First introduced in the 1940s, air polishing 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.

Air polishing was developed in the early 1970s as a technique for fast and efficient removal of extrinsic stains, plaque and other soft deposits from the teeth. It was designed to replace the prophy cup method and has been shown to save more than 50% of the clinical time spent on this tedious procedure. The technique was widely acclaimed when introduced, but this initial enthusiasm was somewhat tempered when it was found that the early technology resulted in frequent clogging problems with the system and the need for frequent servicing and maintenance.

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.

Recent developments have brought new options to the market, including glycine, erythritol, calcium sodium phosphosilicate, calcium carbonate, and aluminum trihydroxide (to name a few). It’s not necessary to review each in detail, but it’s important that hygienists are generally educated on the many options now available for use.

In addition to being less restrictive when it comes to pre-existing patient conditions, two powders can now be used safely in subgingival air polishing: erythritol and glycine. Air polishing has traditionally been thought of as a technique for supragingival plaque and stain removal only; but these new options open the door for effective removal of subgingival plaque and biofilm, even in deep periodontal pockets.

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.

Erythritol, while not currently available in the United States, is a sugar alcohol that has been shown to offer less discomfort, decreased treatment times, and reduced bleeding on probing when compared to scaling and root planing. Glycine is a naturally occurring amino acid that is water soluble, with a non-salty taste that patients often describe as a little bit sweet. This powder offers similar benefits to erythritol, and offers an option that’s less abrasive with a particle size approximately four times smaller than sodium bicarbonate.This smaller particle size means that it’s safe for all the same supragingival applications as sodium bicarbonate powders, but also offers the option to treat patients with periodontal infections, peri-implantitis, patients on a sodium-restricted diet, and those who have cosmetic or other restorative work.

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