The question of whether professional teeth polishing damages enamel is common. While the procedure is routine and generally safe, the risk of damage depends entirely on specific factors. Dental enamel is the hard, highly mineralized outer covering of the tooth, acting as a shield for the sensitive inner layers. Although it is the hardest substance in the human body, enamel cannot naturally regenerate once significantly worn away. When performed correctly by a trained professional, polishing benefits the teeth, but improper technique or material selection can lead to surface wear.
What Dental Polishing Involves
Professional dental polishing is typically the final step after a cleaning. It is designed to smooth the tooth surface and remove minor extrinsic stains. The procedure primarily uses a slow-speed handpiece fitted with a rotating rubber cup or brush, which applies a specialized polishing agent known as prophylaxis or “prophy” paste.
Prophy pastes contain mild abrasive particles, such as pumice, calcium carbonate, or zirconium silicate, suspended in a binder. These abrasives mechanically remove surface irregularities, plaque biofilm, and extrinsic stains. The goal is functional, not just aesthetic, as a smoother enamel surface is less conducive to the adhesion of future plaque and bacteria.
Some dental practices utilize air polishing, which employs a high-pressure stream of water and air mixed with a fine powder, often sodium bicarbonate or glycine. Both air and traditional methods aim to create a lustrous and smooth finish on the enamel. When carried out with the correct choice of paste and technique, the procedure minimizes material removal while maximizing surface smoothness.
Factors That Determine Enamel Wear
Damage occurs when the abrasive force exceeds the necessary level for stain and plaque removal. This abrasive wear is a function of three main variables: the abrasivity of the paste, the technique and frequency of the procedure, and the existing condition of the tooth. The abrasive potential of the paste is often quantified using the Relative Dentin Abrasivity (RDA) scale, which measures how much dentin is worn away under standardized lab conditions.
Polishing pastes are available in different grits, from coarse to extra-fine. A finer grit is less abrasive and safer for the enamel. Using a coarse paste when only a fine polish is needed increases the risk of removing the tooth’s outer layer, which is the most protective and fluoride-rich.
The hygienist’s technique directly influences the amount of friction and material removal. Applying excessive pressure, using a high rotation speed, or spending too long on a single tooth surface can lead to significant localized enamel wear.
Polishing is more hazardous in areas where the enamel is already thin, such as near the gum line, or on exposed root surfaces where the softer cementum or dentin is present. Polishing a compromised tooth surface, such as one with demineralization, can lead to increased sensitivity and a higher risk of future decay.
Minimizing Risk and Protecting Enamel
The modern standard of care to protect enamel is selective polishing. This approach involves polishing only those tooth surfaces that exhibit visible extrinsic staining not removed by scaling. This prevents unnecessary abrasion to healthy enamel, particularly on surfaces that are already clean.
Patients can actively participate in minimizing risk by communicating with their dental professional. It is reasonable to inquire about the specific type of prophylaxis paste being used, asking if a fine or extra-fine grit is planned. If a patient is concerned about existing thin enamel or sensitivity, they should discuss the necessity of polishing all teeth versus performing selective polishing.
An important step following any polishing procedure is the application of a topical fluoride treatment. Polishing temporarily removes the surface layer of enamel richest in fluoride. The post-procedure application of a highly concentrated fluoride varnish or gel aids in the rapid remineralization of the newly smooth surface. This treatment strengthens the enamel and restores its protective qualities, mitigating the temporary loss of the outermost layer.