Coronal Polish Rules

Policy on Coronal Polishing (“rubber cup prophy”)

PLEASE read this policy before completing the Registration Form and the Affidavit of Eligibility.

Definition of Prophylaxis – Child (D1120)

Removal of plaque, calculus and stains from the tooth structures in the primary and transitional dentition.  It is intended to control local irrational factors.

Requirements for calculus removal

Calculus, if present during a “rubber cup prophy”, must be identified and removed by a Georgia-licensed DMD/DDS or RDH only.

Age of primary dentition

The American Dental Association (ADA) lists the presence of primary teeth from approximately one year to about age twelve.  The Georgia Board of Dentistry recognizes and accepts these basic parameters as the ages when primary teeth are present in a child.

Billing as a Prophylaxis

The prophylaxis, D1120, includes the combined processes of examination (DMD/DDS), calculus removal if present (DMD/DDS/RDH) and coronal polishing, “rubber cup prophy” (Trained DA).

Georgia Board of Dentistry Rule on Coronal Polishing 

Training in Coronal Polishing (“Rubber Cup Prophy”) for Dental Assistants

A dental assistant with at least one year of prior chairside experience or a graduate of an approved dental assisting program is eligible to attend an 8 hour pre-approved course of study that includes didactic and clinical applications necessary for coronal polishing (“rubber cup prophy”) and shall include:

• Ethics and Georgia jurisprudence related to coronal polishing
• Identify the potential risks, indications and contraindications for coronal polishing
• Understand the definition of plaque, types of stain, calculus, and related terminology
• Dental anatomy and morphology for the proper identification of adult and child dentition
• Principles of coronal polishing including, but not limited to –
  • armamentarium;
  • proper positioning used/ergonomics;
  • preferred polishing technique using a stable fulcrum;
  • abrasive polishing agents commonly used in coronal polishing;
  • polishing coronal surfaces of teeth on a typodont using a slow speed hand piece
• Indications for professionally applied topical fluoride agents for caries prevention
• Fluoride Delivery Methods