Dental Tribune Middle East & Africa Edition

9Dental Tribune Middle East & Africa Edition | July - August 2013 MEDIA CME parts, a disposable cup that attaches to the air-powder polisher nozzle and a clear tube extension that is attached to the saliva ejector or high volume evacuator (HVE). ‘The patient assessment process should include a thorough health history eval- uation to identify and possibly rule out patients who have hypertension and/ or are on a physician-directed, sodium- restricted diet.’ Clinical technique There is a universal air-powder pol- ishing technique that can be used with all types of systems, however manufacturers may have different instructions for use of their equip- ment.4 The recommended technique prevents undue aerosols from de- flecting back to the clinician or being directed into the patient soft tissues. The use of high-speed evacuation or the aerosol-reduction device is the most efficient way to 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 up- right at 45 degrees with the patient’s head toward the operator to access ar- eas — 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’s lip near the work area will help reduce burning and sting- ing experienced by some patients. The rheostat has two compressions levels: Full compression releases the aerosol powder-abrasive from the tip, and halfway compression produces a stream of water for rinsing and clean- ing. Before the polisher is activated in the patient’s mouth, it is recom- mended 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-towater ratio.20 The clinician should establish and maintain a systemic pattern when using the air-powder polisher. The nozzle tip should maintain an appro- priate distant from the tooth surface (approximately 3 to 4 mm). Hold- ing the nozzle farther away from the tooth surface is not recommended because that reduces the abrasive action and increases aerosol produc- tion. 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 motion, sweeping or paint- brush motion from interproximal to interproximal. In addition, a sys- temic approach 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) that automatically cycles between rinse and polish, thus eliminating the need for the clinician to pump the pedal. Tapping the foot pedal once activates the Tap-On automatic air polishing/ rinse cycle, which lasts for approxi- mately one minute. Tapping the pedal a second time disables the automatic air polishing/rinse cycle. The autocycles work in short, me- dium or long settings (Fig. 7) within timed cycles of one minute. Each cy- cle begins with a two- to three-second stream of water. The “short” auto- cycle is 0.75 seconds of airpowder polishing followed by a 1.25-second rinse; the “medium” autocycle is two seconds of air-powder polishing fol- lowed by a one-second rinse; and the “long” autocycle is three seconds of air-powder polishing followed by a two-second rinse. The “manual” cycle setting enables the clinician to use the Tap On foot technology control to alternate man- ually between air-powder polishing and rinse. When air-polishing the anterior teeth, the tip should be directed at a 60-degree angle to the tooth; for pos- terior teeth the angle should be 80 degrees; and for occlusal surfaces, a 90-degree angle is recommended. Us- ing the aerosol-reduction device, the clinician will apply the disposable cup (attached to the nozzle) to the middle third of the tooth with light pressure to flare the cup. The clinician will then pivot the nozzle inside the cup to adapt to all areas of the tooth surface and polish for two seconds of spray for each segment of tooth. Completion of air-polishing proce- dure At completion of the air-polishing procedure, the clinician should rinse the teeth thoroughly, floss all inter- proximal surfaces and inspect the teeth for any remaining stain. Thor- ough rinsing is essential after air- powder polishing because of the basic nature of the sodium bicarbonate.20 If stain is still present, reinstrumen- tation and/or use of the air-powder polisher may be indicated. Any debris should be wiped off the patient’s face with a moist towel. And a re-applica- tion of lip balm should be offered. The aerosol-reduction device shoul be disposed of and the nozzle should be cleaned with a wirecleaning tool to prevent clogging. Nozzle tips must be autoclaved after each use, and the en- tire unit should be disinfected with an EPA-approved disinfectant. Using a disposable barrier will help minimize disinfecting time. At the end the workday, the unit should be turned off, powder re- moved from chamber and unused powder discarded to prevent clogging of lines. Also, keep the powder cham- ber and air lines free of moisture, which can cause the system to fail.22 The clinician then needs to remove any residual powder from the cham- ber with a HVE and activate the unit for approximately 15 seconds to clear any powder remaining in the cham- ber. Conclusion Therapeutic polishing is the removal of toxins from the unexposed root surfaces, which results in a decrease in disease parameters. Polishing root surfaces is possible with both the rubber-cup or airpowder polisher; however, the rationale for selecting the air-powder polisher is for its ef- fectiveness and efficacy.20 The clinician should follow the pre- cautions and considerations present- ed when polishing for therapeutic benefits with the air-powder polisher. The clinician should be aware to di- rect the air-powder spray against the tooth surface, not the exposed soft tissues. Most importantly the clini- cian must consider all options — es- thetic, therapeutic and patient goals — when designing a treatment plan that meets the individual patient’s specific needs. References are available from the author. mCME SELF INSTRUCTION PROGRAM CAPP with Dental Tribune with its mCME- Self Instruction Program gives you the opportunity to have a quick and easy way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. 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Completion of mCME • mCME participants are required to read a continuing medical education (CME) article in each issue. • Each article offers 2 CME Credit and followed by quiz questioner, which is available in http://www.cappmea.com/mCME/questionnaires.html. • Each quiz has to be return to events@cappmea.com or fax to: +971436868883 in three months form the publication date • A minimum passing score of 80% must be achieved in order to claim credit • Not more then two answered questions can be submitted in the same time • Validity of the article – three months • Validity of the subscription – one year • Collection of Credit hours: you will receive the summary report with Certificate maximum one mouth after expire date of your membership. For single subscription Certificate and summery report will be send one month after the publication of the article. The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available in www.cappmea.com after the publication.For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE WRITERS FIND THE CONTACT DETAIL AT THE END OF EACH ARTICLE. Salim Rayman, RDH, MPA, is an associate professor in the den- tal hygiene program at Eugenio Maria de Hostos Community College of the City University of New York. He can be contacted by email at srayman@hostos.cuny.edu. Contact Information Elvir Dincer, DDS, is an associate professor in the dental hygiene program Eugenio Ma- ria de Hostos Com- munity College of the City University of New York. He can be contacted by email at edincer@hostos. cuny.edu. Contact Information Fig. 5 Aerosol-reduction device. (Photo/Provided by DENTSPLY/ Raintree Essix) Fig. 6 DENTSPLY Cavitron Jet Plus with Tap-On technology. Fig. 7 Setting options for Prophy Mode Auto Cycles: Manual, Short, Medium and Long.

Dental Tribune Middle East & Africa Edition

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