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The Use of Dental Air Polishing

New technology is transforming all areas of the way we live and dentistry is no exception. The innovative air flow polishing technique uses a machine that cleans and polishes the teeth with a mix of water, compressed air and fine powder particles. This method is far superior to traditional cleaning methods that use scraping tools, rubber cups and polishing discs and which can be time-consuming and uncomfortable.

A powerful yet controlled jet of water, air and fine powder not only polishes all the surfaces of a tooth, removing plaque, discoloration and soft deposits, but also reaches deep into periodontal pockets up to a depth of 5 mm. It is far more efficient than traditional scrape and polish treatment at removing the damaging biofilm that develops when dental plaque is colonized by bacteria and can cause periodontitis and peri-implantitis to develop. Air flow polishing is completely safe to use with dental implants, veneers, crowns and bridges.

In air polishing, the powder of choice is usually sodium bicarbonate which is abrasive and helpful with the removal of heavy stains and soft deposits above the gumline. With dental air polishers, the tip is specialized to be able to effectively enter the periodontal pocket and deliver a very low abrasive powder. The powder of choice with air polishing is Glycine. Glycine is an amino acid and is significantly smaller in particle size than sodium bicarbonate. It appears to have an active role in the disruption of bacterial recolonization making it both preventive and therapeutic.

The main goal in air polishing is root debridement resulting in the removal of biofilm. This biofilm elimination can result in a beneficial shift in the oral microbiota. Studies have shown that air polishing tends to have less adverse effects for the patient such as pain and sensitivity versus hand instrumentation. Moreover, the air polisher is much more effective in reaching the base of pockets over 5mm and removing biofilm than hand instrumentation.

Air polishing is also proven to be clinically efficient and effective for the removal of biofilm without endangering soft tissues, enamel, dentin, or cementum. The procedure is very quick and simple. The tip is placed at a 90-degree angle to the long axis of the root, and a 5-second application disperses air, water, and glycine powder for the removal of biofilm.

Air flow polishing is ideal for those who suffer from sensitive teeth. This is not only due to the lack of direct contact and the absence of heat and vibration, but because the tiny micro particles of powder can actually fill any exposed dentine tubules and reduce dental sensitivity. Air flow polishing can also encourage the re-mineralization of damaged teeth.

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The Reason for Choosing Dental Air Polishing

Air polishing is just that – it’s the practice of polishing the teeth using a stream of air that’s directed onto them. Some air polishing machines may also use a stream of water. The air works in two ways. Firstly, it ‘blows’ onto the teeth and gums to remove any buildups of dirt, and get rid of any food that may have become trapped, which is especially common if you choose not to floss. Secondly, it blows an abrasive powder onto the teeth which helps to tackle stubborn stains such as tea and coffee.

There are two powders that are commonly used for air polishing by dental air polisher, and these are sodium bicarbonate and glycerin powders. These are chosen because of their excellent abrasive qualities. Think about when you’ve got a dirty pan in your kitchen – you may use sodium bicarbonate (baking soda) to remove the stains. It’s exactly the same when it comes to your teeth; sodium bicarbonate can help to get them clean.

A powerful yet controlled jet of water, air and fine powder not only polishes all the surfaces of a tooth, removing plaque, discoloration and soft deposits, but also reaches deep into periodontal pockets up to a depth of 5 mm. It is far more efficient than traditional scrape and polish treatment at removing the damaging biofilm that develops when dental plaque is colonized by bacteria and can cause periodontitis and peri-implantitis to develop. Air flow polishing is completely safe to use with dental implants, veneers, crowns and bridges.

Anyone who has ever cringed as a scraping tool digs into their gums or a polishing disc presses onto tooth enamel will welcome air polishing for its painless, fast and non-invasive method of cleaning. Even deep pockets and interproximal areas are easily reached without uncomfortable and potentially damaging probing by curettes and scrapers and with no instrument contact, the technique does not generate any heat or vibration. The non-toxic powder used in air polishing is also more pleasant and less gritty than the heavy paste used in traditional polishing. Air polishing powders with added flavors, such as spearmint, have even been developed for use in machines, making the experience even more pleasant.

Air polishing has only recently become a common option for dental patients, it’s a concept that’s been around for quite a while. Over the past few years, techniques have been perfected, and air polishing is now believed to be a very safe, effective, and efficient way to remove stains from the teeth, although it’s important to remember that air polishing methods may not be suitable for everyone.

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What Should You Know about the Dental Air Polisher

Although air polishing has only recently become a common option for dental patients, it’s a concept that’s been around for quite a while. Over the past few years, techniques have been perfected, and dental air polisher is now believed to be a very safe, effective, and efficient way to remove stains from the teeth, although it’s important to remember that air polishing methods may not be suitable for everyone.

Air polishing is just that – it’s the practice of polishing the teeth using a stream of air that’s directed onto them. Some air polishing machines may also use a stream of water. The air works in two ways. Firstly, it ‘blows’ onto the teeth and gums to remove any buildups of dirt, and get rid of any food that may have become trapped, which is especially common if you choose not to floss. Secondly, it blows an abrasive powder onto the teeth which helps to tackle stubborn stains such as tea and coffee.

Which is better: air polishing or traditional polishing? Well, that’s a difficult question to answer. When the most suitable polishers are used, there really shouldn’t be any differences in the overall result, but some people do prefer air polishing simply because it’s the newer option. But it’s not for everyone.

One of the biggest concerns with air polisher is the use of sodium bicarbonate as an abrasive. It’s reported that 1 in every 3 adults in the US suffers with hypertension, or high blood pressure, and many are advised to adhere to a low sodium diet to help keep symptoms under control. The use of sodium bicarbonate, which has a high salt content, could potentially be risky for some dental patients. A number of clinics are now using calcium carbonate instead, so this is worth checking with your practice.

In supragingival polishing, the powder of choice is usually sodium bicarbonate which is abrasive and helpful with the removal of heavy stains and soft deposits above the gumline. With subgingival air polishers, the tip is specialized to be able to effectively enter the periodontal pocket and deliver a very low abrasive powder. The powder of choice with subgingival air polishing is Glycine. Glycine is an amino acid and is significantly smaller in particle size than sodium bicarbonate. It appears to have an active role in the disruption of bacterial recolonization making it both preventive and therapeutic.

Another concern is that air polishing could reduce bond strengths on tooth restorations, and so it is generally advised that patients with restorations stick to traditional polishing techniques using dedicated nanocomposite polishers which are not only safe to use on restorations, but also provide a great finish.

Overall, air polisher can be good to try, and you may find that you prefer this over traditional polishing methods. However, if you are unable to use air polishing for health reasons, don’t worry. Traditional polishing techniques can be equally as effective, leaving you with smooth, shiny, and healthy teeth.

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The Benefits of Dental Air Polishing

Like many things in dentistry, air polishing has changed since the late 1970s. There are several new dental air polisher designs and new abrasive powders, and we now have the ability to use air polishers subgingivally. Sodium bicarbonate was the original abrasive powder used, but newer abrasive powders include glycine, calcium carbonate, calcium sodium phosphosilicate, aluminum trihydroxide, and erythritol. These additional powders give us more choices for our patients’ individual needs.

Use of 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.

The benefits of 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 chair, less “scraping,” excellent stain removal, reduced dentin hypersensitivity, and improved periodontal status.

Air polishing has been compared to scaling( dental scaler ) and rubber-cup polishing for efficiency and effectiveness of stain and plaque removal. 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.

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The Use of Dental Air Polisher

Dental air polisher was developed in the early 1970’s as a technique for fast and efficient removal of extrinsic stains, plaque and other soft deposits from the teeth. It comprises a stream of pressurized air carrying specially graded particles of a mild soluble abrasive usually sodium bicarbonate, mixed with a stream of water.

Dental root form implants are manufactured from a highgrade titanium alloy, the surface of which consists of a micro layer of titanium oxide. The implant surface can also be treated by plasma spraying, acid etching, sandblasting or coated with HA. The removal of plaque and calculus deposits from these implant surfaces with Dental Instruments designed originally for cleaning natural tooth surfaces can result in major alterations to the delicate titanium oxide layer. Altering the surface topography by roughening the surface may enhance calculus and bacterial plaque accumulation.

Resulting scratches, cuts or gouges may also reduce the corrosion resistancy of titanium, and corrosion and mechanical debris can accumulate in the surrounding tissue. The aim of procedures for debriding dental implants should be to remove microbial and other soft deposits, without altering the implant surface, and thereby adversely affect biocompatibility. Increased surface roughness can lead to an increase in bacterial accumulation and resultant soft tissue inflammation. Because of the critical nature of the implant/soft tissue relationship, metal ultrasonic scaler tips, hand scalers or curettes should not be used as they have been shown to significantly alter the titanium surface.

If inflammation becomes established in the periimplant tissues, pocketing and bone loss can develop, which if left untreated, will result in the loss of the implant. Clinicians worldwide are advocating surgical regenerative procedures to restore or repair lost periimplant tissues.These techniques attempt to achieve the repair or regeneration of lost periimplant tissues,and rely on making the implant surface biocompatible with the healing tissues. This implies a detoxification of the previously infected implant surface.

Airpolishing with the H.S.T polishing system is an efficient and gentle means of debriding the implant surface to aid the removal of bacteria and bacterial toxins. The unique H.S.T. polishing system has been shown to result in no damage to the surface of titanium implants or transmucosol elements. An initial report has indicated that the HA coating can be removed with the H.S.T. polishing system.Removal of HA is sometimes indicated when the HA coating has been seriously compromised by the inflammatory process.

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The Use of Air Polishing in Dental Implants

In most currently available units, the water stream emits through a separate nozzle that may be concentric to that of the powderladen air stream nozzle. The resulting buildup of crystalline anhydrous sodium bicarbonate deposits in the lumen of the air/powder nozzle results in clogging.

More recent technology produces a slurry by introducing the water stream into the powder-laden air stream, within the spray head at a critical moment, to produce a fully homogeneous stream that is emitted from a single nozzle. This stream technology configuration has not only been shown to prevent nozzle clogging by preventing the buildup of deposits, but also results in a much more efficient cleaning action because the slurry is formed prior to emission. Air polishing devices( like dental air polisher ) were originally designed to be standalone tabletop units. They have been considered to be the equipment of choice for the hygiene department, sometimes being combined with ultrasonic scaling devices.

Dental root form implants are manufactured from a highgrade titanium alloy, the surface of which consists of a micro layer of titanium oxide. The implant surface can also be treated by plasma spraying, acid etching, sandblasting or coated with HA. The removal of plaque and calculus deposits from these implant surfaces with Dental Instruments designed originally for cleaning natural tooth surfaces can result in major alterations to the delicate titanium oxide layer. Altering the surface topography by roughening the surface may enhance calculus and bacterial plaque accumulation.

Resulting scratches, cuts or gouges may also reduce the corrosion resistancy of titanium, and corrosion and mechanical debris can accumulate in the surrounding tissue. The aim of procedures for debriding dental implants by dental implant machine should be to remove microbial and other soft deposits, without altering the implant surface, and thereby adversely affect biocompatibility. Increased surface roughness can lead to an increase in bacterial accumulation and resultant soft tissue inflammation. Because of the critical nature of the implant/soft tissue relationship, metal ultrasonic scaler tips, hand scalers or curettes should not be used as they have been shown to significantly alter the titanium surface.

Current methods for professional cleaning of implant or titanium transmucosal elements include the set of plastic ultrasonic tips or hand instruments followed by the prophy cup polishing method or various types of floss and buffing strips. The design of the permanently cemented super structure often does not allow adequate access for the prophy cup, especially in interproximal areas, and plastic instruments are not very efficient for the removal of plaque or mineralized deposits. In addition, the prophy cup and paste method may leave residual paste at the implant/soft tissue interface area.

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The Changes about Dental Air Polisher

Traditionally, a rubber cup and fluoridated prophy paste method has been used for plaque and stain removal. However, this technique has obvious limitations in areas of crowding, around orthodontic fixed appliance and of course, in areas of limited access such as under and around fixed multiple unit restorations.

Dental air polishers typically generate a stream of pressurized air, carrying specially graded particles of a mild soluble abrasive, such as sodium bicarbonate. The abrasive is directed, in the presence of a stream of water, at a tooth surface to be cleaned. The mixture of water and powderladed stream occurs on the tooth surface and forms a “slurry” that is responsible for the cleaning action.

In most currently available units, the water stream emits through a separate nozzle that may be concentric to that of the powderladen air stream nozzle. The resulting buildup of crystalline anhydrous sodium bicarbonate deposits in the lumen of the air/powder nozzle results in clogging. Several attempts have been made to overcome this, including the introduction of a ‘bleed air stream’ that flowed constantly through the air/powder nozzle and changes in the chemical composition or physical nature of the powder

More recent technology produces a slurry by introducing the water stream into the powder-laden air stream, within the spray head at a critical moment, to produce a fully homogeneous stream that is emitted from a single nozzle. This stream technology configuration has not only been shown to prevent nozzle clogging by preventing the buildup of deposits, but also results in a much more efficient cleaning action because the slurry is formed prior to emission. Air polishing devices were originally designed to be standalone tabletop units. They have been considered to be the equipment of choice for the hygiene department, sometimes being combined with ultrasonic scalers.

They offer a large powder chamber holding enough powder for multiple treatments, along with the convenience of a lightweight, fully autoclavable handpiece design. They are activated by a dedicated foot control that can select either a polishing or rinse mode and they require connections to water, air and electrical outlets. As such, they are normally allocated to a particular treatment room.

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The General Uses of Dental Air Polisher

Air polishing units typically generate a stream of pressurized air, carrying specially graded particles of a mild soluble abrasive, such as sodium bicarbonate. The abrasive is directed, in the presence of a stream of water, at a tooth surface to be cleaned. The mixture of water and powderladed stream occurs on the tooth surface and forms a “slurry” that is responsible for the cleaning action.

More recent technology produces a slurry by introducing the water stream into the powder-laden air stream, within the spray head at a critical moment, to produce a fully homogeneous stream that is emitted from a single nozzle. This stream technology configuration has not only been shown to prevent nozzle clogging by preventing the buildup of deposits, but also results in a much more efficient cleaning action because the slurry is formed prior to emission.

Air polishing devices were originally designed to be standalone tabletop units. They have been considered to be the equipment of choice for the hygiene department, sometimes being combined with ultrasonic scaler. They offer a large powder chamber holding enough powder for multiple treatments, along with the convenience of a lightweight, fully autoclavable handpiece design. They are activated by a dedicated foot control that can select either a polishing or rinse mode and they require connections to water, air and electrical outlets. As such, they are normally allocated to a particular treatment room.

Three safety concerns regarding use of the dental air polisher appear in the dental literature including that of the patient, the operator, and others in the treatment room. Patient concerns include systemic problems from absorption of the sodium bicarbonate polishing powder, respiratory difficulties from inhaling aerosols that contain oral microorganisms, stinging of the lips from the concentrated spray, and eye problems from the spray entering the patient’s eyes, especially if contact lenses are worn. Some of these problems could be addressed by coating a patient’s lips with a protective lubricant, using the appropriate technique, removing contact lenses, wearing safety glasses, and placing a protective drape over the patient’s nose and eyes.

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.

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The Developments of Dental Air Polisher

First introduced in the 1940s, dental air polisher has changed noticeably since its inception, thanks mainly to advances in materials science. Compared to polishing with a prophy cup and paste, air polishing eliminates the need for direct tooth contact or pressure against the tooth, along with any discomfort from potential heat generated with prophy cups. This technique also offers more efficient biofilm removal, easier access into pits and fissures, and a less abrasive nature than pumice or prophy pastes.

Many hygienists and dentists will be most familiar with sodium bicarbonate powder, one of the first materials introduced for use with early air polishing systems. In my experience, sodium bicarbonate has been an excellent tool for heavy stain removal, but patients react poorly to the salty taste and abrasive feel. Sodium bicarbonate powders generally have a particle size up to 250 μm, and while damage to enamel has not been reported, researchers and manufacturers warn against prolonged use on cementum, dentin, and certain restorative materials such as composites.

This means that a considerable number of patients are poor candidates for air polishing with sodium bicarbonate powder, including those with implants, restorative materials, sealants, or orthodontic appliances. Other patients contraindicated for treatment with sodium bicarbonate powder include patients on sodium-restricted diets, or those with renal diseases or hypertension.

Selective treatment with sodium bicarbonate air polishing has been a part of my hygiene routine for many years. During the last six months, though, I’ve had the opportunity to try a powder that’s new to the U.S. market. Clinpro Glycine Prophy Powder (3M) has been used successfully abroad for many years, and is now available to American dentists and hygienists. With implants in particular, I find that this type of powder is much gentler and more comfortable for patients when compared to manual scaling. Studies have proved its gentleness as compared to sodium bicarbonate, showing less surface roughness created on the titanium surface of implants.

When my patients have bridge work or pontics that are tight against the tissue, or bridge work with a great deal of recession or hard-to-access areas, I’m able to use the glycine powder to reach those difficult areas. While larger particle powders like sodium bicarbonate are contraindicated for root surface application and subgingival deposits, glycine powder is safe for use along the gingival margins and in deep subgingival pockets.

I’ve even found success using Clinpro Glycine Prophy Powder on soft tissue to break up plaque deposits. A study that compared the safety of glycine powder to sodium bicarbonate powder showed glycine to be 80% less abrasive on human root surfaces. Many air polishing units now offer specialized nozzles designed for subgingival insertion, adding to the efficacy of this technique.

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