Running head: AIR POLISHERS 1

Air Polishers

Nicole Hommer

Brianna Huggans

Jourdan Lemery

In partial fulfillment of

DHYG 421 Dental Hygiene Theory and Practice V

with Jolene Hartnett BS, RDH, MSEd

Fall Quarter

November 29, 2018

Abstract
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In dentistry, various methods and implications for new products are constantly arising.

Air polishing has long been an alternative to the traditional type of prophylaxis polishing, and is

constantly progressing to be used in many different situations involving dentistry. The different

types of polishing powders on the market allow for an array of purposes, including supragingival

and subgingival use. By utilizing the variety of air polishing nozzle designs and powders

available, subgingival use allows for effective removal of plaque in periodontal pockets, while

also removing stain. The variety of uses has expanded the populations that are indicated for the

use of an air polisher, but also demonstrate contraindications just as traditional polishing does.

As dental hygiene students, our main goal is to give all of our patients the individualized care

they deserve. The diversity of an air polisher gives us an alternative course of treatment for those

where traditionally prophylaxis polishing is not the highest standard of care.

Introduction
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Air polishing was introduced in the 1970’s and has been compared to prophylaxis rubber

cup polishing. Air polishers operate by using water, powders, and pressurized water. They have

continually made advancements since 1970 (Johnson, 2016). The purpose of polishing is to

remove stain and plaque (Johnson, 2016). Rubber cup polishing is limited to supragingival use,

whereas, air polishing has the ability to reach subgingivally and interproximally. Since 1970, six

different types of powders have been invented (Barnes, 2013). However, not all of the powders

are able to be used subgingivally. Air polishing continues to advance in its efficiency, but it is

important to be aware of the benefits, indications of use, as well as the contraindications. In a

world where prophylaxis polishing is most commonly used, the implementation of an air polisher

gives dental professionals the accessibility to reach the highest standard of care for all patients.

Body

There is not a one size fits all when it comes to polishing. There are different types of

polishing, like prophy angles or air polishers, as well as different abrasiveness of prophy cups

and air polishing powders. Prophy cups contain extra coarse, coarse, medium, fine, and extra fine

pastes (Shannon B 2013). The abrasiveness of the paste depends on the size, shape, and hardness

of the paste. Most abrasives in prophy paste comes from pumice, which are pieces of volcanic

rock which have been cooled and crushed. Coarse pastes have larger pumice pieces and remove

stain quicker, but they also leave the enamel with larger scratches, which is a nidus for plaque

and bacteria, and reattachment of stain happens quicker. Medium polishing paste is less abrasive

to the enamel, and removes stain well. However, fine abrasive paste leaves small scratches all

over making the surface to appear smoother and shiny. It does not remove stain as well, but stain

also cannot adhere to the surface as quickly (Shannon B 2013).

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Similar to prophy pastes, there are different types of air polishing powders. Sodium

bicarbonate has been the gold standard for air polishing (Barnes, 2013). Although it is considered

the gold standard, there are contraindications for sodium bicarbonate powders. Restricted salt

diets, hypertension, chronic kidney disease, and congestive heart failure are all contraindications

for sodium bicarbonate powder (Johnson, 2016). However, there are other powders available for

those who cannot use the bicarbonate powder. Ammonium tridroxide was developed as an

alternative. It is more abrasive and can cause more damage to composite, porcelain, gold

restorations, and exposed cementum and dentin. Therefore, its main use should be on heavy

stained enamel (Barnes, 2013). Glycine is another type of powder which has amino acids, less

abrasive, and is water soluble (Johnson, 2016). Glycine is currently being tested in Europe, and it

is safe for subgingival use. Calcium carbonate is a powder which is not recommended for

subgingival use. The abrasives are spherical and can remove stain well, but also damage root

dentin (Johnson, 2016). Calcium sodium phosphosilicate is good for a patient with

hypersensitivity because it contains a bioactive glass which promotes remineralization as well as

occludes dentinal tubules (Johnson, 2016). However, due to the hardness and abrasiveness, more

research is needed to prove the safeness of calcium sodium phosphosilicate powders (Barnes,

2013). The last available powder is erythritol which is a sugar alcohol and when it is combined

with chlorhexidine it can help reduce periodontal pockets (Johnson, 2016). Just like prophy cup

polishing, when considering air polishing it is important to be aware size, shape, and hardness of

the pastes and abrasiveness of the powders to know when to use them.

When a patient comes in for prophylaxis and you don’t polish they are likely to notice.

They may say something and think that you did not properly “clean” their teeth. For most

patients, what they notice is the appearance of their teeth and not the fact that their gums are in a
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disease state. As a dental professional we are more concerned about the removal of biofilm and

calculus and the health of the gingiva. By incorporating air polishers into a practice daily, it’s

killing two birds with one stone. Air polishers have shown to be highly effective in stain

removal, which pleases the patient. They are also highly effective in removal of supragingival

and subgingival biofilm, pleasing the dental professional. This is unlike traditional prophy cups

with abrasive paste, which are only used coronally. Air polishers allow access to all areas,

including interproximal and into the sulcus. By using an air polisher subgingivally it would

remove bacteria, decreasing the host response and therefore decreasing inflammation and

bleeding. Glycine and erythritol are both safe and effective powders for subgingival use. Both

when used subgingival have been presented to show benefits in periodontal maintenance

therapies. In a 2013 randomized clinical trial, erythritol powder increased patients’ comfort,

decreased treatment times, probing depths, and bleeding on probing (Daubert). However,

erythritol is only available in Europe.

Glycine powder air polishing (GPAP) has been compared to sodium bicarbonate powder

and hand instruments for its effectiveness on plaque removal. Glycine powder is 80% less

abrasive on root surfaces than sodium bicarbonate, making glycine safer. A study conducted by

Petersilka, who is in the Department of Periodontology at University of Münster,

Waldeyerstrasse, assed the “Efficacy of subgingival plaque removal in buccal and lingual sites

during supportive periodontal therapy (SPT) using a low abrasive air-polishing powder

(Petersilka). Before treatment plaque samples were taken from two teeth that had 3-5mm

pockets. Subgingival debridement was performed on 27 patients using air polisher in half the

mouth and hand instruments on the other half. Plaque samples were taken again, assessing the

mean reduction in total colony forming units in anaerobic cultures. This was repeated again after
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3 months. The results showed that, “low abrasive air-polishing powder is superior to curettes in

removing subgingival plaque from pockets of 3-5 mm depth in supportive periodontal therapy

and offers greater patient comfort (Petersilka).” Another study using GPAP was conducted on

patients with severe periodontitis with Porphyromonas gingivalis and probing depths greater than

6mm. This time an ultrasonic was involved. Patients were randomly assigned for initial therapy

with subgingival GPAP or scaling and root planning followed by coronal polishing. For 2 weeks

after debridement, patients rinsed with 0.12% chlorhexidine gluconate twice daily. The results

showed that, “GPAP resulted in significantly lower total viable bacterial counts in moderate-to-

deep pockets when compared to SRP immediately after debridement and at day 10. Total P.

gingivalis counts in the oral cavity were significantly reduced after full-mouth GPAP compared

to SRP at day 90 (Flemmig).” Although subgingival air polishing doesn’t remove calculus, its

affects at eliminating oral microbial provide significant benefits.

It is often misunderstood when an air polisher is supposed to be used during a dental

appointment. One common misconception is that air polishing replaces scaling or ultrasonic

scaling during a prophylaxis appointment. As stated previously, subgingival GPAP does not

remove calculus and therefore, it does not replace mechanical debridement of calculus through

power or hand instrumentation. It may, however, affect microbial parameters and bleeding on

probing. Some benefits to using an air polisher are the absence of a drilling sound, no direct

contact with the teeth, no vibrations, quicker removal of plaque, more effective stain removal

and is available in less abrasive options.

Determining which patients are good candidates for air polishing is just as important as

knowing which patients are not suited for this type of polishing. Due to the absence of the

stereotypical drilling sound, a patient who experiences fear or anxiety from the sound of the
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slow-speed polishing handpiece, is a good candidate. The vibrations from a traditional handpiece

put off vibrations that often make a patient uncomfortable or have anxiety, so an air polisher is a

vibrationless option. The high pressure mechanism of an air polisher is shown to remove heavy

extrinsic stain, so patients who present with heavy stains are also good candidates. Given that air

polishers do not come in direct contact with the tooth, tricky cleanings such as a patient with

orthodontic brackets is a good candidate for air polishings adaptability.

Contraindications of an air polisher should also be considered when determining the

procedures for our dental prophylaxis appointments. Some patients should not have their teeth

polished using an air polisher. Because some of the powders used are typically very high in

sodium, patients with kidney disease or those with restricted intake of sodium should not be

exposed to the air polishing powder. The air-powder polishing system creates an aerosol, which

can be inhaled, so any patients with respiratory diseases or infectious diseases are not candidates

for use of this type of polishing. An air-powder polishing system also should not be used on

titanium dental implants due to the possibility of damage to the surface of the metal. The

American Dental Hygiene Association lists the following people as contraindicated for use of the

Prophy-Jet® in its 2010 Position Paper on Polishing: Patients with restricted sodium diets,

Patients with respiratory, renal, or metabolic disease, Patients with infectious disease, Children,

Patients on diuretics or long-term steroid therapy, and Patients with titanium implants.

Conclusion

In dentistry, various methods and implications for new products are constantly arising.

Air polishing has long been an alternative to the traditional type of prophylaxis polishing, and is

constantly progressing to be used in many different situations involving dentistry. The different

types of polishing powders on the market allow for an array of purposes, including supragingival
Running head: AIR POLISHERS 8

and subgingival use. The variety of uses has expanded the populations that are indicated for the

use of an air polisher, but also demonstrate contraindications just as traditional polishing does.

As dental hygiene students, our main goal is to give all of our patients the individualized care

that they deserve. The diversity of an air polisher gives us an alternative course of treatment for

those where traditionally prophylaxis polishing is not the highest standard of care.

Works Cited

Barnes, C. (2013, April). Air polishing: A Mainstay for Dental Hygiene. Retrieved November

15, 2018, from

https://www.dentalacademyofce.com/courses/2423/PDF/1305cei_Barnes_RDH_final.pdf

Daubert, D (2013, December 13). Subgingival Air Polishing. Retrieved November 15, 2018,

from https://dimensionsofdentalhygiene.com/article/subgingival-air-polishing/
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Flemmig TF, Arushanov D, Daubert D, RothenM, Mueller G, Leroux BG. Randomized

controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-

to-deep periodontal pockets. (2015, April 1) Retrieved November 15, 2018, from

https://onlinelibrary.wiley.com/doi/abs/10.1902/jop.2011.110367

Johnson, K. (2016, August 16). Air polishing has changed-so why hasn't the dental hygiene

curriculum? Retrieved November 15, 2018, from

https://www.dentistryiq.com/articles/2016/08/air-polishing-has-changed-so-why-hasn-t-

the-dental-hygiene-curriculum.html

Petersilka GJ, Steinmann D, Haberlein I,Heinecke A, Flemmig TF (2013, April 14).

Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-

polishing powder. Retrieved November 15, 2018, from

https://onlinelibrary.wiley.com/doi/full/10.1034/j.1600-051X.2003.00290.x

Shannon B (2013, June 24). Polishing pastes ... look good and taste great! Retrieved

November 15, 2018, from https://www.dentistryiq.com/articles/2010/06/polishing-pastes-

.html

Teeth Polishing: Traditional vs Prophy-Jet. (2017, December 27). Retrieved November 12,

2018, from https://www.definitiondental.com/blog/teeth-polishing-traditional-vs-prophy-

jet.html
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