Gehrig Module #27: Air Polishing

what is the importance of professional subgingival biofilm removal from root surfaces as a routine part of non-surgical periodontal therapy?

nonsurgical periodontal therapy describes nonsurgical steps to eliminate inflammation in the periodontium

what is the desired outcome of nonsurgical periodontal therapy with subgingival biofilm removal?

return periodontium to a healthy state that can be maintained professionally and by the patient.

studies indicate following periodontal instrumentation, subgingival pathogens return to pre-instrumentation levels in about ____ to ____ weeks

9-11 weeks

research evidence shows periodontal maintenance should be performed every _________ or _____ to remove periodontal pathogens

3 months or less

air polishing uses a combination of a _______-based powder with _____, and ______ ______

glycine

water

compressed air

T/F: Clinical research supports that subgingival air polishing is NOT safe or effective for use in nonsurgical periodontal therapy

false

*it is safe and effective

Glycine-based powder is ____% less abrasive than sodium bicarbonate

80%

a ______ ______ nozzle delivers a glycine-based powder in pockets up to 4 mm

standard metal

a ______-______ ______ _____ tip is used in pockets greater than 4 mm

site-specific plastic perio

In the United States, the Food and Drug Administration approved plastic perio tip for use in periodontal pockets up to _______

5 mm

T/F: Clinicians do NOT require special training in the proper use of a subgingival air polishing device

false

which air polishing powder is recommended for stain removal from enamel surfaces?

sodium bicarbonate

which air polishing powder is NOT recommended for use on root surfaces nor exposed root surfaces?

sodium bicarbonate

Indications for the use of sodium bicarbonate based powder?

‐ Removal of ________ _____

‐ Removal of ______ ______

‐ Use on _______ surfaces

‐ Cleaning of _______ prior to ______ placement

‐ supragingival biofilm

- extrinsic stain

- enamel

- fissures; sealant

which air polishing powder can be used subgingivally?

glycine-based

Glycine-Based Powder indications for use:

‐Removal of _____ ______ and _____

‐Use on _____, _____, and _____

‐Use within sulci or periodontal pockets up to _____ in depth

‐Safe on _____ materials

‐Cleaning of _____ prior to _____ placement

‐Cleaning of ____ surface

- plaque biofilm; stain

- enamel, cementum, and dentin

- 5 mm

- restorative

- fissures; sealants

- implant

what are the medical and dental precautions of supragingival air polishing for stain removal?

A thorough review of patient's medical history

Fill in Blank: medical and dental contraindications of supragingival air polishing for stain removal with the use of Sodium Bicarbonate-based Powder?

- patients on ______- restricted diet

- ______ problems (______ created)

- ______ patients

- ______ or ______ patients (women)

- patients with ______ disease, ______ disease or ______ ______

- patients undergoing ______ or ______

- patients with ______ infection

- history of ______ reaction to powder

- patients on medications that affect body's ______-______ balance

- presence of some ______, ______ ______ restorations (avoid margins of ______, ______ because of ______)

- sodium

- respiratory (aerosols)

- immunocompromised

- pregnant or breasfeeing

- addison; cushin; metabolic alkalosis

- chemotherapy; radiation

- communicable

- allergic

- acid-based

- composite, glass ionomer, amalgams, crowns, cement

if a patient is immunocompromised what should you do before air polishing?

physician consult

patients on medications that affect body's acid-base balance include which meds?

potassium

anti-diuretics

Fill In Blank: medical and dental contraindications of subgingival air polishing for biofilm management?

(Glycine Powder)

- _____ problems

- patients undergoing treatments (_____, _____)

- patients with _____ infection

- history of _____ reaction to powder

- respiratory

- chemotherapy, radiation

- communicable

- allergic

T/F: There are NO sodium concerns and is safe on all types of restorative materials including implants for the use of Glycine Powder

true

T/F: during air polishing a saliva ejector is an effective means of controlling aerosols

false

to minimize risk of air emphysema, air polishing should not be used in pocket depths greater than ____ mm until epithelium has healed (takes about _____ _______)

4 mm

14 days

which air polishing powder is used subgingivally and only available in Europe right now?

erythritol-based powder

Symptoms of Iatrogenic Facial Emphysema include:

- _____ _____

- _____ feeling of the face and neck area

- tenderness and _____

- facial swelling

- crackling

- pain

____ _____ ____ is a rare condition that results from accidental collection of air in the soft tissues of the face from pressurized air in dental procedures

Iatrogenic facial emphysema

T/F: if you suspected your patient is experiencing Iatrogenic facial emphysema, they should wait 12-24 hours to see if swelling resolves on it's own before seeking medical help

FALSE

*seek medical help immediately

what 3 things are required for subgingival air polishing?

‐ specialized _____ designed for _______ use

‐ specialized _______ tips

‐ _______ _______ powder

- equipment; subgingival

- instrument

- ONLY glycine-based

the plastic tip, for subgingival biofilm removal, is designed to direct the glycine powder and air mainly _____ the ____ surface, not at the ____ of the pocket

- toward

- root

- base

which teeth do you treat with subgingival air polishing?

- periodontal pockets greater than ___ mm, evaluate amount of ____ ____ ____ remaining around the tooth

- 4

- alveolar bone support

Subgingival Biofilm Removal

- there is a risk of ___ ___ ___ if a tooth site has 3 mm or less of supporting alveolar bone

soft tissue emphysema

Subgingival Biofilm Removal

T/F: plastic subgingival tip is recommended for use on tooth with 3 mm or less of alveolar bone support

false

Perio Plastic Tip Use: 3 Steps

Step #1:

‐Gently insert the _____ plastic perio tip to the base of the pocket. Slide the tip _____ until it makes light contact with the ____ ____.

Step #2:

- Prior to instrumentation, position the unactivated tip by withdrawing the tip approximately _____ in the _____ direction, _____ from the base of the pocket

Step #3:

‐ With the tip correctly positioned within the pocket, step on foot pedal to activate the powder spray. Apply the tip for ___ ______ for each aspect of the tooth. Use overlapping _____ strokes, NOT _____ strokes

- unactivated

- apically

- junctional epithelium

- 1 mm

- coronal

- away

- 5 seconds

- vertical

- horizontal

the ___ nozzle with glycine powder is used for _____ removal and ____ removal in ____ or _____ pockets

- standard

- stain and biofilm

- sulci or shallow

subgingival air polishing with standard metal nozzle and glycine powder can be used up to _____ in pocket depth

4 mm

subgingival air polishing with standard metal nozzle is directed toward the _____ or ____ ____

sulcus or shallow pocket

air polishing with standard metal nozzle with the use of sodium bicarbonate powder is used where?

supragingival ONLY

T/F: Sodium bicarbonate powder used supragingivally is directed toward the soft tissue, sulcus, restorations, crowns, or fixed bridgework.

**FALSE

DO NOT direct this powder towards soft tissue and restorations

Standard nozzle and sodium bicarbonate power technique?

- The nozzle should be held ___ to ___ mm away from the tooth surface

‐Powder spray is directed ___ from the ___

- 3 to 5 mm

- away

- gingiva

for anterior teeth, the angle between the nozzle and tooth can be varied ___ to ___ degrees when using a standard nozzle with sodium bicarbonate powder

30 to 60

T/F: sodium bicarbonate spray should NEVER be directed at gingival tissue, or at soft tissues of the cheeks, lips, or tongue

true

Supragingival Nozzle Placement Sodium Bicarbonate Powder

‐stroke technique — during treatment make a ____ ____ pattern over the coronal tooth surface for ____ to ____ ______

- constant circular

- 1 to 10 seconds

T/F: the powder spray stops immediately after the clinician removes his or her foot from the foot pedal

*false

powder spray continues for a few more seconds

after the polishing procedure (sodium bicarbonate), apply a ___ ___ ___ ___ treatment to teeth

colorless neutral sodium fluoride

Posttreatment instructions for air polshing with sodium bicarboniate include

- sodium bicarbonate powder completely removes the dental ____

‐Pellicle is reconstituted by salivary proteins in ___-___ ____

‐During this period, teeth do not have natural protection to ___ by ____ food or drink

‐Advise patient to avoid ___ ___ food or drink for about 3 hours (ex: ___, ___, or ___)

- pellicle

- 2 to 3 hours

- staining; colored

- highly colored

- coffee, wine, or blueberries