Tag Archives: air polisher

dental equipment

How to Use Air Polishers Effectively

Use of the dental air polisher for stain removal involves three steps: patient selection and preparation, clinician preparation, and the actual clinical technique. Air polishing should follow a careful review of the patient’s medical and dental history, and a thorough examination of the oral hard and soft tissues. Indications and contraindications, effects on hard tissues, restorations, safety, and alternative uses should be reviewed prior to treatment planning the use of the air polisher.

Preparation of the patient should include an explanation of the procedure, removal of contact lenses, an anti-microbial rinse, application of a lubricant to the lips, placement of safety glasses or a drape over the nose and eyes, and placement of a plastic or disposable drape over the patient’s clothing. Operators should use universal precautions, including protective apparel, a face shield or safety glasses with side shields, gloves, and a well-fitting mask with high-filtration capabilities.

During periodontal surgery, air polishers can prepare root surfaces detoxify them effectively and efficiently, and leave a uniformly smooth root surface that is clean and free of diseased tissues. Dentinal tubules are then occluded, which may result in decreased sensitivity. Superior growth and vitality of human gingival fibroblasts was evident when ultrasonic scaling was followed by air polishing, compared to ultrasonic scaling alone. Air polishing produced root surfaces that were comparable to manually rootplaned surfaces, and provided better access to furcations. Tissue healing following air polishing was comparable to that achieved by hand instrumentation in root preparation during periodontal flap surgery.

Research findings also support the use of air polishing with orthodontic patients. It is the most efficient and effective method for plaque and stain removal around orthodontic brackets, bands, and arch wires. It is not contraindicated on orthodontic bracket composite resin adhesive systems.

In restorative dentistry, air polishers have provided stronger composite repairs than traditional etching gels. They also are superior to rubbercup polishing in preparing occlusal surfaces for etching prior to sealant placement because the rubber cup forces debris into the fissures. Air polishing of occlusal surfaces also allows for deeper penetration of the sealant resin into the enamel surface than rubber cup and pumice cleaning of the fissures. Air polishers also have enhanced sealant bond strength compared to traditional polishing with a low-speed handpiece, bristle brush, pumice, and water.

Oral health care professionals have a responsibility to patients to engage in life-long learning in order to provide the most contemporary clinical care. Air polishing has been studied extensively and, when used appropriately, provides a safe, efficient and contemporary approach to achieving a variety of treatment goals.

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The Uses of 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.

Because polishing with a rubber cup and prophylaxis paste has been shown to remove the fluoride rich layer of enamel and cause marked loss of cementum and dentin over time, this method of stain removal has been challenged Rubber cup polishing with prophylaxis pastes, therefore, may not be a suitable method for moderate-to-heavy stain removal on enamel, cementum, or dentin. One study, however, contradicted these findings and suggested that rubber cup polishing with chalk is equally effective in decreasing root-surface roughness caused by sonic scaling. Chalk is not a common polishing agent and no comparison of the abrasiveness was made between it and the sodium bicarbonate used in air polishing powder. This study, therefore, may not simulate actual clinical situations.

Numerous investigations have examined the effects of the air polisher on a variety of restorative materials. Some results have been positive, while others have recommended caution near restorations. Although some studies are contradictory, most suggest caution or complete avoidance when air polishing on or near composite restorations. On composites, surface roughness or pitting was the most common result seen. One study concluded that, although marginal microleakage was greater for composites than for amalgams, this loss was not statistically or clinically significant. More research is recommended since previous studies do not support this conclusion.

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The Effectiveness and Efficiency of Dental Air Polisher

Dental air polisher 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.

Still, researchers and manufacturers caution against prolonged use of the air polisher on cementum and dentin. When moderate to heavy stain is present on root surfaces, dental hygienists are often faced with the problem of removing it with the least alteration of cementum. One choice is to leave the stain and explain to the patient that stain is not associated with oral disease and will not harm the teeth or gingiva since it is only a cosmetic concern. To many patients, this is not a viable choice since appearance is considered so important in today’s society.

Other choices include removing the stain with a rubber cup polisher and prophylaxis paste; sonic, ultrasonic scalers; Dental Hand Instruments or the air polisher. Wilkins recommends removing as much stain as possible during root planing with curets. However, 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.

Effects of air polishing on gold foil, gold castings, porcelain, amalgam, and glass ionomers have been studied. Air polishing of amalgam alloys and other metal restorations has produced a variety of effects, including matte finishes, surface roughness, morphological changes, and structural alterations. One study found no detrimental changes to the marginal integrity of amalgams. Surface roughness, staining, pitting, and loss of marginal integrity were seen on porcelain surfaces. One study reported only minimal changes in porcelain and gold alloys. Hand instrumentation at the gingival margins and caution were recommended when working around these restorations. The surface roughness of glass ionomers increased following either air polishing or rubber-cup polishing. Until research findings on air polishing’s effect on these restorative materials are unequivocal, clinicians should follow manufacturer recommendations to “avoid prolonged or excessive use on restorative dental materials.

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Using Polisher and Scaler to Do Dental Cleaning

Dental hygienists generally use several tools during a dental cleaning, including a tooth polisher and a dental scaler. Tooth polishers buff teeth and eliminate tiny pieces of plaque. They generally have several different sized heads for cleaning hard to reach places. Scalers look a bit like metal hooks and are used to remove hard plaque, especially between teeth. Some people find the use of a scaler uncomfortable, depending on their sensitivity level, pain threshold, the length of time since the last cleaning, and the extent of plaque build-up.

During periodontal surgery, dental air polisher can prepare root surfaces detoxify them effectively and efficiently, and leave a uniformly smooth root surface that is clean and free of diseased tissues. Dentinal tubules are then occluded, which may result in decreased sensitivity. Superior growth and vitality of human gingival fibroblasts was evident when ultrasonic scaling was followed by air polishing, compared to ultrasonic scaling alone. Air polishing produced root surfaces that were comparable to manually rootplaned surfaces, and provided better access to furcations. Tissue healing following air polishing was comparable to that achieved by hand instrumentation in root preparation during periodontal flap surgery.

Use of the air polisher for stain removal involves three steps: patient selection and preparation, clinician preparation, and the actual clinical technique. Air polishing should follow a careful review of the patient’s medical and dental history, and a thorough examination of the oral hard and soft tissues. Indications and contraindications, effects on hard tissues, restorations, safety, and alternative uses should be reviewed prior to treatment planning the use of the air polisher.

Preparation of the patient should include an explanation of the procedure, removal of contact lenses, an anti-microbial rinse, application of a lubricant to the lips, placement of safety glasses or a drape over the nose and eyes, and placement of a plastic or disposable drape over the patient’s clothing. Operators should use universal precautions, including protective apparel, a face shield or safety glasses with side shields, gloves, and a well-fitting mask with high-filtration capabilities.

Future research should continue to explore ways to increase the safety of air polishing, reduce aerosol production, and increase its efficacy in periodontal therapy. Future research should include in vivo studies that directly compare the effects of ?Dental Hand Instruments; air polishers; sonic, ultrasonic, and piezo scalers; and rubber cup polishers on all tooth surfaces. In addition, these studies should attempt to control the variables of quantity of stain, abrasiveness of polishing pastes, and amount of pressure applied to each surface.