Dental air polisher has been compared to scaling and rubber-cup polishing for efficiency and effectiveness of stain and plaque removal. The literature overwhelmingly supports the use of the air polisher as an efficient and effective means of removing extrinsic stain and plaque from tooth surfaces. Air polishing requires less time than traditional polishing methods and removes stain three times as fast as scaling with comers. In addition, less fatigue to the operator has been mentioned as an important benefit of air polishing.
Most investigators agree that intact enamel surfaces are not damaged when stain removal is accomplished with an air polisher. Even after exposure to enamel for the equivalent of a 15-year recall program, surfaces were not altered.
Still, researchers and manufacturers caution against prolonged use of the air polisher on cementum and dentin. When moderate to heavy stain is present on root surfaces, dental hygienists are often faced with the problem of removing it with the least alteration of cementum. One choice is to leave the stain and explain to the patient that stain is not associated with oral disease and will not harm the teeth or gingiva since it is only a cosmetic concern. To many patients, this is not a viable choice since appearance is considered so important in today’s society.
Other choices include removing the stain with a rubber cup polisher and prophylaxis paste; sonic, ultrasonic scalers; Dental Hand Instruments or the air polisher. Wilkins recommends removing as much stain as possible during root planing with curets. However, in one in-vitro study, air polishing was shown to remove less root structure than a curet in simulated three-month recalls for three years. Woodall agrees that the air polisher may be preferable to curets in this situation. Since less root structure is removed, decreased root-surface sensitivity also may be a benefit.
Clinical studies to evaluate soft tissue usually provide generalizable conclusions. Gingival bleeding and abrasion are the most common effects of air polishing. These effects are temporary; healing occurs quickly and effects are not clinically significant. No complications were seen with healing at extraction sites following air polishing of teeth prior to extraction. To avoid tissue trauma, the manufacturer recommends pointing the tip of the air polisher at the facial, lingual, or occlusal surfaces, thus avoiding the gingival margins.
Effects of air polishing on gold foil, gold castings, porcelain, amalgam, and glass ionomers have been studied. Air polishing of amalgam alloys and other metal restorations has produced a variety of effects, including matte finishes, surface roughness, morphological changes, and structural alterations. One study found no detrimental changes to the marginal integrity of amalgams. Surface roughness, staining, pitting, and loss of marginal integrity were seen on porcelain surfaces. One study reported only minimal changes in porcelain and gold alloys. Hand instrumentation at the gingival margins and caution were recommended when working around these restorations. The surface roughness of glass ionomers increased following either air polishing or rubber-cup polishing. Until research findings on air polishing’s effect on these restorative materials are unequivocal, clinicians should follow manufacturer recommendations to “avoid prolonged or excessive use on restorative dental materials.