When I see some of these students, now colleagues, at continuing education events, they tell me that they polish first, and they love it. Regardless of the abrasive used, there was some variation in root defects generated by different devices and the glycine-based powder produced the least amount of root damage. Here is a thorough list of the indications and contraindications for coronal polishing. One of the most common mistakes dental professionals make is to polish all teeth regardless of a patients condition. Conservation of demineralized enamel surfaces is indicated. Or you may have done all the right things! Synonym (s): frontal plane. Professional removal of dental biofilm is absolutely therapeutic. The goal in Expanded Functions for Dental Auxiliary is to promote growth in the skills of the dental assistant. Coronal Polishing Courses for Dental Assistants Basic Dentistry Done Better 2088 Lowe's Dr., Suite C Clarksville, TN 37040 (931) 980-2072 Approval expires: 12/31/24 Chattanooga College Medical, Dental and Tech 248 Northgate Mall Drive #130 Chattanooga, TN 37415 423-305-7781 Approval expires: 12/31/22 Chattanooga State Community College I polished and flossed and had her hold a mirror to watch me floss, not only for technique but to demonstrate what it was removing and the bleeding that occurred. Intracornal preparation are mortise shaped having definite walls and floor joining. State regulations are updated quarterly; we currently have two versions available. and less than optimal home care even though I know she tries. An oral prophylaxis is a routine cleaning done in the dental office, consisting of two parts. You have a respiratory or infectious condition that may be irritated by the aerosol spray involved in polishing. The Board will approve a coronal polishing course that meets the requirements of 12 AAC 28.820 -830. Have questions about your smile? Identify the equipment, materials, and supplies needed for coronal polishing; Identify the potential risks and contraindications for coronal polishing; Demonstrate the preferred technique for coronal polishing; Recognize the proper positioning used/ergonomics; Demonstrate clinical competency in performing coronal polishing in a preclinical setting https://www.linkedin.com/showcase/4000114/. One in vitro study compared the effect of a calcium carbonate-based powder on dentin bonding to an air polishing powder containing glycine. Wilkins also said, Stain removal after gingival and periodontal treatments, including scaling and root planing, is not recommended on the same day.. Use these key points as a checklist to assess whether youre making the right choices when performing coronal polishing. Your dentist wants to clean the tooth surface in order to determine your correct tooth shade. In addition, it's important that guidelines be updated to keep up with the latest research. Oral Care Center articles are reviewed by an oral health medical professional. The degree program consists of open enrollment courses (general education and division specific) and program specific courses with limited enrollment. The Dental Assisting program is a full-time day program to which students are admitted in August of each year. I heard about pre-polishing again in March 1994, less than a year out of dental hygiene school, when I attended a continuing education class on insurance codes presented by Kathy Forbes, RDH. YYYY Colgate-Palmolive Company. Gold, composite, acrylic veneers, porcelain restorations. Part 3 of 3, Untreated periodontitis and COVID-19: What is the evidence? Idiopathic scoliosis is a three-dimensional deformity of the growing spine, affecting 2%-3% of adolescents. (A) Qualifications - Within ninety days from receipt of successfully passing the standardized examination required pursuant to division (B)(5) of section 4715.39 . Rearrange the equation and plot the data in order to determine KtK_tKt and VmaxV_{max}Vmax for glucose transport across the erythrocyte membrane. Oral Health, Dental Conditions & Treatments. This outermost fluoride rich layer of enamel is removed when tooth polishing is provided. indications and contraindications of polishing; (6) selective polishing . 1. "It's not going to impact tooth decay, gum disease or oral cancer.". Coronal polishing is a procedure used to remove stain and plaque from the enamel surfaces of the teeth, after the removal of hard deposits such as calculus from the tooth surfaces. Adam, you guys always have something new. Here are the contraindications for coronal polishing: Absence of stain. For all procedures, patients should be evaluated on a case by case basis. Any student under age 18 must contact the program director/department chair to discuss whether he or she may enroll. It contains xylitol and fluoride, so again, you are applying products that are good for enamel while gently removing plaque. The majority of the sodium is mixed with the particles during the manufacturing process to enhance the calcium phosphate; therefore, the particles dissolve over time, limiting the release of sodium. As oral health-care providers, we are constantly pushing to keep current with technology and research. Petersilka GJ, Bell M, Haberlein I, Mehl A, Hickel R, Flemmig TF. i] (chemical engineering) In petroleum refining, removal of final traces of impurities, as for a lubricant, by clay adsorption or mild hydrogen treating. You have extrinsic stains and light plaque on the crown portion of the tooth. Learn more about the procedure, including benefits, cost, and . Texas This is why, if extra polishing is necessary, it should be done with the least abrasive paste, using the proper technique, pressure and speed. I love dental assistants, but they are not qualified or trained to evaluate and treat this. She said enamel does not get abraded, and she likened this to scrubbing a porcelain sink with cleanser. There are forms of sticky plaque that do not come off with rubber cup polishing. New dental hygiene graduates ask me how they can address the challenge of time management when they get into practice. SmarterDA dental assisting exam prep solution. JADA 2010; 141(8): 995-999. Waterpik also has a new polishing paste (Soft Shine) that is especially formulated for esthetic restorations. Sunday, March 26 7:30 a.m. to 6:30 p.m. BDENT-0200-001, $495 Titanium abutments should not be polished. After your dentist or dental hygienist cleans and polishes your teeth, you may want to enjoy that clean, smooth-teeth feeling more than just twice a year. This information packet prepares you to participate in the course. J Biomed Mater REs Part B: Appl Biomater 2009; 88B: 83-91. https://www.linkedin.com/showcase/4000114/, Mr. Borneo asks Adam, RDH: "What's that huge monstrosity in the corner of your operatory that looks like a muscular elephant trunk? [3] Common practice is to use a prophy cupa small motorized rubber cupalong with an abrasive polishing compound. You have three opportunities to successfully take the TEAS. This device is called Prophy-jet. [5] Materials such as gold, amalgam, composite, porcelain and titanium implants can be polished by using specifically designed pastes such as those that contain rouge, tripoli, cuttle, emery, coarse pumice to prevent roughened or scratched surfaces. Chromogenic bacteria found in plaque that is left behind due to poor oral hygiene can also cause staining. It is also used with polishing paste. Longitudional studies have demonstrated the efficacy of standard treatment approaches (regular mechanical removal of bacterial biofilm), which consist of meticulous debridement of tooth and root surfaces, consistent self-care measures, and supportive maintenance visits. Claire Jeong, RDH, MS, is an educator and entrepreneur. A pilot study. What about the idea of polishing first? However, it shows that those who may seek advancement within their Dental Assistant position or within the dental . Additionally, we offer several Continuing Education courses throughout the year. [4] Within the last century, Alfred Fones, the founder of dental hygiene, began educating students on coronal tooth polishing. 8. Lynne Slim, RDH, BSDH, MSDH, is an award-winning writer who has published extensively in dental/dental hygiene journals. This suggests that tooth polishing should be based on the clients individual needs. ADHA.org, American Dental Hygienists' Association Position Paper on Polishing, webpage updated 2010, http://www.adha.org/profissues/polishingpaper.htm. demonstrate correct coronal polishing techniques including patient/operator position and instrumentation . 12. Coronal Polishing Certificate Practice when the dentist is not physically present ALL SECTIONS OF THIS DOCUMENT MUST BE COMPLETED INDICATING THE DUTIES AND/OR FUNCTIONS YOU HAVE BEEN APPROPRIATELY TRAINED/EDUCATED TO PROVIDE. There are several contraindications for air polishing. The use of the brush should be confined to the crown to avoid injury to the gingiva and cementum. Polishing can: Create a smooth tooth surface that is less likely to retain plaque, calculus, and stain. 13. We hope the information you find here on our website is informative and useful. I tell her that at school we still teach selective polishing, and now part of that is selecting the patients who are appropriate to polish first. Coronal Polishing for Dental Assistants is organized by Creighton University and will be held from Jan 31 - Feb 01, 2020 at Creighton University School of Dentistry, Omaha, Nebraska, United States of America. Prior to the 1970s tooth polishing was provided to all patients as part of their complete care. Cost: $425 Designed For Caries Prevention and Coronal Polishing for the Dental Assistants Course Description. Pelka M, Trautmann S, Petschelt A, Lohbauer U. Dental polishing can remove surface stains on teeth and leaves them shiny and smooth, putting the finishing touches on preventive dental treatment. When adapting the rubber cup, angle to flare at the gingival margin to reach the distal, facial, lingual, and mesial surfaces, and maintain this by rotating the handpiece. 2. I will say, You can be sure that all that gritty stuff will be rinsed out of your mouth by the time treatment is complete.. Rohleder PV, Slim LH. fPRINCIPLES OF CAVITY PREPARATION FOR. For any students applying under the Accelerated Admission for Academic Achievement (AAAA) you must have a GPA of 3.0 with an overall TEAS score of 65 and a science score of 55. What is therapy? 2. By polishing first on a gingivitis patient who requires only one scaling appointment, or polishing the previously scaled quadrant on a patient who requires multiple appointments for periodontal scaling and root planing, you avoid embedding particles that are out of reach from rinsing. Resources. The Coronal Polishing and Local Anesthesia and Nitrous Oxide Sedation certificates are only available to students who have been admitted to a Dental Hygiene or Dental Assisting/Dental Hygiene program. Register, Volume 40, Number 50, December 11, 2015, TexReg, Texas But I did not run back to my office and pick up the prophy angle first. After we've taken or updated the medical/dental history, we can determine if a patient is a good candidate for air polishing. Note: For students under age 18 there may be restrictions on participating in certain Health Sciences programs. The online platform delivers content of the highest quality through the latest e-learning technology. 312-440-4653 | 800-621-8099 x4653, Download the PDF version Dental Health Sciences Dental Hygience Self Study 2020. Other external factors that can lead to extrinsic staining are smoking, some antimicrobial rinses, and environmental working conditions where there is exposure to metallic dust. All faculty members shall have been licensed for a minimum of two years. Perform laboratory exercises utilizing manikins or extracted teeth. However, I have observed that the rubber cup is more effective at removing adherent biofilm and certain types of stain than the prophy jet. View Week 2 assignment and recall.pdf from DENTAL ASSISTING DA23.3 at Carrington College, Phoenix. http://www.adha.org/profissues/polishingpaper.htm, http://www.osap.org/?page=Issues_DUWL_7&hhSearchTerms=polish. There are two popular types of prophy cups: 4 webs and 6 webs. You are interested in working in the dental field. When these teeth have deep, stained fissures, a prophy brush with a bit of pumice works great to remove this stain. Only a thorough dental prophylaxis can remove calculus.When do you say yes to coronal polishing? Description: Denise Kissell, RDH, MS, EFDA Postle Hall 305 W. 12th Avenue This lecture/hands-on course satisfies the 7 hour CE requirement for CDA's seeking Coronal Polishing Certification from the Ohio State Dental Board (OSDB). Always seek the advice of your dentist, physician or other qualified healthcare provider. Upon completion of this short-term certificate the graduate will be eligible to sit for the Ohio CDA examination. [6], Current evidence suggest that prophylactic polishing is only necessary when extrinsic stain is present on the tooth surface. [5] Foods and beverages such as coffee, tea, and red wine can stain the enamel. The goal as dental hygiene educators is to provide students with a foundation of knowledge and skills through the facilitation of quality learning experiences. "It looks rather scary, but the truth is it's a flexible suction arm that captures aerosols. 21. She made this idea visual by showing a slide of a patient with thick plaque and gingivitis. Here are the contraindications for coronal polishing: Absence of stain. Bicarbonate-based air polishing powders have been limited by substantial abrasiveness on composite materials.1 Besides the most common air polishing sodium bicarbonate-based powders, there are some newer air polishing products that are worth mentioning (see "Sources for air polishing powders"). To avoid cross-contamination from dental equipment, infection control specialists agree: "The same chemical treatment regimens and technology used in the dental unit should be effective with the ultrasonic and air polishing equipment, which also pose risk of bacterial contamination via biofilm tubing."2. Approval of coronal polishing courses . The whole procedure went very well, and I was queen for a moment - that is until I got her 9-year-old sister in the chair. Evaluate tissue color, contour, consistency, and bleeding at the same time plaque is removed. When I see Wendy at continuing education events, I tell her what an influence she has had on me, and what I have learned about polishing first. Most of the in vitro research on sodium phosphosilicate, to date, has been focused on its ability to form a layer of hydroxycarbonate apatite on tooth dentin and enamel, as well as its effectiveness as a desensitizing and remineralizing agent. Phoenix, AZ 85007 Seat the patient and and him or her with a waterproof napkin. Identify the potential risks and contraindications for coronal polishing. Flemmig TF et al. Tooth polishing is done to smooth the surfaces of teeth and restorations. Results showed that GPAP for five seconds per surface was effective in removing most of the subgingival plaque/ biofilm with an anatomic probing depth of 2 mm to 3 mm. After removing supragingival deposits, the glycine spray was applied for four to five seconds in all sites 5 mm in the test quadrant, whereas curette/ultrasonic debridement was used in the control quadrant. Are you prepared to do the procedure correctly? Prophy brush: can be used for removing extrinsic stain from grooves, pits and fissures, or used prior to placing sealants. To determine whether a renal patient is a candidate for air polishing, you would have to know the stage of renal disease (there are five stages), the treatment for renal disease (some treatments allow greater flexibility in diet than others), the adherence to treatment and medications, the patient's medical status, comorbidities, etc. All rights reserved. Note: For students under age 18 there may be restrictions on participating in certain Health Sciences programs. J Clin Periodontol 2008; 35 (Supp. The following scenarios, outlined by an article published in DentistryIQ, are usually the only times a dentist would recommend an extra polishing: If tooth stains reach inside the enamel, otherwise known as intrinsic stains, polishing is not recommended since it won't be effective for this type of staining. The Michaelis-Menten equation can be rearranged so that a plot 1/V01 / V_01/V0 versus 1/[glucose] produces a straight line. Forbes said she polishes first to remove plaque and stain, then there is less plaque to remove with scaling. ), Most peri-implant lesions (peri-implant mucositis or peri-implantitis) are caused by plaque/biofilm colonization around the implant surface.19 There is a statistically significant higher incidence of peri-implantitis for dental implants placed in patients with a history of chronic periodontitis (28.6%) compared with periodontally healthy individuals (5.8%).20 The correlation between the presence of periodontitis and the development of peri-implantitis has been supported by a recent systemic review.21, Schwarz et al. The board may, upon its own motion or upon request of any interested person, approve a course of instruction . It is challenging to read every professional journal and keep up with all of the latest information available. Just as air polishing devices often result in clinically relevant tooth surface damage and restorative material loss, air polishing of sealants always results in substance loss and surface damage, according to Pelka, Altmaier, Petschelt and Lohbauer.13 The authors made plane specimens (N=180) of dental restorative materials and treated the specimens with standardized air polishing for 10 seconds each. The Commission on Dental Accreditation can be contacted at 800-621-8099 or 312-440-4653 or at 211 East Chicago Avenue, Chicago, IL 60611-2678. Heyman SN, Babayof L., Emphysematous complications in dentistry, 1960-1993: an illustrative case and review of the literature. 10, No.9, copyright 1997 by the American Dental Hygienists' Association, http://www.osap.org/?page=Issues_DUWL_7&hhSearchTerms=polish. Kotsovili S, Karoussis IK, Trianti M, Fourmousis, I. Demineralized spots. Now that youve mastered when and when not to provide coronal polishing, l will explain one more concept. [5] Particles within the prophylactic paste can go below the gumline and cause inflammation or delayed healing. For cosmetic restorations, use Proxyt by Ivoclar Vivadent. Click here for the Dental Hygiene Program Advisory Committee, Sinclair Community College A 1.0m1.0 \mathrm{~m}1.0m long segment of wire lies along the xxx-axis and carries a current of 2.0A2.0 \mathrm{~A}2.0A in the positive xxx-direction. She has a full dentition (30 teeth!) No adverse events were reported in this study, and there was minimal gingival irritation. One explanation given for this phenomenon is that it results from Part 2 of 3. You need to remove residue from temporary cements. Question. Code 114.5 - Coronal Polishing. Any student under age 18 must contact the program director/department chair to discuss whether he or she may enroll. Although some procedures can be messier than others, virtually all dental procedures produce aerosols, and the air polisher is no exception. Periodically revisit the assortment of air polishing equipment/powders and apply evidence-based decision-making to clinical decision-making. Furthermore, even if we determine a patient is a good candidate for air polishing (from a medical standpoint), we also have to evaluate them from a dental standpoint. Preparation path. n. 1. She can be contacted at catblue@aol.com, or visit her Web site at dentalinspirations.org. CAST RESTORATION. Coronal / cosmetic polishing - This type of polishing removes the plaque and superficial dental stains. 3. When these conditions are present, it is best to postpone coronal polishing until healing takes place. Coronal Polishing- A technique used to remove plaque and stains from the coronal surfaces of the teeth Endogenous Stains- Stains developed from within the structure of the tooth Exogenous Stains- Stains developed from external sources Extrinsic Stains- Stains that occur on the external surfaces of the teeth that may be removed by polishing Areas of exposed cementum (due to tissue recession) or exposed dentin should not be polished. Prophy cup: I prefer a small, short [pedo size] soft rubber cup. Rubber cups should not be used over the cementum area as it may remove a layer of cementum at the cervical area. I sometimes feel a bit guilty that I might be removing so many microns of enamel. (2005). I first heard of pre-polishing when I worked as a dental assistant between 1987 and 1991. Influence of air-polishing devices and abrasives on root dentin an in vitro confocal laser scanning microscope study. [5] Based on these variants, pastes are available in fine, medium, coarse and super-coarse grits. All faculty members shall have the education, background, and occupational experience and/or teaching expertise necessary to teach, place, and evaluate coronal polishing. http://www.adha.org/proissues/polishingpaper.htm (accessed 28 June 2006). Faculty Marie Desmarais, CDA, M.A.T. A colleague who went to work in an office with 50-minute hygiene appointment times for adult patients rather than the traditional one-hour, started polishing first to help her stay on schedule. An initial therapy patient who requires quadrant scaling with anesthesia would not be a candidate for polishing first. Know appropriate patient and operator positions. Tooth Polishing Procedures Extracoronal preparation are created by occlusal and axial surface reduction. McGraw-Hill Dictionary of Scientific . An ultrasonic scaler will provide more effective irrigation, particularly subgingivally, than just rinsing with an air/water syringe. You are encouraged to complete Cardiopulmonary Resuscitation for the Health Care Provider (or ALH 1130 Basic Life Support Training) prior to entry to the Dental Assisting program. Many ideas and opinions exist about polishing teeth, including whether or not polishing is a necessary part of a prophylaxis appointment. Lynne is also the owner and moderator of the periotherapist yahoo group: www.yahoogroups.com/group/periotherapist. Once the training is complete, the student must take a state written and practical exam to demonstrate proficiency in placement of dental restorations. The enamel surface is strong enough to withstand repeated tooth polishing, but it should be avoided on newly erupted teeth, exposed root surfaces and areas of demineralization. Objectives: The successful student will meet the following objectives and demonstrate an understanding of the facts, principles and techniques in this course. To qualify for entry to limited enrollment courses, please see the Applicant Information packet located on the webpage. Aerosols are produced during tooth polishing and may transmit infectious diseases to other people in the dental office. I treated these lovely girls into college age. The agency is operational but staff members are working remotely. Below is a comparison between our most recent version and the prior quarterly release. No one likes the cleaning lady stigma. This patient described polishing first in a wonderful way, Its like sweeping the floor before you scrub it. Why would you want to mop around a bunch of loose dirt on the floor? Bednarsh HS, Eklund KJ, and Mills S. Reprinted from Access Vol. Microbiologic samples were taken and total bacterial counts and counts of six periodontal pathogens were determined by real-time polymerase chain reaction. Lynne speaks on the topic of conservative periodontal therapy and other dental hygiene-related topics. The only stains I cannot see in my mouth are on the linguals of the maxillary anterior teeth. Saunders 2003. Desensitize with new polishing pastes that are more logically applied prior to scaling. I selected coarse prophy paste, because I did not need disclosing solution to tell me this dental biofilm was thick and adherent. For example, the UT Health San Antonio School of Dentistry offers a training course that is required for any dental assistants who want to perform coronal polishing in Texas. 444 West Third Street The glycine-based powder product produced the smallest defect depth and volume loss. Polish coronal surfaces Take x -rays Various ortho functions Various Direct supervision and Approved program and exam Approved program and exam Dental Auxiliary NEBRASKA Indirect supervision, approved Dental Assistants Take x -rays, coronal polishing, monitor nitrous oxide, place amalgam program & 1-year experience as a DA. It is a flag that should prompt us to consult with the patient's nephrologists and/or the patient's renal dietitian to determine acceptable sodium exposure. Your teeth are newly erupted and the enamel hasn't fully mineralized. RDH Magazine. With selective polishing, to continue with the example of the decalcified tooth, you can work on the other teeth and skip the ones with decalcification, or you can polish the teeth that have only visible extrinsic stain. 2010 Jul-Aug; 41 (7): 3 141-8. Coronal polish procedures may aggravate ulcerations and/or wounds of the lips and intraoral tissues and highly inflamed or traumatized gingiva thereby complicating the healing process. 1. Patients with periodontitis/gingivitis, and unhealthy, spongy, edematous tissue. Concepts and techniques of basic equipment, four-handed dentistry, oral evacuation, instrument identification, and proper use are discussed. Discover how coronal polishing differs from a routine dental cleaning, and learn why your dentist may recommend it. For example, the ADHA position paper on air polishing lists renal disease as a contraindication. This includes the use of a toothbrush. J Clin Periodontol 2009; 36 (Suppl. (9th ed). [Epub ahead of print]. She did not like the hand scaling, and the tears in her eyes were pretty impressive, so I used the ultrasonic to complete treatment. Excessive pressure can lead to frictional heat that may cause pulpal discomfort or necrosis of the dental pulp.[5]. Many states allow dental assistants to perform coronal polishing. The open enrollment courses may be taken prior to entry into the limited enrollment courses. Gutkowski S. (Nov. 2001). To provide opportunities to further student skills in the areas of expanded functions for the dental auxiliary and with the basics of dental assisting. This brings up another point - I completely disagree with dental offices that schedule children in the dental assistants chair for coronal polishing and charge for a prophy. If the patient is stable, adherent to care, and responds well to their medical care, then sodium might not be a huge issue. I knew for certain the toothbrush would not tackle this formidable foe. Registered dental hygienists work in private dental offices, public health settings, and in higher education. A copy of the standards and Commissions policy on third-party comments may be obtained on the internet at www.ada.org. Lastly, a recent study in 2010 evaluated the safety, patient acceptance, and short-term microbiologic effect of GPAP in periodontal maintenance patients with residual pockets 5 mm.15. Epub 2009 Dec 9. The Dental Hygiene Program at Sinclair Community College prepares students who are able to assess, diagnose, plan, implement, evaluate and document contemporary dental hygiene care. 1. characteristics of abrasives used for polishing; 2. aerosol production during polishing; 3. effects of heat production during polishing; 4. American Dental Association This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. 20. Coronal Polishing Certified Polishes coronal surfaces of teeth, or prepare teeth for band cementation or bonding of brackets utilizing a slow speed rotary hand piece and rubber cup or brush and applies topical fluoride and desensitizing agents as directed. Philadelphia, PA: Lippincott Williams & Wilkins: p. 6. It is small enough to polish small and malposed teeth, access the gingival margins comfortably for the patient, and is ergonomic for the clinician. Patient Preparation Check the patient's medical history for any contraindications to the coronal polishing procedure. Regardless of a patients best efforts at self-care, there are areas where plaque will be missed. I proceed in this manner every time I see the patient. When reviewing a medical history, we often refer to recommended guidelines and position papers. What is coronal polishing? discuss the indications and contraindications, objectives, and uses of coronal polishing techniques. I may elect to selectively polish certain areas as I move through the dentition (I still scale/debride by sextant). The goal is to enhance knowledge and become the best dental professional you can be! 3. 10. Lets start with why coronal polishing is part of the dental treatment. Arizona State Board of Dental Examiners. The curriculum is approved by the Commission on Dental Accreditation of the American Dental Association and leads to an Associate of Science Degree in Dental Assisting. - before placement of a sealant. So it seems logical and advantageous to polish first, because the subsequent use of power-driven and hand scalers and frequent rinsing during the hygiene procedures will rinse these particles away. Dentistry and dental hygiene, on the other hand, change by the minute. Register Cost: $400 Designed For Dental Assistants Dental Credit Statement Coronal Polishing Application V4 - Texas State Board of Dental . This creates a smooth, clean surface that helps repel plaque, notes Essentials of Dental Assisting. The Ohio State Dental Board allows Certified Dental Assistants, Registered Dental Assistants,and Registered Dental Hygienists to enroll in this training. So that is why Wendy polished first.. Polishing can be done at succeeding appointments. It did not take me long to observe the benefits of polishing first, so I started performing the procedure on adults as well.
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