Dental Asia Sep/Oct 2018

User Report DENTAL ASIA SEPTEMBER / OCTOBER 2018 38 Background The mechanical removal of bacterial bio̬lm is of utmost importance in the prevention and control of caries and periodontal diseases and air polishing devices have shown to be efficacious in removing supra- and sub-gingival biofilm. The EMS AIRFLOW ® Master Piezon in my clinic, which will soon be replaced by the newly launched A I R F LOW ® P r o p h y l a x i s Ma s t e r (Fig. 1), has been my daily workhorse in providing quality prophylaxis care for my patients with high degree of c omf o r t , i n a c c o rdan c e t o t h e Gu i d e d B i o f i l m T h e r a p y ( GBT ) philosophy. Details on GBT have been covered in my earlier article (Dental Asia November/December 2017) and can be found on Dental Asia’s o ̮ cial website. Application in tooth whitening Tooth whitening has been a much sought- after, patient-driven procedure in our relentless pursuit to achieve the perfect smile. Treatment can be broadly classi̬ed into the four categories: 1. Professionally applied (In-office ) by dentist 2. Dentist dispensed for home use 3. Over the counter whitening products like toothpaste or mouthwash 4. Non-dental options According to the guidelines by the Health Science Authority of Singapore, following the ASEAN Cosmetic Directive, products containing up to 0.1% hydrogen peroxide can be supplied directly to consumers, whilst whitening products containing more than 0.1% and up to 6% of hydrogen peroxide are only allowed to be used by or supplied through registered dentists for home use by patients and not be sold directly to consumers. Any whitening products containing more than 6% and up to 35% of hydrogen peroxide are only legally accessed by registered dentists to be applied professionally in the dental clinics. Hydrogen peroxide is potentially corrosive and some of the known side e ̫ ects include short-term tooth sensitivity and gingival irritation. According to recommendations by the Singapore Dental Association, dentists should ensure caries control and carry out a round of prophylaxis to remove plaque and stains before starting any form of whitening procedures. Smoking together with the consumption of staining beverages and foods have been documented to be associated with tooth discolouration, and such extrinsic staining can a ̫ ect the longevity of tooth whitening. While most studies on whitening agents will usually exclude smokers to eliminate the confounding factors of tobacco staining, a recent study by de Geus et al was conducted to evaluate the colour longevity using home bleaching with 10% carbamide peroxide (which will decompose to release 3.5% hydrogen peroxide in an aqueous medium) in smokers and non-smokers after one year. The results showed that the bleaching e ̫ ect in both groups remain stable after one year, provided that the extrinsic stains from diet and smoking were professionally removed through professional prophylaxis. A simple demonstration was conducted using the air polishing function of the AIRFLOW ® Prophylaxis Master to remove the extrinsic stains on a quail egg. The polishing powder used was the AIRFLOW ® PLUS powder which contains erythritol with a mean particle size of 14 micron. The result demonstrated a complete removal of the stains (Fig. 2). Following on from his article in the Nov/Dec 2017 issue of Dental Asia, Dr. Wong Li Beng shares his experience of using the EMS AIRFLOW ® Master Piezon. By Dr. Wong Li Beng Fig. 1: AIRFLOW ® Prophylaxis Master B e s i d e s i t s u s e f o r b i o f i l m removal, this article will highlight AIRFLOW ® Prophylaxis Master possible application in enhancing and prolonging the whitening effect from our routine whitening procedures in our daily dental practices. Fig. 2: Stain removal using AIRFLOW ® PLUS powder (left side of the quail egg) The demonstration was extrapolated t o c omp a r e t h e s t a i n r emo v a l effect between air polishing using AIRFLOW ® PLUS powder and ultrasonic scaler. Air polishing was found to remove the stain more e ̫ ectively than using an ultrasonic scaler (Fig. 3). I n t h e c l i n i c a l s e t t i ng , a l mo s t all of my periodontal patients have mechanical debridement and biofilm r emo v a l c a r r i e d ou t u s i ng t h e EMS AIRFLOW ® Master Piezon. Although the whitening e ̫ ect of air polishing was not my primary objective during the non-surgical initial periodontal therapy, self-assessment by the patients often include a subjective improvement in the tooth colour shade together with the