Air Polishing Darlene Armstrong, Ed.D.(c) M.A., RDHAP Aug 17, 2012 Aug 17, 2012 - LLU AS Darlene Armstrong, Ed.D.(c) M.A., RDHAP Aug 17, 2012 Air polishing Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP

2 Types of Air Polishers NSK Prophy Mate Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS Prophy Jet Plus – Dentsply cavitron NSK Prophy Mate Neo – Brasseler NSK Prophy Mate very similar – tip & powder lid/gaskets are different. 2 Types of Air Polishers Other brands are also available; Brasseler donated NSK air polishers to LLU DH

EFFECTS OF POLISHING BACTERMIA II. ENVIRONMENTAL FACTORS Air Polishing Aug 17, 2012 - LLU AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS EFFECTS OF POLISHING BACTERMIA At risk patients may need antibiotic prophylaxis II. ENVIRONMENTAL FACTORS A. Aerosol Production – reduce using HVE and special fittings B. Spatter – eyewear necessary for all team members and patient III. EFFECT ON TEETH A. Removal of Tooth Structure – less with proper use of air polishing B. Areas of Demineralization – use remineralizing paste C. Areas of Thin Enamel, Cementum, or Dentin D. Surface Roughness of Teeth and Restorations – only use agent recommended by manufacturer of restorative materials E. Heat Production – light pressure, slow motion, plenty of moisture to avoid pain and discomfort EFFECT ON GINGIVA Polish before root planing or at re-evaluation Wilkins and Barnes, Extrinsic Stain Removal Ch42 - Wilkins' Clin Prac of DH, 9th ed Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP

INDICATIONS FOR STAIN REMOVAL Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS INDICATIONS FOR STAIN REMOVAL I. TO REMOVE EXTRINSIC STAINS NOT OTHERWISE REMOVED DURING TOOTHBRUSHING AND SCALING A. Patient Instruction – encourage patient in habit changes to reduce staining B. Scaling and Root Planing – scaling best for removal of black line stain II. TO PREPARE THE TEETH FOR CARIES-PREVENTIVE AGENTS A. Pit and Fissure Sealant – must remove abrasive grit completely Fluoride OK, Air powder polishing is method of choice B. Professional Application of Fluoride Solutions or Gels – removal of calculus is necessary before Fluoride application, polishing is not III. TO CONTRIBUTE TO PATIENT MOTIVATION A. Development of Biofilm – begins within 1-2 hours B. Motivation – shows patient appearance and feeling of clean mouth Wilkins and Barnes, Extrinsic Stain Removal Ch42 - Wilkins' Clin Prac of DH, 9th ed

CLINICAL APPLICATION OF SELECTIVE STAIN REMOVAL Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS I. SUMMARY OF CONTRAINDICATIONS FOR POLISHING A. No Unsightly Stain B. Characteristics of Patients at Risk for Dental Caries – rampant caries, nursing caries, root caries, early demineralization, xerostomia C. Patients with Respiratory Problems – emphysema, cystic fibrosis, lung cancer, patients using oxygen, or when breathing is a problem D. Tooth Sensitivity – use special products (MI Paste+) or do not polish E. Restorations – use proper materials, or do not polish F. Newly Erupted Teeth – due to incomplete mineralization G. Conditions Requiring Postponement for Later Evaluation – patient has inadequate biofilm control, spongy tissue, or immediately after root planing II. SUGGESTIONS FOR CLINIC PROCEDURE A. Give Instruction First B. Remove Stain by Scaling C. Use Minimal Polishing Techniques Wilkins and Barnes, Extrinsic Stain Removal Ch42 - Wilkins' Clin Prac of DH, 9th ed

AIR-POWDER POLISHING I. PRINCIPLES OF APPLICATION Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS AIR-POWDER POLISHING I. PRINCIPLES OF APPLICATION II. USE OF AIR-POWDER POLISHING A. Requires less time and ergonomically favorable to the clinician and generates no heat B. Sodium bicarbonate is less abrasive than traditional prophylaxis pastes, which makes the air-powder polisher ideal for stain and biofilm removal. C. Removal of heavy, tenacious tobacco stain and chlorhexidine-induced staining D. Stain and biofilm removal from orthodontically banded and bracketed teeth and dental implants E. Prior to bonding procedures F. Root detoxification for periodontally diseased roots Wilkins and Barnes, Extrinsic Stain Removal Ch42 - Wilkins' Clin Prac of DH, 9th ed

AIR-POWDER POLISHING, continued Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS AIR-POWDER POLISHING, continued III. TECHNIQUE A. For Anterior Teeth – 55-60° B. For Posterior Teeth – 80° C. For Occlusal Surfaces – 90° D. Incorrect Angulation – 90° causes reflux of spray to clinician IV. RECOMMENDATIONS AND PRECAUTIONS A. Aerosol Production – preprocedural rinse and HVE or attachment B. Protective Patient and Clinician Procedures – eyewear, protective gown, hair cover, lubricate patient’s lips, avoid direct spraying into gingiva* V. AT-RISK PATIENTS: AIR-POWDER POLISHING CONTRAINDICATED A. Contraindications – use non-sodium for sodium-restricted diets B. Other Contraindications – root surfaces and soft, spongy gingiva Wilkins and Barnes, Extrinsic Stain Removal Ch42 - Wilkins' Clin Prac of DH, 9th ed

Brasseler NSK Prophy-Mate neo Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS Brasseler NSK Prophy-Mate neo

Dentsply cavitron prophy-jet plus Air Polishing Aug 17, 2012 - LLU AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS Dentsply cavitron prophy-jet plus Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP

Air Polishing Aug 17, 2012 - LLU AS Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP Aug 17, 2012- LLU - AS Resources Wilkins Clinical Practice of Dental Hygiene 9th & 10th editions Photographs from Darlene/Daniel Armstrong NSK/Brasseler equipment information and website http://www.nsk-nakanishi.co.jp/en/dental/product/oralhygiene/index.html Dentsply Prophy Jet Plus product materials Darlene A. Armstrong, Ed.D.(c), M.A., RDHAP