Coronal polish and fluoride on a patient with exposed root surfaces
A 62-year-old woman presents for a prophylaxis and fluoride application. She has generalized 2 to 3 mm gingival recession with exposed root surfaces, several areas of root caries that are being monitored, and a history of head and neck radiation that ended three years ago. She wears a partial denture. She reports dry mouth and drinks several sugary sodas daily. The dentist has ordered a coronal polish and a topical fluoride application. Her medical history includes type 2 diabetes and hypertension, both controlled.
1. Is she a candidate for coronal polishing today, and what precautions apply?
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Coronal polishing is a cosmetic procedure that removes stain and plaque from the crowns, and it is not a substitute for scaling and root planing. It is generally contraindicated over active caries, and she has monitored root caries and exposed root surfaces, so avoid polishing those areas and any demineralized enamel. Because of her radiation history and dry mouth, her tissues may be fragile and her caries risk is high, so use a soft rubber cup with a nonabrasive or low-abrasive polishing paste and light pressure, and avoid desiccating the tissues. Confirm with the dentist that polishing is appropriate given the caries status. Do not polish over the root caries lesions. Use suction and keep the field comfortable.
2. What fluoride product and application approach would be appropriate, and why?
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She is at high caries risk because of radiation-induced dry mouth, exposed roots, frequent sugary drinks, and existing root caries, so a professionally applied high-concentration fluoride varnish is generally preferred over a gel or foam, especially with exposed roots, because varnish adheres to the surface and is not rinsed away. Follow the dentist's order and the product instructions for amount and application. Dry the teeth lightly, apply the varnish to the caries-prone surfaces including exposed roots, and avoid polishing immediately before if the product instructions require a clean surface. Tell her not to brush or eat hard foods for the period specified, often several hours. Note that varnish is not a substitute for reducing sugar intake and improving salivary flow.
3. What oral hygiene and nutritional counseling would you give, and how does her partial denture factor in?
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Recommend brushing twice daily with a fluoride toothpaste and cleaning interproximally with floss or interdental brushes, taking care at the receded areas. Because of dry mouth, suggest frequent sips of water, sugar-free gum or lozenges to stimulate saliva, and a fluoride rinse if the dentist approves. Address the sugary sodas: recommend reducing frequency and substituting water, since sipping throughout the day keeps the teeth bathed in acid. Advise not to sip slowly over long periods. Clean the partial denture daily and remove it at night, and keep it clean to reduce plaque and fungal risk. Encourage regular recalls and mention that the monitored root caries needs continued professional care.