Air polisher: when air polishing replaces the rubber cup and when it does harm instead

Why powder choice matters more than the machine, on which surfaces air polishing is indicated and on which it is contraindicated, and how to set angle and distance to avoid causing emphysema.

Air polishing works by projecting a jet of air, water and abrasive powder onto the tooth surface, and its advantage over a cup with paste lies in reaching what the cup cannot: fissures, interproximal surfaces, areas around brackets and attachments, and the margins of complex restorations. In professional hygiene practice it advantageously replaces conventional polishing for removing biofilm and extrinsic staining, with less working time and less abrasion provided the powder is the right one. The four-hole connection is the standard that allows the handpiece to be supplied directly from the unit, without a separate console.

The decisive variable is the powder, and this is where the costliest errors are made. Sodium bicarbonate has high particle size and hardness: it effectively removes staining from enamel but is too aggressive for exposed dentine, for root cementum and for the surfaces of aesthetic restorations, which it dulls. Glycine-based powders, and erythritol-based ones still more so, have much finer particles and were developed precisely to work safely subgingivally, on exposed roots, around implants and on composites and ceramics. The practical rule is simple: bicarbonate only supragingivally and only on sound enamel, glycine or erythritol in every other case — including periodontal and peri-implant maintenance appointments, where bicarbonate should be avoided.

Technique removes almost all the residual risk. The jet should be held a few millimetres away and angled to the surface, never perpendicular and never directed into the gingival sulcus at an angle that drives air into the tissues: subcutaneous emphysema, a rare but real complication, almost always arises from a jet aimed in the wrong direction or from use near lacerated tissue. Movement should be continuous and circular, without dwelling on a single point, and high-volume suction should be positioned before starting, not after, because the aerosol produced is copious. The contraindications to respect are known: lacerated or ulcerated mucosa, patients with severe respiratory disease and, for sodium-based powders, low-sodium diets and therapies affecting electrolyte balance.

On maintenance, nozzle blockage is the commonest fault and is almost always due to moisture entering the powder chamber: emptying the chamber at the end of the day and running air through empty before storing the handpiece prevents most downtime.

On Oralzon you will find the air polishers available on the marketplace and, to complete the professional hygiene appointment, also scaler tips and single-use interdental brushes.