First introduced in the 1940s, dental air polisher has changed noticeably since its inception, thanks mainly to advances in materials science. Compared to polishing with a prophy cup and paste, air polishing eliminates the need for direct tooth contact or pressure against the tooth, along with any discomfort from potential heat generated with prophy cups. This technique also offers more efficient biofilm removal, easier access into pits and fissures, and a less abrasive nature than pumice or prophy pastes.
Many hygienists and dentists will be most familiar with sodium bicarbonate powder, one of the first materials introduced for use with early air polishing systems. In my experience, sodium bicarbonate has been an excellent tool for heavy stain removal, but patients react poorly to the salty taste and abrasive feel. Sodium bicarbonate powders generally have a particle size up to 250 μm, and while damage to enamel has not been reported, researchers and manufacturers warn against prolonged use on cementum, dentin, and certain restorative materials such as composites.
Recent developments have brought new options to the market, including glycine, erythritol, calcium sodium phosphosilicate, calcium carbonate, and aluminum trihydroxide (to name a few). It's not necessary to review each in detail, but it's important that hygienists are generally educated on the many options now available for use.
In addition to being less restrictive when it comes to pre-existing patient conditions, two powders can now be used safely in subgingival air polishing: erythritol and glycine. Air polishing has traditionally been thought of as a technique for supragingival plaque and stain removal only; but these new options open the door for effective removal of subgingival plaque and biofilm, even in deep periodontal pockets.
Erythritol, while not currently available in the United States, is a sugar alcohol that has been shown to offer less discomfort, decreased treatment times, and reduced bleeding on probing when compared to scaling and root planing. Glycine is a naturally occurring amino acid that is water soluble, with a non-salty taste that patients often describe as a little bit sweet. This powder offers similar benefits to erythritol, and offers an option that's less abrasive with a particle size approximately four times smaller than sodium bicarbonate.This smaller particle size means that it's safe for all the same supragingival applications as sodium bicarbonate powders, but also offers the option to treat patients with periodontal infections, peri-implantitis, patients on a sodium-restricted diet, and those who have cosmetic or other restorative work.