hygiene the international C.E. magazine of dental hygiene

10 I IC.E. article_ air polishing hygiene 1_2013 according to the recommendations of the Centers for Disease Control and Prevention. When the unit’s chamberisbeingfilledwithabrasivepowder,theunit must be turned off. It needs to be filled with powder tothetopofthecentertube.Thecliniciancanplacea finger over the tube in the middle of the chamber to prevent powder from blocking the air line. Next, the clinician needs to use the control on top of the pow- der chamber cap to adjust the powder flow accord- ing to the patient’s needs. For treating patients with heavystains,itisrecommendedthatthecontrolknob shouldbeturnedto“H”forheavypowderflow,which isapproximatelythe12o’clockposition.Forpatients with light staining, the control knob will be set to “L” forreducedpowderflow,whichisapproximatelythe 6 o’clock position (Fig. 4). An aerosol-reduction device that connects to the saliva-ejector or high-speed-evacuation sys- tem used with the air-polisher handpiece has been showntobeeffectiveincontrollingandreducingair- powder aerosols, thus decreasing the potential for disease transmission. The aerosol-reduction device reduces or eliminates the visible aerosols normally produced during air-powder polishing. Additionally, the aerosol-reduction device (Fig. 5) eliminates the need for exact angulations with cup/nozzle, use of gauze, hand cupping and patient positioning. Another advantage to the aerosol-reduction de- vice is that it minimizes the possibility of tooth abrasion because the cup is placed on the tooth — as in traditional polishing techniques. When using the aerosol-reduction device, the clinician must follow the manufacturer’s instructions for assembling and disassembling. The aerosol-reduction device con- tainstwoparts,adisposablecupthatattachestothe air-powderpolishernozzleandacleartubeextension that is attached to the saliva ejector or high volume evacuator (HVE). _Clinical technique There is a universal air-powder polishing tech- nique that can be used with all types of systems, however manufacturers may have different instruc- tions for use of their equipment.4 The recommended technique prevents undue aerosols from deflecting backtotheclinicianorbeingdirectedintothepatient soft tissues. The use of high-speed evacuation or the aerosol-reductiondeviceisthemostefficientwayto control the aerosol spray. While positioning of the patient and operator are basically unchanged, direct vision and access become elementally important when the polisher is active.20 Positioning the patient slightly upright at 45 degrees with the patient’s head toward the opera- tor to access areas — and reclining to treat maxillary lingual surfaces — provides a better field of vision and increase patient comfort. Placing moistened 2-by-2-inch gauze square over the tongue or on patient’slipneartheworkareawillhelpreduceburn- ing and stinging experienced by some patients. The rheostat has two compressions levels: Full compres- sion releases the aerosol powder-abrasive from the tip, and halfway compression produces a stream of water for rinsing and cleaning. Before the polisher is activated in the patient’s mouth, it is recommended that the clinician check the amount of water and powder coming from the unit, test the sensitivity of the alternating cycles and confirm the powder-to- water ratio.20 The clinician should establish and maintain a systemic pattern when using the air-powder pol- isher. The nozzle tip should maintain an appropriate distant from the tooth surface (approximately 3 to 4 mm).Holdingthenozzlefartherawayfromthetooth surface is not recommended because that reduces theabrasiveactionandincreasesaerosolproduction. Cupping the lip with the index finger and thumb to pool water in vestibule minimizes aerosol and eases evacuation. The nozzle tip also should be angled diagonally so that the spray is directed toward the middle third of the tooth. The clinician should use a constant circular mo- tion,sweepingorpaintbrushmotionfrominterproxi- maltointerproximal.Inaddition,asystemicapproach of polishing one or two teeth at a time will ensure that all tooth surfaces are adequately polished. And alternate cycles of full-compression powder-spray and half-compression rinse every two or three teeth will increase efficiency and patient comfort.20 The clinician must polish each tooth approximately one to two seconds; and to avoid loss of tooth structure, not subject any tooth to more than 10 seconds of air-polish slurry. Root surfaces should be exposed to slurry for even less time or entirely avoided because they abrade more rapidly than enamel. The DENTSPLY Cavitron Jet Plus™ has Tap-On™ technology(Fig.6)thatautomaticallycyclesbetween ‘The patient assessment process should include a thorough health history evaluation to identify and possibly rule out patients who have hypertension and/or are on a physician-directed, sodium-restricted diet.’