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The Research about Dental Air Polisher

Use of dental air polishers decreased as the clinician’s age and experience increased. Curricula in many dental hygiene schools do not include clinical instruction in the use of this polishing device due to inadequate numbers of units and difficulty in moving units between clinic stations. Inadequate or insufficient knowledge and experience, therefore, appears to be a major factor in the underutilization of the air polisher. In an attempt to provide a suitable knowledge base for practicing dental hygienists, the primary purpose of this article is to provide a comprehensive summary and critique of the research on all aspects of air polishing. In addition, a suggested technique, common concerns, and possible solutions will be discussed.

Discussions are based on a review of the relevant literature on air polishing. Tables organize the data into categories to facilitate access of needed information. Because of the various research designs employed and the number of variables that must be controlled, comparative analyses of the studies are difficult. However, where possible, analyses of the validity and reliability of the studies are provided. It should be remembered that while laboratory (in vitro) investigations are useful, the most definitive conclusions must be obtained through clinical (in vivo) studies. Case reports or opinion articles have limited applications. Therefore, interpretation and application of research results must be done with caution.

Air polishing has been compared to scaling and rubber-cup polishing for efficiency and effectiveness of stain and plaque removal. The literature overwhelmingly supports the use of the air polisher as an efficient and effective means of removing extrinsic stain and plaque from tooth surfaces. Air polishing requires less time than traditional polishing methods and removes stain three times as fast as scaling with comers. In addition, less fatigue to the operator has been mentioned as an important benefit of air polishing.

Most investigators agree that intact enamel surfaces are not damaged when stain removal is accomplished with an air polisher. Even after exposure to enamel for the equivalent of a 15-year recall program, surfaces were not altered.

in one in-vitro study, air polishing was shown to remove less root structure than a curet in simulated three-month recalls for three years. Woodall agrees that the air polisher may be preferable to curets in this situation. Since less root structure is removed, decreased root-surface sensitivity also may be a benefit.

Clinical studies to evaluate soft tissue usually provide generalizable conclusions. Gingival bleeding and abrasion are the most common effects of air polishing. These effects are temporary; healing occurs quickly and effects are not clinically significant. No complications were seen with healing at extraction sites following air polishing of teeth prior to extraction. To avoid tissue trauma, the manufacturer recommends pointing the tip of the air polisher at the facial, lingual, or occlusal surfaces, thus avoiding the gingival margins.

Patients also have noticed a salty taste with air polishing, but this was not objectionable. Covering the tongue with moist gauze may prevent irritation and excessive salty taste, as will rinsing with water, mouthwash, or a mint-flavored powder.

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The Benefits of Dental Air Polisher

Dental air polisher was introduced in the late 1970s as an alternative to a rubber cup filled with pumice. Using a slurry of water, abrasive powder, and pressurized air, the air polisher effectively removes extrinsic stain, plaque biofilm, and prepares occlusal surfaces of teeth for sealant placement. Originally, air polishers were only intended for use on supragingival surfaces since the abrasive powder could potentially harm the softer tissues, such as the cementum, dentin, and gingival epithelium.

Low-abrasive polishing powders: First, let’s examine some benefits of low-abrasive powders. Glycine, an amino acid powder, and erythritol, a natural sweetener powder, are unlike sodium bicarbonate, calcium carbonate, or aluminum trihydroxide powders traditionally used with air polishing devices for supragingival use. In terms of micron size, these supragingival powders are between 40 and 76 microns in size. By comparison, glycine has a micron size of 20-25, and erythritol powder has a micron size of 14.

On the Mohs hardness scale (which measures the hardness of various minerals) these supragingival powders are between 2.5 and 4. Glycine and erythritol powders rank 2 on the Mohs hardness scale. These differences in micron size and hardness translate into a broader use for air polishing, which enables safe use for the removal of biofilm above and below the gum line. In the U.S., glycine powder is currently available, and erythritol powder is undergoing FDA approval.

A controlled stream of air, water and sodium bicarbonate, which passes through a mixing nozzle to allow polishing of the enamel of the tooth. Sodium bicarbonate is a mild polishing agent. The air polisher is suitable for the removel and dissolution of biofilms. It is also used to clean discolorations. Air polisher is a safe and effective form of treatment.

The air polishing for the dental professional include less operator fatigue, less time involved than the traditional polishing technique, and improved access to difficult-to-reach areas. Benefits to the patient include less time in the portable folding chair, less “scraping,” excellent stain removal, reduced dentin hypersensitivity, and improved periodontal status.

Training regarding indications, contraindications, advantages and disadvantages is imperative for use of the air polisher. When used by a properly trained clinician, the clinical benefits as well as patient safety increase. But today, as an educator, I consider dental hygiene curriculum and wonder why not much has changed in regard to training students to use air polishers. The air polishers themselves have evolved, the list of uses has increased, and yet, in many schools, our students are lucky if they learn how to use one.