Air Polishing

Purpose & Key Features:

• Efficient removal of stains and biofilm

• Delivers adjustable slurry: air + water + powder

• Propels abrasive particles to the tooth surface

Pressures:

• Air pressure: 40–100 PSI

• Water pressure: 20–60 PSI

Uses & Advantages:

Advantages:

• NO heat generation

• ergonomic> than handpiece polishing

• powders are less abrasive than polishing paste

Uses:

• Removes extrinsic staining (heavy): Tobacco, chlorhexidine, and betel

• Preferred for orthodontic appliances

• Acceptable before sealant placement

Personal Protective Equipment (PPE)

• Clinician (mandatory): Level 3 mask or higher, gown, gloves, face shield

• Patient: Eye protection (prescription glasses or safety glasses), Mask + shield combination, and extra bib or paper towel

Contraindications

Systemic (Air polishing):

• Respiratory disease or swallowing/breathing disorders: asthma, COPD, cystic fibrosis, and pulmonary hypertension

• Communicable airborne diseases: cold, flu, and COVID.

• Very immunocompromised patients: AIDS, cancer treatment, uncontrolled diabetes, immunosuppressive meds, hemophilia, neutropenia, agranulocytosis

Oral contraindications (air polishing):

• open wounds

• ≤3 mm supporting alveolar bone → risk of subcutaneous emphysema

  • Caused by angulation into sulcus

  • Symptoms: swelling, tenderness, crackling sensation, and extreme pain

  • Management: emergency treatment, observation, antibiotics, and analgesia

Systemic (Prophy-Jet technique):

• End-stage renal disease, Addison’s disease, Cushing’s disease, metabolic alkalosis

• Patients on potassium, antidiuretics, or steroid therapy

Oral contraindications (Prophy-Jet):

• Root surfaces, Soft, spongy, or inflamed gingiva

Systemic (Sodium bicarbonate only):

• sodium-restricted diet, high blood pressure, kidney disease, heart problems

Technique — Nozzle Position & Angulation

• Prophy-Jet Technique:

  • Nozzle 4–5 mm from tooth

  • Anterior teeth: 60° to the facial/lingual surfaces

  • Posterior teeth: 80° to buccal/lingual surfaces

  • Occlusal surfaces: 90° to occlusal surfaces

Air-Flow Technique:

• Supragingival:

  • Nozzle 2–5 mm from tooth

  • Angulation: use between 15°–80° (avoid 90°)

• Subgingival (plastic tip):

  • Insert inactive tip to base of pocket, slide apically until contact with JE, withdraw 1 mm coronally (away from base)

  • Activate and apply 5 seconds with overlapping vertical strokes

  • FDA: approved for pockets ≤5 mm (Canada: ≤10 mm)

  • Note: tip directs to root surface, not base of pocket

Powders — Properties & Indications

• Sodium Bicarbonate (SB)

  • Original powder: salty taste and may sting

  • Use: anatomical crown only

  • Compatible: amalgam, gold, porcelain; NOT for some restorations or root surfaces

  • Mohs hardness: 3.0 size: 74 µm

• Aluminum Trihydroxide

  • Alternative to SB

  • Use: anatomical crown only; not for restorations

  • Mohs: 4.0 size: 80 µm

• Calcium Carbonate

  • Main ingredient in antacid

  • Use: anatomical crown only; effect on restorations unknown

  • Mohs: 3.0 size: 45 µm

• Calcium Phosphosilicate

  • Bioactive glass — researchers warn against use (destructive to enamel/root)

  • Mohs: 6.0 size: 120 µm

• Glycine

  • Amino acid powder

  • Reduces abrasiveness to the root by ~80% vs SB

  • Use: supra- and subgingival; safe on all restorations

  • Also detoxifies the root surface

  • Mohs: 2.0 size: 20 µm

• Erythritol

  • Water-soluble polyol (sweetener)

  • Use: supra- and subgingival; safe on all restorations

  • Detoxifies the root surface

  • Mohs: <2.0 size: 14 µm

Clinical Reminders

• Always review manufacturer instructions and powder compatibility with restorations and root surfaces