Dancing on air?
Hygienist Tracey Lennemann celebrates the new wave in air polishing
Do you have an air polishing device? Are you actively using it or has it been sitting in a closet or drawer for years? Why did you stop using it? Was it too messy, the salty taste, the gingival damage it caused or the high risk of creating subcutaneous emphysema? For whatever those reasons were, it is now time to get out your air polisher, clean it up and get ready to use it again. Air polishing has changed!
It wasn’t until the late 1970s that Dr Robert Black’s 1945 invention of air abrasives started to get noticed by dental clinicians.¹ The original idea being a device that used compressed air, water, and a highly abrasive powder to eliminate pain from cavity preparation, making anaesthesia unnecessary.² This was called air abrasion which, later in the 1980s, was introduced as a similar procedure but used for heavy stain removal for difficult areas and was called air polishing.
The powder of choice has been sodium bicarbonate, mainly used for heavy stain removal from chlorhexidine, smoking, coffee or tea stains.
It has been shown to be effective around orthodontic braces and brackets and as a better choice for sealant retention as opposed to the traditional method of polishing paste with a prophy brush.3,4,5 However, other studies have shown significant limitations when using sodium bicarbonate.6,7,8
A 1986 study by Galloway and Pashley demonstrated that the air polisher can cause, clinically, significant loss of tooth structure when used excessively and should, therefore, not be used on exposed cementum or dentin.6
An article published in RDH Magazine stated: ‘In its position paper, the ADHA highlights that air polishers should be avoided around most types of restorative materials due to the possibility of scratching, eroding, pitting, or margin leakage’.7
Likewise, a root dentine study concluded: ‘Air polishing applications increased the surface roughness of all composite resin restorative materials tested. Composite restorations may require re-polishing after air polishing.’8
After 60 seconds using sodium bicarbonate. (no further cleaning possible)
After just 20 seconds using Sylc
Consequently, it has become general practice not to air polish any restorative materials.
Due to academic studies – and more general concerns – many clinicians choose to put away their polishers and revert back to the traditional method of hand polishing with pumice, prophy paste, brushes and prophy cups.
The air polishing market had effectively gone into hibernation with little innovation throughout the late 20th century.
It wasn’t until the new millennium did air polishing begun to wake up and change. New powders were introduced to overcome the problems experienced with sodium bicarbonate. One such powder was calcium carbonate with micro-sphere technology. This material was formed from rounded particles of food grade calcium carbonate, which helped reduce aerosol spray due to better angulations during delivery. Studies showed reduced gingival irritation yet still being as effective for heavy stain removal as sodium bicarbonate. Its neutral taste is more pleasing to the patient as well being able to use it with patients on sodium-restricted diets.10, 11 Calcium bicarbonates cleaning effect with decreased contraindications have opened the door to more effective air polishing.
Glycine also joined the world of air polishing with numerous studies supporting effective, gentle biofilm removal subgingivally, around implants and on restorative materials.12
Now, let’s jump ahead to 2011. Air polishing has another player in the game and its name is Sylc. This new material was developed as an air polishing powder containing high concentrations of calcium sodium phosphosilicate by researchers at the Dental Institute of King’s College in London. Calcium sodium phosphosilicate was invented by Professor Larry Hench at the University of Florida in the late 1960s, originally found utility in the remineralisation and repair of new bone tissues.13,14
Later, in the mid-1990s, uses of this unique material were expanded to include dentin remineralisation and subsequently branded as NovaMin.15
Sylc is a ‘powder therapy’ that decreases dentinal hypersensitivity, uniquely repairs dental tissues and brightens teeth. It has been proven to clean, polish and desensitise by remineralising dentine surfaces in one treatment when applied like a conventional prophy powder.16 Unlike sodium bicarbonate which is contraindicated for some patients, Sylc is suitable for almost all patients and is applied as an air polishing powder typically in a Kavo ProphyFlex, NSK ProphyMate Neo or in an EMS Handy when used with an OSspray Ceramic Tip. When the Sylc material is applied as a powder via an air polishing system, or when slightly damp via a rubber cup, the level of tubule occlusion was significantly higher than that of the other air polishing powders, as shown in (Cavitron prophy jet, EMS AirFlow perio) and polishing pastes (Tooth Mousse, Colgate Sensitive Pro-Relief and Nupro).17
It’s recommended that you…
• Avoid patients with restricted sodium diets
• Avoid patients with respiratory, renal, or metabolic disease
• Avoid patients with infectious disease
• Avoid children
• Avoid patients on diuretics or long-term steroid therapy
• Avoid patients with titanium implants (research is still needed in this area)9
Additionally, researchers have also proven the Sylc powder therapy remineralises the surface of dentine, giving a regain in mineral content and micro hardness within just 24 hours and one single application.18 In this form, Sylc can remove stain, plaque and biofilm while desensitising and remineralising all at the same time.
For exposed root surfaces under restorative materials, the SmarTip, a small individual tip used without water from a special turbine handpiece, is recommended. Sylc is to be used on natural teeth only as it can matte, dull and pit some restorative materials. Air polishing has certainly come a long way in 30 years – it’s safe and a vital part of prophylaxis and periodontal maintenance, as well as the stand alone ‘powder therapy’.
• References available on request
Tracey Lennemann is a speaker and trainer. She has been a clinical dental hygienist since 1986. In addition to completing her associate degree in dental hygiene (Spokane, Washington, USA), Tracey also holds a Bachelors Degree from Eastern Washington University. Since 1988, Tracey has practised dental hygiene and preventive dentistry in Munich, Germany, and Austria and is working with Dr Parag at Facial Wellness. Tracey also lectures for many different dental companies, symposiums and dental associations. For more information on Sylc, visit www.osspray.com. J&S Davis is the exclusive distributer.
Email [email protected]
Phone 01438 758 908