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Tooth polishing: Relevance in present day periodontal practice

Article  in  Journal of Indian Society of Periodontology · April 2009

DOI: 10.4103/0972-124X.51899 · Source: PubMed

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Charu Madan Rhythm Bains

King George's Medical University
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 Practitioner Section

Tooth polishing: Relevance in present

day periodontal practice
Charu Madan, Rhythm Bains1, Vivek K. Bains2

Senior Lecturer, Abstract:

Department of Time has seen the emergence of more efficient and effective devices like jet abrasives. However, the role
Periodontics, Manav of rubber cups with prophy angles cannot be overlooked as they are still being widely used and provide an
Rachna Dental College, economical alternative. Owing to several shortcomings associated with the air polishing device using sodium
Faridabad, bicarbonate (NaHCO3), trends are shifting towards the usage of low abrasive powders. Recent demonstration of
Haryana - 121 001, Glycine Powder Air Polishing (GPAP) in removing subgingival biofilm results in less gingival erosion than hand
1 instrumentation or NaHCO3 air-polishing. Despite the emergence of latest advances in polishing, data suggesting
Senior Lecturer,
selective polishing of teeth is compelling.
Department of
Key words:
Conservative Dentistry
and Endodontics, Air polisher device, polishing, porte polisher
2
Assistant Professor,
Department of
Periodontics, Career
Post Graduate Institute I n present day dental practice, polishing agents
are used in stain removal as a “selective
procedure”. Not every patient needs it, especially
of Dental Sciences and
Hospital, Lucknow, on regular basis, as continuous polishing over
UP – 226 020, India time causes morphological changes in teeth by
abrading tooth structure, in addition to ßuoride
in outer enamel layer. During the initial or
supportive periodontal therapy, polishing devices
such as rotating rubber cups with polishing paste
or air powder polishing devices are frequently
used for professional supragingival plaque
removal.[1] Port polisher consisting of orangewood
points is helpful in situations when aerosol should
not be produced, in abraded cervical areas,
or when electricity is not available. However
slowness of the procedure and amount of hand
strength for instrumentation are its drawback.
Although highly abrasive in nature, polishing or
Þnishing strips present an option for interproximal
areas or line angles but should be cautiously
Address for used to avoid cutting of soft tissues.[2] For over
correspondence: half a century, the most common method of
Dr. Vivek K Bains, tooth polishing is using rubber cup and pumice,
Department of and the widely used polishing paste consists of
Periodontics, ßour of pumice, glycerine, colour additive and
Career Post Graduate in addition, sodium ßuoride (NaF) or stannous
Institute of Dental
ßuoride (SnF2) might be added to this mix for
Sciences and Hospital,
Sitapur-Hardoi Bypass desensitising effect. Other agents for polishing
Road, Near IIM, such as zinc oxide or kaolinite pastes, emery
Lucknow, UP - 226020, and tinoxy ore have also been suggested but Þne
India. pumice powder and glycerine paste or prophy
E-mail: doc_vivek76@ paste enjoys maximum popularity, and recent
yahoo.co.in use of perlite as a prophylaxis paste, make it a
promising agent that might possess the abrasive
Submission: 10-02-09
Accepted: 11-04-09 properties of an ideal prophylaxis paste,[3] but
aggressive use of rubber cup may remove a layer
DOI: 10.4103/0972- of cementum, which is thin in the cervical area.
124X.51899 It is recommended to clean and heat sterilise
all prophy angle and slow speed hand piece
components used intra-orally between patients
and in addition, disposable prophy angle serve
as an alternative solution that eliminates the
possibility of cross contamination inherent with
sterilisation, from organic debris that survives it,
though at some additional cost. While polishing
with rubber cup, hand-piece used should
be having sufficient torque to ensure steady
speed (2500 rpm to 3000 rpm) that can easily be
maintained. Empty cup will generate heat instead
of polishing and one full rubber cup is sufÞcient
for one or two teeth.[2] Least abrasive polishing
paste should be used to remove stain with
intermittent pressure that allows dissipation of
heat, moreover inclusion of moisture throughout
polishing reduces temperature rise during the
process. Rotation speed, abrasiveness of paste,
pressure applied with hand piece and duration
inßuence the efÞcacy of polishing with rubber
cup and prophylaxis paste.[1]
Nowadays, air powder polishing devices have
overcome conventional rubber cup polishing
paste systems for supragingival plaque removal
as it reaches surfaces that are inaccessible to
a rotary device.[1] The air powered abrasive
machines used for prophylaxis in the past
(Air Dent Machine) sprayed 30 µm alumina or
dolomite particles at a pressure of 80 psi and at a
velocity of 1900 ft./sec. Redesigned Air Polishing
Device (APD), the Prophy-jet, works by directing
pressurized slurry of sodium bicarbonate
in warm water on to the tooth surface, at a
suggested distance of 4-5 mm and angulation of
around 60o.[4] Stream of abrasive particles being
conveyed to the tooth surface by a non-abrasive
vehicle and in case of the Prophy-jet the abrasive

58 Journal of Indian Society of Periodontology - Vol 13, Issue 1, Jan-Apr 2009

 Madan, et al.: Clinical relevance of tooth polishing
is NaHCO3 with Tri-Calcium Phosphate (added upto 0.8% of
weight to improve ßow characteristics) and the non-abrasive
vehicle is a combination of water and air. Powder-water setting,
the distance of the jet from the treated surface and the shape
and size of the particles used control the effectiveness of the
device.[1] It is a time saving, safe and effective for stain removal
(also for smoking and chlorhexidine stain), thus minimize
the operator and patient fatigue. However, cautious use of
air polishers in patients with restricted sodium diets, with
respiratory renal or metabolic disease, infectious diseases,
children, on diuretics or long term steroid therapy, and with
titanium implants has been advocated. Dentinal sensitivity
is diminished following the use of Prophy-jet that may be
explained by the fact that bicarbonate crystals may block the
tubular openings and it has a unique ability to remove plaque
from areas that are otherwise difÞcult to reach like furcations,
ßutings and close root proximities. APD is effective mean for
removal of plaque from orthodontically banded and bracketed
teeth as it does not disturb the wires or rubber bands and also
is not detrimental to zinc phosphate or resin cements, used
to attach brackets and bands, when the spray is directed at
90o.[5] Substantial reduction of gingival bleeding and marginal
redness in orthodontic patients has been observed with
air polishing method, but this system has the potential for
removing considerable amount of resinous restorative material
when used at recommended 60û although porcelain amalgam
and gold alloy restorations are not signiÞcantly affected. It
is useful in root detoxiÞcation during periodontal surgery
however, APD with NaHCO3 may not be safely utilised on
exposed root surfaces. A 30- second exposure of a Þxed point
on a root surface to a Prophy-jet action produced crater like
defects upto 636 µm in depth, which can be minimised using
novel low abrasive air polishing powder.[6] The possibility of
systemic absorption of NaHCO3 that raises blood levels of Na+
and CO3- probably through mucosal absorption, ingestion,
inhalation, or combinations and development of marginal
alkalosis as measured in venous blood exists and hence it is
judicious not to use this device in individuals with Na restricted
diet. Owing to the limitation of Prophy-Jet in sodium restricted
diet individuals, non-sodium Prophy Powder, containing
Journal of Indian Society of Periodontology - Vol 13, Issue 1, Jan-Apr 2009
View publication stats
aluminium trihydroxide (Cavitron, Jet- fresh) instead of sodium
bicarbonate has been introduced. The aerosols generated by
air polishing may present an infection control hazard hence,
preprocedural rinse is always recommended along with aerosol
reduction devices (ARD). Subcutaneous emphysema which
can occur whenever compressed air is employed intra-orally
highlights the iatrogenic potential and reinforces the need to
follow manufacturer’s instructions appropriately.[7]
Recent introduction of Glycine Powder Air Polishing (GPAP)
in removing sub-gingival bioÞlm abridge periodic sub-gingival
instrumentation and serve as an alternative to conventional
techniques that results in less gingival erosion alongwith
80% reduction in abrasiveness on root surface than hand
instrumentation or NAHCO3 air-polishing.[8]
REFERENCES
1. Petersilka GJ, Ehmke B, Flemmig TF. Antimicrobial effects of
mechanical debridement. Periodontol 2000 2002;28:56-71.
2. Rethman J. Polishing angles, cups and pastes. Pract Hyg 1997;1:
32-3.
3. Lutz F, Sener B, Imfeld T, Barbakow F, Schupbach P. Self
adjusting abrasiveness: A new technology for prophylaxis pastes.
Quintessence Int 1993;24:53-63.
4. Galloway SE, Pashley DH. Rate of removal of root structure by
the use of the Prophy-Jet device. J Periodontol 1987;58:464-9.
5. Barnes CM, Russel CM, Gerbol R, Wells BR, Barnes DW. Effects
of an air powder polishing system on orthodontically bracketed
and banded teeth. Am J Ortho Dentofac Orthop 1990;97:74-81.
6. Atkinson DR, Cobb CM, Killoy WJ. The effect of an air- powder
abrasive on in vitro tooth surfaces. J Periodontol 1984;55:8-13.
7. Liebenberg WH, Crawford BJ. Subcutaneous emphysema
secondary to the use of an air abrasive device. Quintessence Int
1997;28:31-8.
8. Petersilka G, Faggion CM Jr, Stratmann U, Gerss J, Ehmke B,
Haeberlein I, et al. Effect of glycine powder air-polishing on
gingiva. J Clin Periodontol 2008;35:324-32.
Source of Support: Nil, Conflict of Interest: None declared.
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