Selective Polishing in a Patient With Veneers, Recession, and Chlorhexidine Stain
A 58-year-old woman arrives for her routine prophylaxis. Six months of chlorhexidine rinse, prescribed during periodontal therapy, have left a light brown extrinsic stain across her maxillary anterior facial surfaces. She has porcelain veneers on #7 through #10, composite restorations on #5, #12, and #19, and 2 mm of buccal recession with exposed root surfaces on #5, #6, #11, and #12 that she describes as tender when cold. She gags easily, dislikes mint, takes lisinopril and daily low-dose aspirin, and her last cleaning was eight months ago. Light supragingival calculus is present on the lower anteriors. The dentist has written routine prophy with selective polishing and expects a fluoride varnish afterward. On the cart are coarse, medium, and fine prophy paste, a rubber cup, a bristle brush, and a desensitizing paste. She asks whether polishing sands off her enamel and whether you can whiten the veneers while you are at it.
1. Which surfaces would you polish, which would you avoid, and which paste and armamentarium would you choose? Justify each decision.
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Selective polishing means polishing is limited to surfaces that actually carry extrinsic stain or plaque, not a routine pass over every tooth.
Polish: the stained facial surfaces of #6-#11, using fine-grit paste in a rubber cup at low speed, light intermittent pressure, and a wet cup. Chlorhexidine stain is superficial and responds to fine paste; coarse grit adds abrasion without adding benefit, especially for a patient on aspirin with receded gingiva.
Avoid: the exposed root surfaces on #5, #6, #11, and #12. Cementum and dentin are far softer than enamel, and polishing them removes tooth structure and worsens the cold sensitivity she already reports. Skip the bristle brush for the same reason. Use the desensitizing paste on those surfaces instead.
Restorations: fine paste only around the composite margins, and do not linger on porcelain; coarse abrasive paste can scratch porcelain and dull its glaze and roughens composite margins. A coarse paste is not needed anywhere in this mouth.
Sequencing: scale the lower anteriors first (polishing does not remove calculus), then polish, rinse, and apply the varnish last. Paste residue and moisture interfere with varnish retention. Use a small cup and a mint-free paste because of her gag reflex and taste aversion.
2. How do you answer her two questions, about enamel loss and about whitening the veneers, and what do you say about the cold sensitivity?
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On enamel loss: a rubber cup with fine paste and light pressure removes plaque and extrinsic stain with negligible enamel loss. The risk rises with coarse grit, high speed, prolonged contact, and, most importantly, polishing exposed root surfaces, which is why selective polishing exists. Her enamel is not being sanded away; the areas to protect are the receded roots, and you are protecting them.
On whitening: polishing does not change intrinsic tooth color, and it will not whiten porcelain veneers. Prophy paste cannot lighten them, and abrasive paste can dull the glaze instead. If she wants a brighter smile, that is a separate conversation with the dentist about options, including the fact that natural teeth and porcelain may need different approaches to match.
On sensitivity: the cold tenderness is consistent with exposed dentin at the recession. Tell her you are using a desensitizing paste, avoiding those root surfaces with abrasive paste, and keeping the tooth from overheating during polishing. Advise her to report sensitivity that persists or worsens, and note that her low-dose aspirin is not a bleeding concern for a routine prophy. Document the conversation and the desensitizing paste used.