250 CHAPTER 11  Materials and Processes for Cutting, Grinding, Finishing, and Polishing
TABLE 11-4 Effect of Prophy Pastes on Polished
20m
A the pastes (Proxyt Fine) did not alter the surface smoothness
100m
B ganisms and stains better than rougher surfaces could; and
FIGURE 11-21  Scanning electron micrograph images of enamel stylus
abraded by glazed crowns (A) and by optimally polished crowns (B).
(Courtesy of Dr. Siegward Heintze.)
TABLE 11-3 Effect of Prophylaxis Pastes on Glazed
Ceramic Surface Roughness
Surface
Product Roughness
Proxyt coarse (Ivoclar Vivadent, Amherst, NY) 0.183 ± 0.08
Proxyt fine (Ivoclar Vivadent, Amherst, NY) 0.066 ± 0.03
Nupro coarse (DENTSPLY International, York, PA) 0.209 ± 0.11
Nupro fine (DENTSPLY International, York, PA) 0.188 ± 0.07
Control (glazed surface) 0.061 ± 0.03
PROPHYLAXIS PASTE SELECTION FOR DENTAL
HYGIENE PROCEDURES
It should be noted that, depending on the particle size of the
abrasive and its composition, the abrasiveness of the prophy
pastes may have adverse effects on exposed cementum and
dentin surfaces as well as esthetic restorative materials. Table
11-3 shows the mean roughness values obtained on glazed
ceramic surfaces after three rounds of 10-second application
of various prophy pastes by the same operator. Only one of
Composite Surface Gloss Reduction,
Measured by Gloss Units, after a
60-Second Application
Product Mean GU ± SD
Nupro coarse −40.86 ± 4.22a
Nupro fine −40.57 ± 5.64a
Proxyt coarse −41.61 ± 3.32a
Proxyt fine −16.24 ± 3.34b
The difference between mean values of groups represented by the same superscripts
are not statistically significant.
significantly. Similarly, another study revealed the effect of the
same prophy pastes on the gloss reduction of a polished resin
composite (Table 11-4).
DENTIFRICES
Tooth cleaning substances such as dentifrices are available as
toothpastes, gels, and powders. Dentifrices have three impor-
tant functions: (1) Their abrasive and detergent actions
provide more efficient removal of debris, plaque, and stained
pellicle compared with use of a toothbrush alone; (2) they
polish teeth to provide increased light reflectance and supe-
rior esthetic appearance, and the high polish, as an added
benefit, enables teeth to resist the accumulation of microor-
(3) they act as vehicles for the delivery of therapeutic agents
with known benefits—for example, fluorides, tartar control
agents, desensitizing agents, and remineralizing agents.
Fluorides improve resistance to caries and may, under a
proper oral hygiene regimen, enhance the remineralization
of tooth surfaces with incipient noncavitated enamel lesions,
thereby hardening the surface. Tartar-control agents such as
potassium and sodium pyrophosphates can reduce the rate at
which new calculous deposits form supragingivally. Desensi-
tizing agents with proven clinical efficacy are strontium chlo-
ride and potassium nitrate. The therapeutic benefits of other
additives such as peroxides and bicarbonates are under inves-
tigation. The products advertised as “whitening toothpastes”
may contain an abrasive agent alone or both a chemical agent
and an abrasive agent. The former type of additive acts
through a surface stain-removal mechanism, whereas the
latter additives act through a combined mechanism of abra-
sion and bleaching.
DENTIFRICE COMPOSITION
Typical components of some dentifrices are listed in Table
11-5. The abrasive concentrations in paste and gel dentifrices
are 50% to 75% lower than those of powder dentifrices.
Therefore, powders should be used more sparingly and with
greater caution by patients (especially where cementum and
dentin are exposed) to avoid excessive dentinal abrasion and
pulpal sensitivity.
 Dentifrices 251

TABLE 11-5 Typical Dentifrice Components*

Pastes Composition
Component and Gels (wt%) Powders Materials Purpose
Abrasive 20–55 90–98 Calcium carbonate Removes plaque or stain
Dibasic calcium phosphate dihydrate Polishes tooth surface
Hydrated alumina
Hydrated silica
Sodium bicarbonate
Mixtures of listed abrasives
Detergent 1–2 1–6 Sodium lauryl sulfate Aids in debris removal
Colorants 1–2 1–2 Food colorants Are used for appearance
Flavoring 1–2 1–2 Oils of spearmint, peppermint, Provides flavor
wintergreen, or cinnamon
Humectant 20–35 0 Sorbitol, glycerine Maintains moisture content
Water 15–25 0 Deionized water Acts as suspension agent
Binder 3 0 Carrageenan As thickener, prevents liquid–solid
separation
Fluoride 0–1 0 Sodium monofluorophosphate Prevents dental caries
Sodium fluoride
Stannous fluoride
Tartar control agents 0–1 0 Disodium pyrophosphate Inhibits formation of calculus
Tetrasodium pyrophosphate above the gingival margin
Tetrapotassium pyrophosphate
Desensitization agents 0–5 0 Potassium nitrate Promotes occlusion of dentinal
Strontium chloride tubules
*Some compositional information provided by Dr. George Stookey.

DENTIFRICE ABRASIVENESS
The ideal toothpaste should provide the greatest possible
cleaning action on tooth surfaces with the lowest possible
abrasion rate. Dentifrices do not have to be highly abrasive
to clean teeth effectively. This is fortunate because exposed
root-surface cementum and dentin, respectively, are abraded
at rates of 35 and 25 times the rate of enamel. Standardized
laboratory tests have been developed to measure the cleaning
ability and abrasiveness of dentifrices. Only the abrasiveness
test is discussed in this section.
Currently, the preferred means of evaluating dentifrice
abrasiveness is to employ irradiated dentin specimens and
brush them for several minutes with test and reference den-
tifrices. An abrasiveness ratio is then calculated by comparing
the amounts of radioactive phosphorus (P32) released by each
dentifrice, and this value is multiplied by 1000. A dentifrice
must obtain an abrasiveness score of 200 to 250 or less to
satisfy the abrasiveness test requirements proposed by the
American Dental Association (ADA) and the International
Organization for Standardization (ISO). This means that a
test dentifrice must abrade dentin at 20% to 25% of the rate
of the reference standard to be considered safe for normal
usage. A problem with this laboratory test is that it does not
account for all variables that would affect abrasiveness under
in vivo conditions. Some of the factors affecting dentifrice
abrasiveness are listed in Box 11-1.
Another problem is that not all dentifrices respond in a
similar manner under this test. For example, dentifrices that
BOX 11–1 Factors Affecting Dentifrice Abrasiveness
Extraoral Factors
Abrasive particle type, size, and quantity in dentifrice
Amount of dentifrice used
Toothbrush type
Toothbrushing method and force applied during brushing
Toothbrushing frequency and duration
Patient’s coordination and mental status
Intraoral Factors
Saliva consistency and quantity (normal variations)
Xerostomia induced by drugs, salivary gland pathology, and radia-
tion therapy
Presence, quantity, and quality of existing dental deposits (pellicle,
plaque, calculus)
Exposure of dental root surfaces
Presence of restorative materials, dental prostheses, and ortho­
dontic appliances
contain sodium bicarbonate yield poor test results because
the particles dissolve completely approximately 1 minute into
the 8-minute test. This illustrates that it is very difficult or
impossible to use a laboratory test to predict the in vivo abra-
siveness of various dentifrices. Patients should experience
similar amounts of relative wear from the various dentifrices
as those found in laboratory tests. The majority of modern
dentifrices are not exceedingly abrasive. In fact, one pub-
lished document has rated four dozen dentifrices with regard
252 CHAPTER 11  Materials and Processes for Cutting, Grinding, Finishing, and Polishing
to cleaning ability and abrasiveness. The products are ranked
as high, moderate, or low in abrasiveness. It is highly probable
that most of the evaluated products meet the American
National Standards Institute (ANSI)/ADA and ISO test
requirements. Thus, these rankings should be considered a
guide to products that do not exceed a maximum acceptable
(safe) abrasiveness value.
TOOTHBRUSHES
The bristle stiffness of toothbrushes alone has been shown to
have no effect on the abrasion of hard dental tissues. However,
when a dentifrice is used, there is evidence that more flexible
toothbrush bristles bend more readily and bring more abra-
sive particles into contact with tooth structure, albeit with
relatively light forces. This interaction should produce more
effective abrasion and cleaning action on the areas that the
bristles can reach. Battery-powered toothbrushing devices
provide a variety of cleansing actions that are claimed to
improve tooth-cleaning actions even further than those
achieved by manual toothbrushes.
? CRITICAL QUESTION
One observes new fine scratches on a metal partial denture frame-
work when an additional increment of the same abrasive paste is
applied with a buffing wheel that was used previously. What is the
cause of the new scratches?
S ELECTED READINGS
Carr MP, Mitchell JC, Seghi RR, et al: The effect of air polishing on
contemporary esthetic restorative materials. Gen Dent 50(3):238–
241, 2002.
This article describes the effects of air polishing on different
dental materials.
Consumer Reports: Toothpastes. September:602–606, 1992.
This study evaluated 48 toothpastes in independent laboratories
for abrasiveness and cleaning effectiveness. All toothpastes were
subsequently ranked for these criteria.
Cooley RL: Aerosol hazards. In Goldman HS, Hartman KS, Messite
J, editors: Occupational Hazards in Dentistry, Chicago, Yearbook
Medical, 1984, pp 21–33.
Sources of dental aerosols, their hazards, and preventive mea-
sures are presented.
Dorfer CE, Hefferren J, Gonzales-Cabezas C, et al: Methods to
determine dentifrice abrasiveness. Summary proceedings of a
workshop in Frankfurt, Germany. J Clin Dent 21(Suppl), 2010.
Fairhust CW, Lockwood PE, Ringle RD, et al: The effect of glaze on
porcelain strength. Dent Mater 8:203–207, 1992.
Fruits TJ, Miranda FJ, Coury TL: Effects of equivalent grit sizes
utilizing different polishing motions on selected restorative
materials. Quintessence Int 27(4):279–285, 1996.
Hefferren JJ: Laboratory method for assessment of dentifrice abra-
sivity. J Dent Res 55:563, 1976.
This reference describes the dentifrice abrasiveness test.
SUMMARY AND RECOMMENDATIONS
Lab technicians, dentists, and dental hygienists should care-
fully select the appropriate abrasive system for each material
product. Although it is convenient to use the same instru-
ments for grinding and finishing different materials, the
quality of the finished tooth or material surfaces may be far
less than ideal if the optimal processes and abrasives recom-
mended for specific materials are not followed. For in vivo
processes, use liquid coolant, whenever possible. In situations
where a copious supply of liquid coolant is not possible,
intermittent application of polishing pressure should be
performed.
To determine whether successive abrasive steps with finer
and finer abrasives are used, change the orientation of the
polishing path from one abrasive to the next. Polishing instru-
ments or carriers (e.g., brushes or rag wheels) should be
cleaned thoroughly between abrasive stages so that coarser
particles are not incorporated with finer abrasives. If possible,
use new carriers. Use lighter pressure as the final stages of
each abrasive step are reached. Rinse the treated surface off
periodically to remove wear debris that may interfere with the
ability to produce the finest possible surface finish.
ACKNOWLEDGMENT
The contributions of Dr. Charles DeFreest to the initial devel-
opment of this chapter in the 10th edition are appreciated.
Hutchings IM: Tribology: Friction and Wear of Engineering Materi-
als, Boca Raton, FL, CRC Press, 1992.
This publication thoroughly describes the scientific basis of fric-
tion, wear, and lubrication.
Jones CS, Billington RW, Pearson GJ. The in vivo perception of
roughness of restorations. Brit Dent 196:42–45, 2004.
The tactile ability of the tongue to discern very small changes in
surface roughness intraorally are suggested in this study.
Kroschwitz JI, Howe-Grant M, editors: Kirk-Othmer Encyclopedia
of Chemical Technology, Vol 1, ed 4, New York, Wiley, 1991,
pp 17–37.
This encyclopedia presents a thorough review of specific
abrasives, their physical properties, and their methods of
manufacture.
Mackert JR: Side effects of dental ceramics. Adv Dent Res 6:90–93,
1992.
This article presents information on silicosis and the potential
hazards of porcelain dust generation during grinding
procedures.
Nakazato T, Takahashi H, Yamamoto M, et al: Effects of polishing
on cyclic fatigue strength of CAD/CAM ceramics. Dent Mater J
18(4):395–402, 1999.
Phark J-H, Huh I, Botta AC, Duarte S, et al: Influence of tooth
brushing on surface roughness of restorative materials. J Dent
Res 89(Special Issue A):1052, 2010.