote user="Pynadath George"]We now don't think that way.[/quote]

Yes, fashions change.

[/quote] Actually I said you should polish really only for stain removal. I presumed you were polishing purely for this as that's what the dental profession polish for ( but rarely for other reasons too such as restorations etc). You then explained it was for micro scratches at the surface subgingivally and to decrease plaque maturation. I said this was like to cause damage to o enamel, cementum, dentine and the gingivae. And it's unlikely to have much of a difference on decreasing plaque maturation.

Re: Dentals... to polish or not to polish...?

Evelyn Barbour-Hill — Wed, 17 Oct 2012 22:41:51 GMT

You sent me three links to somewhat simplistic education material asserting that polishing was of little value. Some of the important reasons given for not polishing were utterly irrelevant .

[quote user="Pynadath George"]We now don't think that way.[/quote]

Yes, fashions change.

Re: Dentals... to polish or not to polish...?

James Laidlaw — Wed, 17 Oct 2012 21:00:17 GMT

Key problem here is the two professions while dealing with teeth are dealing with different species. More info required, we can't just extrapolate direct from animal to humans or vice versa.

Re: Dentals... to polish or not to polish...?

Pynadath George — Wed, 17 Oct 2012 19:50:16 GMT

Evelyn, you originally asked me why do we polish subgingivally. I had disagreed and said we (human dentist) don't. We selectively polish supragingivally but vvv rarely (never) subgingivally. You said you were taught this with sem slides by dentists. Your statement was "subgingival polishing and 1 mm supragingivally was the important part". This is the part I disagreed with. I said that was how the profession used to think about polishing. We now don't think that way. You said you would need some of data to make you change your opinion/stance on this matter. I tried to send you links of human dentistry (as it was human dentistry evidence that you were shown originally) on the new standpoint showing polishing to be of little value whether subgingival or supragingivally. This does go against your original point that subgingival polishing is important. Now where is that *sigh* emoticon?

Re: Dentals... to polish or not to polish...?

Evelyn Barbour-Hill — Wed, 17 Oct 2012 19:19:17 GMT

[quote user="Pynadath George"]Thank you Anne Seawright. So there you have it Evelyn.you may not have seen what parts are relevant of dispute your practice but I have copied and pasted the first 2 links relevant parts and Anne has done the third. I'm not sure if you Are arguing for the sake of it now. Don't get me wrong I'm sure there are some in the dental profession who still polish all the teeth. But there is no real reason for it except cosmetic and they too are going against common sense advise. Why would you want to 1)remove more healthy enamel especially in the area where is needed the most and lost the most, 2)remove cementum and 3)traumatise the gingival cuff in an attempt to go subgingivally? This notion of smoothening microscratches is outdated essentially. This isn't to say I don't polish. I do, mainly with a air polisher as mentioned. I use sylc. It's less abrasive and I only use it when requested by the patient. I also use it on dentine sensitivity to block dentinal tubules. Those are the only 2 times I use it.

[/quote]

This will have to do for a reply to all your posts of this date on this subject.

We need an emoticon for "sigh..........."

Your three links were to simplistic educational documents, not scientific reviews. I don't mind, I'm sure the scientific reviews exist . I've looked at the third one now and i say again there's nothing in these three I would dispute.

By the way, there are plenty of dentists and hygienists who polish... or "still" polish if you like...... not the whole mouth, no, just the bits that need it. As I do the bits that need it.

[quote user="Pynadath George"] This notion of smoothening microscratches is outdated essentially.[/quote]

OK, it's outdated. You mean that microscratches are no longer to be found? Seems unlikely. You mean that polishing does not reduce and round off microscratches? Obviously not, unless the laws of mechanics have changed. You must mean that it's now thought unnecessary to think about microscratches. Once again, we hear that plaque starts to form, bacteria start to adhere, soon after their removal anyway. Yes, we all know that, it's elementary periodontology. Nobody is suggesting that polishing prevents plaque initiation, that would be ridiculous. What I'm saying is that I believe correct polishing to be an important (or useful, if important is too much for you to swallow) aid (no more than "aid") in the discouragement of the thickening and maturation of plaque. If that belief has been shown to be utterly unfounded, I'll cheerfully abandon it, but nobody seems to be presenting any useful argument or evidence against. You seem to be simply asserting, over and over again. You don't even seem to appreciate the distinction between plaque (which is pretty near unavoidable) and mature plaque (which can be avoided or suppressed).

Many of the points raised by those links have either no relevance to animals, or have relevance that needs interpreting differently for animals. For instance: fluoride and the fluoride content of enamel is utterly irrelevant. For instance again: if humans have their teeth polished, it might be every six months for the whole of their lives. Dogs might have polishing done once, twice, maybe three times in their whole lives, and cats fewer times than that. Humns can be relied upon (well, mostly I guess ....... or be forced ) to brush their teeth regularly, while animals can be difficult to brush or otherwise clean effectively.

When I hinted at our respective wavelengths, I implied that I would be happy to discuss all this in great detail with someone who was ready to conduct a rational discussion. Somehow I just can't follow your points logically, even though I'm sure you mean to be logical. I didn't at that time mean to imply that it would be easier to discuss with someone who knew just a little about the oral anatomy, physiology, occlusion and pathology of species other than Homo sapiens. I have had association over the years with many dentists, some of them very distinguished, who either had such knowledge or were keen to hear it.

Re: Dentals... to polish or not to polish...?

Arlo Guthrie — Wed, 17 Oct 2012 18:33:09 GMT

[quote user="james herriot lied"]

Mr George

Like many others, I welcome you to the forum and find what you say to be interesting and thought-provoking. However, I do feel that some of your rebuttals are a bit dismissive; that's not to say that you haven't had a good bit of provocation - I'd apologise for some of the comments that have been sent your way if I thought you weren't able to withstand them. But perhaps less of the exasperation at being surrounded by simpletons would go down better. I AM a simpleton, but it's not that much fun to be reminded

[/quote]

Reviewing this thread, it's hard to put my finger exactly on the point where things started getting a bit heated. Pynadath made a comment pretty early on which seemed to me to be slightly (or perhaps very) patronising by stating what Evelyn took to be the plainly obvious.

However, it is difficult for anyone to judge the level of someone else's knowledge, and especially hard for someone who is new to the site.

On balance, though, I think the problem in this thread lies with the fact that Pynadath's posts have often been blunt, which is getting people's backs up, causing a less courteous reaction than normal.

Plus, of course, Pynadath, you are new to these forums and starting off by challenging the status quo. Nothing wrong in that (on the contrary). But I do think it is advisable to take special care to soften what you have to say, almost to the extent of being overly polite. For example, if you think you are saying something that is so obvious, it may be insulting the reader's intelligence, then explain that you are only saying it to put something else in context / explain your own thinking.

Ding ding. Seconds out.

Re: Dentals... to polish or not to polish...?

tess — Wed, 17 Oct 2012 17:39:44 GMT

Thanks for that- will revert back to the normal stuff.

Re: Dentals... to polish or not to polish...?

Pynadath George — Wed, 17 Oct 2012 17:31:49 GMT

Hi Tess, You're absolutely correct. Whitening toothpastes are a big no no. We see an increase amount of abrasion wear in the cervical area of the tooth and further loss of attachment due to this. Purely for the same reasons as polishing (whixh we have been discussing here). Avoid them. They're just a marketing thing by big brands.

Re: Dentals... to polish or not to polish...?

tess — Wed, 17 Oct 2012 17:25:53 GMT

Pynadath, do recommend people not using whitening toothpastes? Are they abrasive and could they cause harm long term when used in conjuction with an electric toothbrush? It seems quite a similar action to a polisher.

I'm asking this purely for personal advice!

Re: Dentals... to polish or not to polish...?

Pynadath George — Wed, 17 Oct 2012 13:51:11 GMT

Ok let's put it this way guys. You mention you can't change your practice as what I'm spouting out as its to do with humans. But wasn't polishing animals teeth originally done due to human research ( vets were taught this evidence by human dentist). So where is the animal research/evidence on animals to show that you need to polish? If what you are saying is that you need evidence to stop polishing animal teeth based on animal trials. Where is the evidence on animal trials showing you do need to polish?

Re: Dentals... to polish or not to polish...?

Mark Holmes — Wed, 17 Oct 2012 13:38:18 GMT

[quote user="Dagmar Steele"]

[quote user="Pynadath George"]James, I feel I haven't been rude to Evelyn. If you can point out where ill happily apologise. Like I said before you don't always need a rct on a particular species to extrapolate what may be the same prinicpals in all mammals. Hence the use of animal trials for humans.

[/quote]

I am in no way a dentist - I am one of the very inferior GPs... Hence I've so far kept out of this discussion as I didn't have much to add. But this one constantly annoys me. As a vet I know that every species I treat is very different, cat's teeth are nowhere near dog's teeth (FORL being one example). Talking of same principles on mammals made me laugh, I've just had a rabbit in to have some work done on its teeth ;-))))) Something human doctors always forget about, many extrapolate from humans and don't understand how many different species we treat with all their specialities we have to be aware of. Canine teeth are definitely different from human teeth (karies?) and even if there are some trials on dogs this doesn't mean everything that applies to human applies to dogs as well. And yes, I found some of the comments rude if not arrogant.

[/quote]

I would agree that extrapolation is risky given the many many different types and uses of teeth, although in this case Pynadath is advising caution due to enamel damage, given that many domestic species have thinner enamel that caution would on the face of it be of greater rather than lesser importance and in the light of limited evidence support no polishing surely.

Re: Dentals... to polish or not to polish...?

Dagmar Steele — Wed, 17 Oct 2012 13:30:21 GMT

[/quote]

Re: Dentals... to polish or not to polish...?

Anne Seawright — Wed, 17 Oct 2012 13:18:14 GMT

[quote user="Mark Holmes"]

[quote user="Rachel Perry"]If I could try to arbitrate a little. There is evidence available in the human field suggesting that polishing should be selective, and the current recommendations of many human dental associations reflect that. However, a Cochrane review in 2008 found much of the evidence to be poor quality, so much so they couldn't make recommendations about suggested interval or need for polishing after scaling. Let us also remember the difference though, between human patients and our patients. Humans will have many more epIsodes of scaling/ polishing in their lifetime- possibly 40 years worth of hygienist every 6 months! Most of our patients are lucky if they have ONE episode in their lifetime. I can count on one hand the patients that regularly come every year for work. That's difference one. The second difference is that enamel is much thinner in our patients than humans, so perhaps each episode of polishing has a bigger impact. Also, our patients are much less prone to extrinsic stain (not many of my patients smoke, drink coffee or red wine). So perhaps we shouldn't be polishing at all? But as it is there simply isn't enough high quality evidence in OUR patients to make a decision. What worries me far more is that many vets and nurses in practice do not know how to polish safely- they use far too high a speed, too much pressure, too long a contact time, too coarse a paste etc etc so in these cases far better not to polish at all! The fact is, we need more evidence in cats and dogs to suggest what we should be doing!

[/quote]

BUT given the evidence available should we be continuing to polish until further evidence suggests we don't, or stopping until further evidence we should. Given what has been posted I would be of the opinion that we should stop or at least be very selective about its use until evidence indicates otherwise. I was always taught to polish out surface abraisons but I wonder if that was somebody's "idea" which sounded good but based on little evidence, rather than solid advice. It may well have been perpetuated into "good practice" with little review.

[/quote] I was also taught to polish out surface abrasions with the aid of electron micrographs to evidence the abrasions after scale and their reduction after polishing. This was much more recently than Evelyn was taught and also from a human dentist who worked on small animals. I am not in any way a dentist, but would be interested to know were these electron micrographs fake/based on rubbish research/have techniques for scaling and polishing changed so these abrasions no longer happen/are these abrasions of no consequence/other option? Btw my other half is also a human dentist who argues similarly to Pynadath but without giving me a satisfactory answers to my above questions!

Re: Dentals... to polish or not to polish...?

Mark Holmes — Wed, 17 Oct 2012 13:15:23 GMT

[/quote]

Yes you have

[quote user="Pynadath George"] Evelyn mentioned she was taught these principles by dentists at the time.[/quote]

Re: Dentals... to polish or not to polish...?

james herriot lied — Wed, 17 Oct 2012 13:15:11 GMT

Mr George

As for Evelyn: I'll let 'her' fill you in on a couple of things there

Re: Dentals... to polish or not to polish...?

Gillian Mostyn — Wed, 17 Oct 2012 13:06:50 GMT

erm...I may be being thick here (apologies) but do dogs and cats have this same 'fluoride layer' on the teeth?

Re: Dentals... to polish or not to polish...?

Pynadath George — Wed, 17 Oct 2012 13:06:26 GMT

James, I feel I haven't been rude to Evelyn. If you can point out where ill happily apologise. Like I said before you don't always need a rct on a particular species to extrapolate what may be the same prinicpals in all mammals. Hence the use of animal trials for humans.

Re: Dentals... to polish or not to polish...?

Pynadath George — Wed, 17 Oct 2012 13:03:32 GMT

Rachel You make very good and valid points. However the question that was brought about was open and not breed specific. Evelyn mentioned she was taught these principles by dentists at the time. I'm merely pointing out that dentistry has changed it's stand point an that's all. I have tried to explain the reasons why. I AM NOT trying to persuade anyone from changing their treatment in veterinary care. I cannot comment on that. But I can comment the treatment of choice for humans. Also you have to remember a lot of periodontal surgery like what we are discussing is generally trialled in dogs before applying principles. This should work the other way round? Also we cannot get high end evidence such as meta analysis and systematic reviews on everything before we do something. But we can apply common sense. A lot of what we do in surgery has very little high end evidence.

Re: Dentals... to polish or not to polish...?

james herriot lied — Wed, 17 Oct 2012 12:51:04 GMT

Arlo

Can you just switch the star system back on for ten minutes, so I can give Rachel a bunch? A very timely intervention, given some of the testosterone on here at the moment.

FWIW, I also welcome people like Mr George, but the duty to behave well applies to both sides. One of the issues here is that the human dentists are largely relying on human references, and we on veterinary: the days of simple extrapolation of human principles into our work have, thankfully, gone. Mr George can lay down whatever references he wishes to, but unless the studies have been carried out in our target species, then perhaps we should be careful about over-adoption.

This morning I used a fine brush at 2000rpm, with a soft paste. Contact time on each tooth surface probably no more than 5 secs (if that). Followed by air blow of detritus and rinse. I'm currently eating my pasty without any feelings of reservation - on this matter at least.

Re: Dentals... to polish or not to polish...?

Mark Holmes — Wed, 17 Oct 2012 12:42:21 GMT

[/quote]

Re: Dentals... to polish or not to polish...?

Rachel Perry — Wed, 17 Oct 2012 11:48:19 GMT

If I could try to arbitrate a little. There is evidence available in the human field suggesting that polishing should be selective, and the current recommendations of many human dental associations reflect that. However, a Cochrane review in 2008 found much of the evidence to be poor quality, so much so they couldn't make recommendations about suggested interval or need for polishing after scaling. Let us also remember the difference though, between human patients and our patients. Humans will have many more epIsodes of scaling/ polishing in their lifetime- possibly 40 years worth of hygienist every 6 months! Most of our patients are lucky if they have ONE episode in their lifetime. I can count on one hand the patients that regularly come every year for work. That's difference one. The second difference is that enamel is much thinner in our patients than humans, so perhaps each episode of polishing has a bigger impact. Also, our patients are much less prone to extrinsic stain (not many of my patients smoke, drink coffee or red wine). So perhaps we shouldn't be polishing at all? But as it is there simply isn't enough high quality evidence in OUR patients to make a decision. What worries me far more is that many vets and nurses in practice do not know how to polish safely- they use far too high a speed, too much pressure, too long a contact time, too coarse a paste etc etc so in these cases far better not to polish at all! The fact is, we need more evidence in cats and dogs to suggest what we should be doing!

Re: Dentals... to polish or not to polish...?

Pynadath George — Wed, 17 Oct 2012 07:40:19 GMT

[quote user="James Laidlaw"]

Is there any info available on how fast/slow the rotor should be for polishing? RPM's or otherwise - obviously the oscillation vs rotary is going to be irrelevant unless at comparative speeds too.

[/quote] For humans it's 2500rpm

Re: Dentals... to polish or not to polish...?

Pynadath George — Wed, 17 Oct 2012 07:32:25 GMT

http://www.enotes.com/tooth-polishing-reference/tooth-polishing

Quoted "The American Dental Hygienist Association (ADHA) considers that polishing of the teeth is a cosmetic procedure with little therapeutic benefit. Some have argued that continuous polishing over time can cause morphological changes in the teeth by abrading tooth structure and removing fluoride in the outer layers of the enamel. In some cases, polishing is required where there is heavy staining that cleaning with hand instruments will not take care of, but polishing should not be considered a routine part of the oral prophylaxis and the dentist and dental hygienist must assess each patient for the amount, type, and location of stain present to determine the need for polishing."