1. AIR-POWDER POLISHING Darby pages: 447-451 Fundamentals of Periodontal Instrumentation pages: 610-611

2. A.Requires less time and ergonomically favorable to the clinician and generates no heat B.Sodium bicarbonate is less abrasive than traditional prophylaxis pastes, which makes the air-powder polisher ideal for stain and biofilm removal. C.Removal of heavy, tenacious tobacco stain and chlorhexidine-induced staining D.Stain and biofilm removal from orthodontically banded and bracketed teeth and dental implants E.Prior to bonding procedures F.Root detoxification for periodontally diseased roots USE OF AIR-POWDER POLISHING

3. Chlorhexidine Stain

4. Tobacco stain

7. Air Polishing A method of stain removal that uses a specially designed device with a handpiece that delivers a spray of warm water and sodium bicarbonate under pressure  Requires less time and less operator fatigue

8. Effects on enamel, cementum and dentin Enamel is not damaged – air polishing may be the least damaging and most efficient Prolonged use on cementum and dentin can remove significant tooth structure and should be avoided

9. Effects on soft tissues Gingival bleeding and abrasion are most common effects  Temporary, healing occurs quickly  Not clinically significant Salty taste

10. Restorations Clinicians should avoid extended use of air polishing on all restorative dental materials

11. Implants Research not in- avoid at this time

12. Safety Issues Patient: absorption of the sodium bicarbonate Respiratory difficulties from inhaling aerosols Stinging of lips Eye problems DHCP: PPE’s, high-volume evacuator, aerosol reduction device, pre-procedural rinse

13. Medical Contraindications Low-sodium diet or history of hypertension Respiratory illness Infectious disease Renal insufficiency Addison’s disease Cushing’s disease Metabolic aldalosis Medications such as mineralocorticoid steroids, antidiuretics, or potassium supplements

14. Technique Dangers of Incorrect Nozzle Angulation  Never direct at the soft tissues of the cheeks, lips, gingival margin, or tongue. Could result in severe tissue sloughing  Never angle the powder spray directly into the sulcus or pocket Could result in subcutaneous facial emphysema = a sudden unilateral swelling of the face, head, or neck because of the presence of air in the connective tissue.

15. Technique Distance from tooth: 3-4 mm Adaptation for anterior teeth: 60 degree angle Adaptation for Posterior Teeth: 80 degree angle Adaptation of occlusal surfaces: 90 degree angle to the occlusal surfaces

16. TECHNIQUE For Anterior Teeth For Posterior Teeth For Occlusal Surfaces

21. Aerosol Control Aerosol reduction can be significantly reduced by:  Correct positioning of the nozzle tip  Use of high-velocity evacuation  Correct patient positioning 45 degree recline for most tooth surfaces Supine for lingual surfaces on the maxillary arch  Correct patient head position  Tissue cupping

22. Stain Management Procedures Human Need for a wholesome facial image Identify the cause of the stain When stains are intrinsic bleaching is a viable alternative

23. OTC products Whitening toothpastes may have peroxide or titanium dioxide Commercial bleaching kits

25. Contraindications to Tooth Bleaching Pregnancy Breastfeeding Allergy to any of the ingredients Cervical erosion Large, defective restorations Gingival periodontal or mucosal conditions that could be irritated by use of a bleaching tray or rubberdam Recession Enamel cracks Toothsensitivity Caries

26. Home bleaching with professionally supplied products Custom-fitted tray and bleaching agent  Nightguard vital bleaching  Oxidizing agent – 10 - 22% carbamide peroxide  Yellow – brown responds better than blue – gray  Tetracycline – stained may become worse  Restorations don’t change color  Most common side effects are mild thermal toothe sensitivity and gingival irritation

27. In-Office Bleaching Vital tooth bleaching is bleaching of a tooth with a vital pulp Nonvital tooth bleaching is bleaching of an endodontically treated tooth Rubber dam, etching, heat source ADA approved: Starbrite In-Office Bleaching Gel and Superoxyl (both 35% hydrogen peroxide)

29. DH role 1. Provide education 2. Determine etiology of stains, allergies to products 3. Assess for contraindications 4. Assess for tooth sensitivity 5. Evaluate the translucency of the teeth 6. Assess gingival recession 7. Assist in setting realistic expectations with shade guide, IOC 8. Assess the presence of cracks 9. Remove calculus and extrinsic stains 10. Take impressions and fabricate custom trays 11. Provide in-office bleaching