How useful is dental polishing after descaling?

RE: How useful is dental polishing after descaling?

phil barr — Wed, 01 Nov 2023 12:59:08 GMT

Hi Arlo, that's very kind, I wasn't expecting anything but always happy to accept booze :)

I'll check I have correct details registered now....

RE: How useful is dental polishing after descaling?

Arlo Guthrie — Wed, 01 Nov 2023 11:58:23 GMT

phil barr Don't let me forget, I owe you a bottle of champagne for this question (sorry, meant to get it to you earlier, but slipped my mind). Could you confirm that your registered address on this site is the correct one for delivery.

RE: How useful is dental polishing after descaling?

phil barr — Mon, 02 Oct 2023 14:40:07 GMT

Hi all, just wanted to say thanks to everyone for their answers and opinions - I guess I'll most likely continue to gently polish as 'that's what we do' & there's no real reason to stop even if it is not overly useful.... Have a good week, Phil

RE: How useful is dental polishing after descaling?

Steve Hallahan — Mon, 02 Oct 2023 13:09:08 GMT

Surely the risk of causing thermal damage to the pulp with an (albeit slow) handpiece with no water - which 99% of veterinary dental units have - isn't acceptable? We use plaque disclosing solution in a 2-step scaling procedure: not alone is it safer, but it's far more satisfying for the operator to clean off!

As Evelyn said, COHAT might be a mouthful (forgive the pun) to explain, but it covers all bases and you're not claiming to polish.

2 thumbs up for Rachel's point about root planing

RE: How useful is dental polishing after descaling?

Paul Cooper — Sun, 17 Sep 2023 15:21:00 GMT

Can I just add two reasons I still recommend polishing where there is a degree of periodontal disease being treated. It does, as Rachel says, do everything possible to make the mouth as clean as possible at the end of the procedure. The fact that without homecare plaque returns very quickly does not affect my actions- it is up to the client once the patient leaves my surgery. They have all the information given to them both before and after on how to maintain their pets periodontal health, and even after 45 years of practice I still can't second guess which owners will brush, and which wont.

The second reason for polishing the teeth is as a final check on each tooth as I polish that I have not missed any pathology, piece of calculus, forgotten to extract a tooth the initial examination examination indicated needed extraction, etc etc. It is especially easy to miss something in a mouth with extensive calculus and multiple extractions, and you really don't want the client to find it the next day!

RE: How useful is dental polishing after descaling?

Evelyn Barbour-Hill — Sat, 16 Sep 2023 13:10:38 GMT

[quote userid="6386" url="~/f/clinical-questions/30767/how-useful-is-dental-polishing-after-descaling/242487#242487"]What about in cats? I'm concerned that polishing may do more harm than good. Am I wrong in thinking that?[/quote]

No, you're not wrong. Cats have very thin enamel compared with humans. Frequent polishing (which of course cats don't often get) could remove most of it in prominent spots.

I don't polish cats' teeth any more, except in certain spots where in the individual case it seems indicated. That's because no available polishing cup or point that I know of will, it seems to me, effectively polish near or below the gum line in a cat. Yes, you can whizz round with your prophy cup and prophy paste and easily kid yourself you've done a good job.

RE: How useful is dental polishing after descaling?

Kate Richardson — Sat, 16 Sep 2023 09:55:23 GMT

What about in cats? I'm concerned that polishing may do more harm than good. Am I wrong in thinking that?

RE: How useful is dental polishing after descaling?

Evelyn Barbour-Hill — Fri, 15 Sep 2023 16:59:42 GMT

There's another thing I'm going to throw out, to set the cat among the pigeons as it were. There's this great dogma that we all subscribe to (yes, me too, up till now) that we should get the tooth surface as smooth as we possibly can, to "reduce plaque formation".

This forum being what it is, I must be clear that I'm putting this as something to discuss, not to argue a particular thesis.

Hmm. Plaque forms anyway. It doesn't need a rough surface to help it. It seems to me that the point of smoothing the surface is to make it easier for a toothbrush to clean the plaque off again: so the principle of "smooth as possible" is absolutely right for human dentistry. Is it applicable so much to veterinary dentistry? I'm not so sure. Maybe it's one of those things we've just taken from human dentistry without thinking too hard. And does the principle apply just as much to dentine as to enamel?

Discuss.

RE: How useful is dental polishing after descaling?

cairncross — Fri, 15 Sep 2023 07:56:00 GMT

Cleaning the wound removes a source of nutrition for bacteria ,removes attraction of flies , allows better visualisation and a clean wound that becomes dirty bloody etc will hopefully alert the owner to note something is going on . So I think this has medical reason.

RE: How useful is dental polishing after descaling?

Rachel Perry — Fri, 15 Sep 2023 06:57:17 GMT

Thanks for the link Bob. Microdont ultrasonic scraper?? The only microdont polishing cups I can see are polishing cups for acrylic/composite/metal polishing so I’m not surprised it removed enamel! Not sure that we can use this to infer scaling scratches enamel and polishing smooths it without damage - what pressure did they use… 10seconds is a long time on one tooth - the heat generation I suspect would be extreme . Sorry- show us better evidence.

RE: How useful is dental polishing after descaling?

Bob Partridge — Wed, 13 Sep 2023 22:44:37 GMT

www.scielo.br/.../

RE: How useful is dental polishing after descaling?

Arlo Guthrie — Wed, 13 Sep 2023 15:42:49 GMT

phil barr Look what you've started

Joking aside, great discussion, and I think it well illustrates why VetSurgeon.org is so much better than other social media for asking questions like this.

Hope you're finding it helpful.

RE: How useful is dental polishing after descaling?

Rachel Perry — Wed, 13 Sep 2023 14:05:39 GMT

Evelyn you raise many good points - especially the long-held myth still cited in many places (still!) which suggests we polish to remove the scratches we create by scaling. If we think about this for a second- to achieve a smooth surface we need to remove enamel to the depth of the deepest scratch. Is this desireable? No! Is this feasible with a soft polishing cup and fine paste? I sincerely doubt it.

RE: How useful is dental polishing after descaling?

Rachel Perry — Wed, 13 Sep 2023 13:57:52 GMT

[quote userid="6386" url="~/f/clinical-questions/30767/how-useful-is-dental-polishing-after-descaling/242431#242431"]Rachel Perry So do you, or do you not, polish the teeth? [/quote]

People come to me for gold standard care at referral level- so most of my patients will have their teeth polished.

If coming in for periodontal disease then 100% will.

2 year old Labrador with fractured canine and minimal deposits for root canal therapy may not - and I wouldn’t lose sleep over it.

I‘m not going say GP vets definitely should or shouldn’t polish teeth.

But if practices have a blanket ‘no polishing’ then informed consent should be considered.

In those practices though, if there are clients who perform regular and effective toothbrushing then it would be right to polish that pet’s teeth - giving the client the cleanest place to start again from.

If vets are polishing teeth then it should be done safely.

One person mentioned he didn’t think his clients would expect their pet’s teeth to be polished - but has he asked them what they’re expecting?

Most people that see me expect their pets teeth to have been radiographed by their vet if they’ve already had dental treatment and seem flabbergasted if they haven’t had X-rays already, so maybe clients expect more than we realise.

Another example - which might create an annoying tangent - what level of anaesthetic monitoring do clients expect we provide? Beepy anaesthetic monitor like on Casualty or a nurse with a stethoscope?

One thing that has not been mentioned and is sadly lacking from veterinary dentistry is the concept of scaling and root planing.

Scaling and polishing doesn’t really exist as a ‘thing’ in human dentistry - and if you look at any human periodontal disease textbook polishing is barely mentioned.

Scaling and root planing however, forms the mainstay of periodontal therapy in people.

Where periodontal pockets exist and we aren’t extracting the teeth they should absolutely have scaling and root planing.

RE: How useful is dental polishing after descaling?

Evelyn Barbour-Hill — Wed, 13 Sep 2023 13:48:59 GMT

Quite a number of things cannot be extrapolated directly from human to veterinary dentistry. For one thing, possibly above all, continuous oral hygiene at home is assumed in any treatment plan for people. For another, human teeth have much thicker enamel than cats and dogs. For another, fluoride is totally irrelevant in our patients. For another, cosmesis, halitosis and how the teeth "feel" do not bother our patients or interfere with their social interactions, while in humans the opposite is the case.

Having said that, while I do not carry out procedures for cosmetic reasons, when carrying out a procedure for good medical or surgical reasons I do endeavour to get the best cosmetic result that I can – doesn't every veterinary surgeon do that?

In many a periodontal treatment there may be certain teeth in which polishing of certain aspects will be a beneficial part of the procedure – while I've got the polishing gear in my hand, I'll generally polish off cosmetic marks on other teeth, time permitting – why not? Dogs especially do get "stain" on their teeth – though "stain" is a misnomer as it's more like a varnish.

"Scaling", when properly done, is also really a bit of a misnomer. Yes of course you remove all the calculus (though unless very thick and rough, calculus that's up on the crown and well away from the gum line has no relevance to gum health), but that's merely a start . Assuming you are using a decent machine, you are endeavouring to remove every scrap of plaque from below the gum line and a millimetre or so above it. You also remove plaque from higher up the crown, but that's nearly irrelevant to health.

Sure, plaque forms again within two hours and may be maturing below the gumline after 48 hours. That's why, when you've finished your procedure that's just the start. You haven't finished your job. The next bit is to instruct the client on oral hygiene and to work out an individual hygiene plan to suit the owner and the patient.

To say "polishing is useless because the plaque will be back in 48 hours" is to admit that your procedure has been pointless. And if your procedure was just "GA, scale and polish, there you are Mrs. Jones, Binky's teeth all shiny again, see you next year, pay at the desk please" then your procedure was not only useless but arguably verging on the fraudulent.

The "annual scale and polish" for cats and dogs is good for corporate income perhaps but not for anything else.

I never put "scale and polish" on a consent form and never would if I were still in general practice . If a client asks for "scale and polish" I spend some time explaining periodontal health. Personally I like the term "complete oral health assessment and treatment" (COHAT) but other forms of words can work just as well. "Periodontal assessment and treatment" is not so good as it implies you will ignore anything not associated with the periodontium.

Another thing. "Polishing" can mean many different things. When I polish my brass plate, I remove the thin layer of brass that has been oxidised – there is an actual loss. When I polish my car (rarely!) or my shoes, I remove accumulated deposits and then add a layer of waxy substance. When I polish my glasses, I just remove accumulated deposits. When I polish slate or a composite filling (or in younger days, car body filler) I grind it away with abrasives of successively finer grades. Which are you intending when you polish a tooth? You need to be sure.

With regard to teeth of our patients, polishing of the enamel should be the removal of accumulated deposits, no more. It used to be said that polishing removed the scratches left by scaling, and there were electron micrographs in the textbooks to demonstrate it. But that was then when scalers were crude and technique not always understood. If you are using a decent modern scaler, and using it correctly, I doubt if there are scratches to remove.

Oh, one other thing. The last time I saw the WSAVA guidelines, they said "every square millimetre of every tooth should be polished". That's absolute bunkum. And it's not the only statement in that document which fits that description.

RE: How useful is dental polishing after descaling?

Kate Richardson — Wed, 13 Sep 2023 13:19:26 GMT

Rachel Perry So do you, or do you not, polish the teeth?

RE: How useful is dental polishing after descaling?

Rachel Perry — Wed, 13 Sep 2023 11:26:21 GMT

Arlo you’re absolutely correct- we wouldn’t polish to remove stain on animals’ teeth as they don’t do those things like we do - and we’d never do something purely for cosmetic reasons as a vet.

Which means- when we polish animals teeth we are doing it to purely remove plaque and small calculus deposits.

Because this only lasts a few hours before plaque starts to re-form that’s why many vets say there is no point.

I was playing Devil’s advocate by saying that may be true - but what if clients expect it to be done, what if we are invoicing for it, if we are not removing plaque, then are we being thorough when we have patients in for a dental procedure?

The Cochrane review shows there is no health benefit to routine scaling and polishing - in people though - that presumably have some degree of oral hygiene at home.

We don’t know the benefit of routine scaling and polishing in dogs and cats but it’s worth considering my previous points to look at things from slightly oblique angles.

RE: How useful is dental polishing after descaling?

Andreas Ege — Wed, 13 Sep 2023 10:56:30 GMT

@ Dinu Catilina

Ah, never mind. Just noticed it was the second post you disagreed. Never mind, I can appreciate different opinion on that aspect. :-) Should have checked better before posting.

RE: How useful is dental polishing after descaling?

Andreas Ege — Wed, 13 Sep 2023 10:53:06 GMT

[quote userid="2161" url="~/f/clinical-questions/30767/how-useful-is-dental-polishing-after-descaling/242417#242417"]

Does your invoice include a charge for ‘scaling and polishing’? Do clients expect their pets’ teeth to be polished? Do you inform them if you don’t polish?

If practices choose not to polish then I think the client should be fully informed.

If practices choose to polish then it should be done safely- soft cup, low speed, fine paste. Badly performed polishing is worse than no polishing as a coarse paste with hard cup and firm pressure.

Badly performed polishing will lead to enamel scratches which will hasten plaque re-accumulation - hence the often cited myth - ‘ooh don’t start scaling and polishing as once you start it builds up again more quickly’.

This is an interesting read: https://www.cochrane.org/CD004625/ORAL_routine-scale-and-polish-periodontal-health-adults which suggests no health benefits to routine scale and polish.

However, we do have a duty to detect periodontitis/tooth resorption/fractures etc in our patients.

[/quote]

Sorry for the big quote, multi quote for a single post doesn't seem to work on my system.

No, our invoice only says dental procedure (and if happening, extractions in various ways). I do take it out of the discharge letter as well, as I haven't done it. I don't know if my clients expect it, but I don't think so. As far as I'm aware it never gets mentioned specifically.

The cochrane link basically confirms what I said about the medical side of polishing.

(Key results

The studies found little or no difference between regular planned scale and polish treatments compared with no scheduled scale and polish for the early signs of gum disease (gingivitis or bleeding gums; plaque deposits; and probing depths or gum pockets). There was a small reduction in calculus (tartar) levels, but it was uncertain if this is important for patients or their dentists.

Participants receiving six-monthly and 12-monthly scale and polish treatments reported feeling that their teeth were cleaner than those who were scheduled to receive no treatment. However, there did not seem to be a difference between groups in terms of quality of life.

Available evidence on the costs of the treatments was uncertain.

Neither of the studies measured side effects (such as damage to tooth surfaces and tooth sensitivity), changes in attachment level, tooth loss or halitosis (bad breath). Neither study compared scale and polish treatments provided by different professionals, e.g. dentists, dental therapists and hygienists.)

For the last point, unless I've severely missed something, I don't need polishing to detect periodontitis/ tooth resorption/ fractures etc. Xrays would be much more helpful, for that reason I do inform clients most of the time that we do not have a dental xray machine and might miss something and offer them referral. Most clients decline.

Dinu Catilina With what part of my post do you actually disagree? Surely can't be the polishing if you're writing you 'tend not to polish' yourself. *confused*

RE: How useful is dental polishing after descaling?

Clive Ansell — Wed, 13 Sep 2023 10:00:50 GMT

[quote userid="2161" url="~/f/clinical-questions/30767/how-useful-is-dental-polishing-after-descaling/242417#242417"]

However, a few things to consider. Patients are coming to us and clients are paying considerable sums for periodontal therapy - this should surely include removal of all dental deposits? Plaque and calculus. Calculus removal is pretty much a cosmetic endeavour as it’s plaque which causes periodontal disease.

Does your invoice include a charge for ‘scaling and polishing’? Do clients expect their pets’ teeth to be polished? Do you inform them if you don’t polish?

[/quote]

Good point about invoicing. Most practices do invoice clients for "dental scale and polish" , in which case that is what they expect and are paying for, and it should be carried out

One of my practices uses the term "peridontal assesment and treatment" on the invoice rather than "(De)scale and polish", which seems to me a far more accurate description of what we are or should be doing.

RE: How useful is dental polishing after descaling?

Dinu Catilina — Wed, 13 Sep 2023 09:59:19 GMT

In my hands 2-3 minutes but maybe I'm doing it wrong

RE: How useful is dental polishing after descaling?

Arlo Guthrie — Wed, 13 Sep 2023 09:57:57 GMT

[quote userid="9239" url="~/f/clinical-questions/30767/how-useful-is-dental-polishing-after-descaling/242421#242421"]Arlo, realistically polishing teeth adds very little costs to a "dental".[/quote]

Thanks Dinu. How long does it take to polish?

RE: How useful is dental polishing after descaling?

Dinu Catilina — Wed, 13 Sep 2023 09:55:53 GMT

[quote userid="2100" url="~/f/clinical-questions/30767/how-useful-is-dental-polishing-after-descaling/242420#242420"]Surely in a cost of living crisis, when there is a competition commission investigation into the profession, that is not a strong enough reason, and anything which adds to the time and cost of a consultation without adding a measurable benefit for the animal needs looking at?[/quote]

Arlo, realistically polishing teeth adds very little costs to a "dental". We spend a lot more time on removing calculus, checking gums and extracting teeth. A drop in an ocean.

I tend to not polish.

RE: How useful is dental polishing after descaling?

Arlo Guthrie — Wed, 13 Sep 2023 09:42:16 GMT

[quote userid="2161" url="~/f/clinical-questions/30767/how-useful-is-dental-polishing-after-descaling/242417#242417"]Patients are coming to us and clients are paying considerable sums for periodontal therapy - this should surely include removal of all dental deposits? Plaque and calculus. Calculus removal is pretty much a cosmetic endeavour as it’s plaque which causes periodontal disease. [/quote]

Rachel Perry Hi Rachel, can I play devil's advocate? Bear in mind that I am a layman, so my question may just expose my own stupidity!

You've said polishing achieves stain removal. Not being a vet myself, I am not sure how much dogs' teeth get stained (mine doesn't smoke, drink red wine or coffee!), but even if frequently, I wouldn't have thought that is a reason for performing on dogs, is it? Perhaps show dogs?

Then you say it also removes plaque biofilm (which reappears 48 later), and calculus (which is cosmetic too).

So I read your post to say that the rationale for polishing is: Do clients expect their pets' teeth to be polished? Does your invoice include it?

Surely in a cost of living crisis, when there is a competition commission investigation into the profession, that is not a strong enough reason (or rather it's a reason to change the wording on the invoice), because anything which adds to the time and cost of a consultation without adding a measurable benefit for the animal needs looking at?

I'll get back in my box now!

RE: How useful is dental polishing after descaling?

Rachel Perry — Wed, 13 Sep 2023 08:55:52 GMT

Polishing achieves two things:

Stain removal - which is important in humans who drink tea, coffee, red wine etc - which is achieved by using coarse then medium then finer pastes to literally achieve a smooth/polished surface to the enamel. Teeth feel and look nice (polished and shiny!). This will remove a small amount of enamel which is why over a human patient’s lifetime there is concern over unnecessary enamel removal hence ‘selective’ polishing. Research has shown some patients want their teeth to be polished and expect it to be performed.

Polishing also removes plaque biofilm and tiny fragments of calculus.

Its true plaque biofilm removal only lasts 48 hours until another mature biofilm has formed on the teeth, leading to many vets choosing not to polish at all as there’s ’no point’.

Does your invoice include a charge for ‘scaling and polishing’? Do clients expect their pets’ teeth to be polished? Do you inform them if you don’t polish?

If practices choose not to polish then I think the client should be fully informed.

If practices choose to polish then it should be done safely- soft cup, low speed, fine paste. Badly performed polishing is worse than no polishing, as a coarse paste with hard cup and firm pressure will cause scratches in the enamel which will cause plaque to re-accumulate very quickly.

This is an interesting read: https://www.cochrane.org/CD004625/ORAL_routine-scale-and-polish-periodontal-health-adults which suggests no health benefits to routine scale and polish.

However, we do have a duty to detect periodontitis/tooth resorption/fractures etc in our patients.

So, while I don’t buy into a yearly cleaning for every patient I do recommend GA /rads/ cleaning on an individual basis with individual timescales