Air polishing primer

Air polishing was introduced as an alternative that is less time-consuming and labor-intensive than the previously mentioned professional methods.

The air polishing system uses air and water pressure to deliver a controlled stream of specially processed sodium bicarbonate in a slurry through a handpiece nozzle. Fine particles of sodium bicarbonate are propelled by compressed air in a warm spray.

Water temperature is controlled and maintained at about 37 degrees Celcius or 100 degrees Fahrenheit. Air polishing has been firmly established as an equally safe and effective alternative to traditional methods of plaque and stain removal.

The first air polishing devices became available in the 1970s with mechanics that have not changed much since that time. The device uses pressurized air, water and sodium bicarbonate powder as the polishing medium. The inlet air pressure from the device is about 60 psi, with the outlet pressure being delivered at about 58-60 psi. The water pressure ranges from 10-50 psi.

The sodium bicarbonate is a food grade tribasic combined with small amounts of calcium phosphate and silica that allow the powder to remain free flowing.

This powder, combined with the pressurized air and water, will remove surface stains, plaque and other soft deposits frequently found on the tooth surfaces.

The decision to use air polishing should be based on the patient’s medical history and patient assessment. Indications for use include:

• General post-scaling procedure
• Cleaning of pits and fissures
• Interproximal cleaning
• Tooth preparation prior to etching
• Neutralization of acids prior to other procedures
• Removal of temporary cement residue
• Surface cleaning
• Cleaning of orthodontic bands and brackets

Contraindications for use include:

• Patients with respiratory, renal or metabolic disease
• Patients with exposed cementum or dentin
• Prolonged polishing of root surfaces
• Patients taking potassium, anti-diuretics or steroid therapy

The air polishing technique is one that can be used with all systems. A correct technique prevents undue aerosols from deflecting back to the clinician and from being directed into the patient’s soft tissues.

To control aerosols, high speed evacuation should be used. The handpiece nozzle should be used in a circular pattern with the tip kept 3 to 4 mm away from the enamel surface.

The angulation of the tip is critical in order to prevent tissue trauma. The universal angulations are: 60 degrees to the anterior teeth away from the gingiva, 80 degrees to the posterior teeth, and 90 degrees to the occlusal surfaces.

If directed at 90 degrees to the anterior and posterior surfaces, there will be deflection of the spray toward the patient and clinician.

Research indicates there are many advantages to the use of air polishing over that of traditional polishing. These include:

• Removal of up to 100 percent of bacteria and endotoxins
• Use on implants
• Creation of uniformly smooth root surfaces
• Greater access for stain removal in pits and fissures
• Less abrasiveness
• Use before bonding or sealant placement
• Increased patient comfort
• No heat generation
• No tooth contact
• Reduced operator fatigue
• Temporary relief of dentinal hypersensitivity

Air polishing is safe for use on amalgam, gold, porcelain and orthodontic bands and brackets. It is not safe for use on all types of composites, glass ionomers, and luting agents.

Air polishing with the recommended sodium bicarbonate mixture does not damage titanium used for implants and is the method of choice for decontamination.

Recently new air polishing powders have been developed that include glycine, calcium carbonate and calcium sodium phosphosilicate (NovaMin®).

Glycine is available in two grades: pharmaceutical and technical. Glycine crystals can be grown using a solvent of water and sodium salt and then prepared for use in powder formulations.

Calcium carbonate, a naturally occurring substance, is often used as a filler for pharmaceutical drugs and as a main ingredient in antacids.

Calcium sodium phosphosilicate is a bioactive glass. It has the ability to interact with oral fluids and release sodium, calcium and phosphate ions resulting in remineralization of tooth enamel.

Consider including air polishing in your professional armamentarium as an effective and safe alternative to traditional methods.

Stephanie Wall may be contacted at rdhms@live.com.

References

Barnes, C. An In-depth Look at Air Polishing. Dimensions of DH, March 2010.
Essex, G. A Predilection for Polishing. Dimensions of DH, March 2005.