Air Polishing: An Effective Method to Improve Optimal Patient Care

You're listening to The Dr. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. Today we'll be discussing air polishing, which, by the way, has been around since the 1970s. Utilizing a slurry of air, water, and a non-abrasive powder, it's used to remove dental plaque biofilm and stains. While it delivers benefits to the patient, it also offers a time-saving and ergonomic solution to the practitioner. To tell us more about it is our guest today, Dr. Sheri Doniger. Dr. Doniger is a leading dental clinician, author, international educator, and consultant who currently practices dentistry in Lincolnwood, Illinois. She has a lifetime of experience moving from a dental assistant to a dental hygienist and then to a dentist. That's pretty impressive. Her book, Practical Practice Solutions in Dentistry, focuses on building practice success. Dr. Doniger, it's a pleasure to have you on Dental Talk. Phil, it's an honor. I'm very excited to be here and talk about one of my favorite pieces of equipment in my dental practice. Yeah, we want to hear about it. Regarding your book, where can you buy that book? Thank you for asking. Currently, you could buy it on Amazon. It's volume one. We are working on volume two as we speak, and hopefully we'll get that together in the next six to eight months. It's kind of like a textbook, right? It is. The gist behind that was to be able to have... topics for practice management. As we all know, dental schools have so much curriculum that they have to have included in their mandatory that we got very little information on practice management. this is a sort of a roadmap to tell and to try to explain to students what they have to look forward to that you know how to set up a practice to work with an accountant to work with a banker do they want to associate do they want to set up on their own and you know social media just a whole bunch of topics that if used in a classroom setting or even just read by you know by the clinician themselves, you can seek out other experts in the field and get more information. But it's certainly great for the classroom. And I felt it was something that was necessary because we had so little and I graduated a long time ago and they still don't have anything to practice management. The curriculum still is deficient in that. If you do a search on Amazon and type in Doniger, I guess you would find it. Yes, there's two donagers in there. One of them is Hindu spiritualism, and that's not me. And the other one is the book cut. That might be good, too. Hindu spiritualism sounds good. Wendy's an expert in the field. Yeah, right. The combination of Hindu spiritualism and practical practice solutions in dentistry might be a very synergistic read. I don't know. All right. So getting to this podcast, and I appreciate you coming on the show on the 23rd of December, which is right before Christmas. We have a big holiday coming up for many of us. We do appreciate you coming on. How would the air polisher be utilized and why use it instead of the traditional prophy polish systems that we are so used to? That's a great question, Phil. There's several reasons. Less clinician time is used with the air polisher. It's quicker. Less clinician fatigue because you aren't hand scaling off the darkest and stickiest stain on patient's teeth, even though you still have to get. all the calculus off, you can use the air polisher and easily remove the stain. It's certainly more efficient in stain and biofilm removal than hand instruments alone. And air polishing is really less abrasive than traditional prophy polish. It removes 100% of the bacteria and endotoxins. It will create a uniformly smooth surface. great for pit and fissure stain removal, safer implants and no heat's generated because you know when you're using traditional profi paste, you leave the cup on the tooth for just a little bit too long and you will be generating heat and that's nothing that we want to do. What do you think the usage is as far as percentage-wise of practitioners using an air polisher versus the traditional profi polish? I think, as you mentioned in the introduction, it's been around since the 70s. I was lucky enough to be in a practice that did wind up using that initial profi polisher that was available, the Mark IV, I think it was, which has long evolved truly into one of the brands that are out there today, the Cabajet. Probably about 30 percent of practices have this. I think a lot of hygienists are using it. I think a lot more hygienists should be using it. But it's just one of those things that, you know, you have to if you know about it, you want it. And if you don't know about it, you know, it's great to find out in a podcast like this to be able to find out the benefits of using air polishing, because I think it's just such a great adjunct for clinical practice. Yeah. And with the newer systems that are out there, they're not. as bulky, right? They're kind of all-inclusive in the handpiece. I looked at some of the videos before this podcast and some of the images that was on NSK's site. I think it's called the ProfiMate Neo. It doesn't look that cumbersome. So how easy is it to incorporate an air polisher into the workflow of the practice? It's so easy, especially the ProfiMate Neo. That unit you put right in where you would put your handpiece and you get the air and the water coming out. from the handpiece hosing. You put powder in there. Let me step back just for a second. With the new OSHA and ADA rules, just like with any ultrasonic or handpiece, you have to run air and water through it to clean the hoses out to make sure the airlines are cleaned for about 30 seconds at the beginning of the day and 20 seconds between each use. I wanted to get that in the word from the ADA sponsor, so to speak. You put powder in the little cap, close the cap, and... aim it on the tooth. It's usually you have the about half a second exposure in each area of the tooth that you're rotating very slowly through the mouth. And it's so simple. And you're done polishing in less than five minutes, which you should be. There's no grit in the patient's mouth. It's usually, especially with the Profimate Neo, you're using a sodium bicarbonate. There's a couple different powders that you can use, but you're using a sodium bicarbonate powder. And it has a sweet, salty taste. And once you rinse out after you finish going through the entire mouth, the patients aren't. feeling that grit that they're tasting like five hours later with their dinner. And it goes a lot quicker, especially with the ProfiMate Neo. One of the things that I love about it is the tip of it sort of rolls in your finger. So you have really very good directional use of the product. You don't have to twist your hand to get the air. flow in any particular way. You could just use your fingers and get that, you know, just sort of roll it very gently. It's so easy. It's so easy to incorporate. It's just so easy to work with. So you were a dental assistant, then you were also a dental hygienist. Yes. Now we know you're a dentist. So your experience with ergonomics is really extensive. What advantages does this system have compared to the traditional ways of doing this regarding ergonomics? the tethered handpiece or the prophy angle and this unit a air polisher you have to think about there's going to be the cord that you're going to you're sort of pulling the cord no matter which way but this is a much lighter unit that you're working with you're also using less time. It's less force. You're not hand scaling hard to try to get the dark, dark stain off of the teeth. You're using this air polish, which basically you feel like you're getting some air abrasion on your teeth. So the air abrasion. is so much easier on your hand and your grip than trying to scale. And, you know, as we all know, we hold onto the instruments just a little bit too tight sometimes. And there's less hand fatigue. I think that this is one of the instruments that saved me, saved my hands from, you know, having major issues because I use this instead of constantly hand scaling off heavy stain. When you say tethered, are you saying this is a cordless unit, the one that you mentioned? No, it's corded. It's corded. It's corded to the handpiece where you would put your handpieces in. So it does sound like this removes plaque biofilm and stains faster. Yes. With the kind of rotational features that this unit that you talked about, or maybe there's other units on the market that do the same thing, that gives the very simple... direction of where this polishing powder will go, right? Directing it to the right part of the tooth. So you have excellent control over it. Less fatigue, it's faster. So you reduce chair time. What's the downside? What are some of the contraindications? You wouldn't want to blast the air polish unit on composites because you don't want to upset the bond area between the composite and the tooth. Also with glass ionomers, you don't want to get glass ionomers either or any cemented margins. If patients have any kind of respiratory, renal, or metabolic diseases, that's also a contraindication. Any infectious diseases two years ago when COVID-19 started and we completely stopped using any ultrasonics, piezos, or air polishers because of the aerosol, now we are back to using air polishing and hand pieces and everything else, but we have a little bit better control of the spray than we did before. There's some devices that I use to make sure that I have my aerosol managed, but patients with infectious diseases we would not use. a air polisher with. Also, if patients have a lot of exposed cementum or dentin, you wouldn't want to do that because the, you know, obviously the dentinal tubules are exposed and you don't want to have any more irritation. Patients taking patients on a sodium restricted diet are also patients that you would possibly not want to use the air polisher with because the sodium bicarbonate is a high salt product. So you have to really be able to control the direction of these particles, right? Because if you're removing stain from a patient, they may very well likely have composites as restorative work in their mouth. So how do you, if they have a stain near the composite area, you still feel comfortable using an air polisher, even though you want to avoid the composite itself? I do because I've been using it for so long. It's certainly the technique. You would be near it. You wouldn't be on it. I think that with any device in the mouth, we operate everything with care. The one thing that I didn't mention is the subcutaneous emphysema that potentially can happen. It's very rare. It's characterized by a rapid swelling in the facial area. And what happens is if you misdirect, and you're talking about misdirecting around a composite, but if there is an open surgical site or periodontal pocket or periimplantitis defects, any lacerations, this is where you can wind up having the subcutaneous emphysema. So those would be areas you would avoid as well. As far as the composite, I get as close as I can. And of course, you always have to hand scale. I mean, even before you would even start using. an air polisher you would hand scale everything to make sure that you have all the calculus off and usually during that hand scaling you would get a lot of the stain off that's around the margins of any composites like anything else i mean when you pick up a handpiece that's rotating at 260 000 rpm or more We could do a lot of damage with that handpiece. So obviously, the benefits of the air polisher, in your mind, far outweigh the risk. And we just need to be very careful with directing the polishing spray to where we want it to go. It removes the light, moderate, heavy stain very easily. You can use it to remove plaque prior to sealant placement. One of my favorite things in the world to use it for is orthodontic brackets. I mean, in an ortho practice, they could use this before they bond to polish the teeth quickly and then put the bonding on. But when I have an ortho patient in and I can go around and air polish, first of all, the brackets just gleam afterwards. I mean, they are just shiny. It's just great. And then, you know, you show the child how this is how clean your teeth are supposed to be. And look at all the plaque that you had. before, so it's a great before and after. You can also use it to, I've used this to assess shades when I'm deciding on shades for a tooth and any tooth whitening, you can do it. It's just so great because it's less abrasive. There's no pressure on the teeth, as I had said earlier. You're not using the cup and you're not putting any heat or any pressure or anything on the tooth. There's much less cheer time, which is great. Patients love it because there's less cheer time and there's no grit remaining. It's such an easy adjunct to put into the practice. There are just a couple things that I just wanted to say about for my practice. We always give our patients eye protection. We will also give our patients some lip balm. Sometimes they just don't like the feel of sodium bicarbonate at all. And the best thing that has come out of this pandemic is my wearing a face shield because I love it because I would never go and do a patient, either a high-speed handpiece or an air polisher without a face shield anymore. So to protect the patient and protect ourselves, it's really, really important. So depending on the patient and the case, In the practice, you would recommend that an air polisher should be part of everybody's armamentarium in their office. Whether they use it on every patient for every case, that's up to them. But to have it in your office for the applications that you just described would be recommended. Absolutely. I think that with the short learning curve, the air polishing device will offer clinicians so many benefits and benefits to the patients. When a practice is looking to decide how they want to set it up, they have a couple factors that they'd have to consider. One of them is portability. Do they want to use something like the awesome ProfiMate Neo that they can move from room to room? And if there's three hygienists working and they can all, of course, to get three of them, but if they just are starting out having one, then they can actually have some portability using that after it's cleaned and autoclaved in different operatories as opposed to a unit that is completely stationary. It's also important to think about cleansability. The maintenance of the ProfiMate Neo is very simple. Everything is pretty much autoclavable. You clean out the powder after each patient. The other thing that I have found is putting the nozzle in a very light vinegar solution to help make sure that the airway is patent to make sure that there's no clogs in there because the last thing you want to do is get next to a patient and all of a sudden you're pushing and pushing and pushing and nothing's coming out. So you always want to test and make sure that it's clean and you want to check to make sure that the team knows the ease and maintenance and sterilization. Again, the ergonomics, the maneuverability. Again, I love the fact that I can just twirl the nozzle of that ProfiMate Neo and get to all air. areas of the mouth so simply, and I don't have to twist my hand or move anything else. The flexibility, as I basically said before, of being able to use it in one app or two apps or sharing between hygienists and docs. That actually answers most of what my last question was going to be, which was what would a clinician look for in purchasing an air polishing unit? So I think you covered that very well. Do you have any closing recommendations for us before we wrap up this podcast? Honestly, if... there's holiday wishes still available and if you still need something to purchase, I would certainly look into getting one or two of the ProfiMate Neos for your practice. I think as a doc, your hygienist will love you. I also think that you will enjoy using this product yourself. I think there's so many ways that we can use it in our practice. Also, it's something that patients talk about. It's something that people, everybody doesn't have, as we talked about in the beginning, you know, even if 30% of the practices have it. So if you're one of the 30, you're a little different than somebody else. And that makes good talk about. when people are discussing why they would pick a practice, because your practice has devices in there that are advanced and into science, and that's why you like coming to practice. So that's what I would recommend. I'm very honored to be included in this illustrious group of speakers that you have. Thank you for allowing me to talk a little bit about air polishing. Yeah, our pleasure. I think our audience gleaned some great information on it, and I encourage them to ask their colleagues about it that do use it. With what you just laid out here, which was very, very well done, Dr. Doniger, I appreciate it. Thanks for the nice words. I think it's been a great help for people to understand the benefits, and we look forward to having you on future Viva Learning CE activities next year. We have a lot coming up next year, so we hope you're part of it. Thank you.