Objectives: This study aimed to evaluate the effects of different polishing strategies on extrinsic stain removal in primary teeth using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX)—materials and Methods: A total of 48 primary molars with 12 samples in each group were used. External surface staining was created in all samples, and then samples were randomly divided into four groups: Group I: the teeth were polished using an ultrasonic scaler; Group II: the teeth were polished using pumice; Group III: the teeth were polished using an electric toothbrush and whitening toothpaste; and Group IV: the teeth were polished using an Aqua-care air abrasion device. Before and after polishing, teeth were examined using SEM, EDX, and visual shading. The data obtained were tabulated and subjected to statistical analysis. Results: in group I (Ultrasonic scaler) after polishing the enamel surface, there was an alternation in surface smoothness and multiple irregularities, while in groups II (pumice paste) and III (electric toothbrush and whitening toothpaste), enamel showed a relatively homogenous surface and a few superficial depressions on the enamel surface. On the other hand, in group IV, after the aquacare treatment application, the enamel appeared to have a generalized smooth surface. Conclusion: Teeth polishing using an air abrasion device seems to be the safest and most effective method for removing extrinsic dental stains in primary teeth.