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The Prophy Jet Challenge

May 28, 2019 By Trish Walraven 4 Comments

Why you should improve proficiency at air polishing

No, we’re not daring you to eat your Prophy Jet. Read on.

What has changed little over the past 50 years and is the most performed yet overvalued service provided in dental practices? If you guessed rubber cup polishing, you’d be correct.

Overvalued? Sure—from a health perspective, polishing is more or less a cosmetic procedure. Then why do most patients still get their teeth polished with prophy cups and paste? It’s certainly not because it’s the most thorough way to remove plaque and stain; if it were, we wouldn’t have the need for adjunct cleaning methods. Often, the bulk of plaque and stain is removed with curettes, ultrasonic scalers and lavage, and the polishing paste is merely the finishing touch—the smoothing out that makes everything feel nice again after a major prophy jam session.

No, the reason that rubber cup polishing is the method used on probably 90% of patients in the United States is because it’s less technique-sensitive and equipment-sensitive. Not because it’s better. It’s also because of tradition. We find that prophy polishing is the standard of care because of what we experienced as patients in our childhood and also how we were taught to polish in school. You do it not because it’s right, but because it’s easier.

Rubber cup polishing is good enough … well, at least until it isn’t. Nowhere is the incompleteness of a prophy cup polish more evident than when trying to perform one on an orthodontic patient in full brackets and wires. Only then do you switch up your routine and reach for an adjunctive polishing system. Why? Because you’re relatively inexperienced using alternatives like air polishing on a regular basis, which translates into a messy melee for you and the patient, so the trade-off needs to seem “worth it.”

The only way to combat inexperience, though, is with experience, which you won’t get unless you start using your prophy jet on a regular basis. This means you’re being challenged to replace your prophy angle with the air polisher—yes, even on patients without a lot of stain or without orthodontia! But first, let’s dispel some of the biggest myths about air polishing that may have already caused you to dismiss the thought of making this change.

Myth #1: Air polishing is too messy.

It can be, but only during the learning phase or if you’re using poorer-quality equipment.

After air-polishing my patients almost exclusively for more than 10 years, I’ve found that the Dentsply Prophy Jet and Cavitron Jet Plus machines are unmatched for not only longevity and quality but also the ability to minimize overspray. Some lesser brands may not mix the water and powder into a slurry properly, so you end up with excessive powder all over the patient’s shoulders afterward. If you learn how to adjust the powder control, better angulation, correct working distances between the jet nozzle and the tooth, suction management and even patient positioning, over time you will realize that air polishing is no more of a cleanup disaster than prophy paste.

Myth #2: Patients hate the taste of baking soda.

What’s worse when you go to the beach on a windy day: tasting salt spray or biting into a sandy hot dog? I’d much rather taste the ocean. Why? Because it’s expected. You expect to taste salt water when you splash in the waves. The same can be true for your patients if you prepare them before you blast: Let them know exactly what to expect before you use the air polisher on their teeth for the first time. Explain why you’re using it instead of pumice, and you may be surprised at how many patients are agreeable about trying something new, especially if it benefits them. Try to use a powder that has flavoring as well, because this reduces patients’ perception that they’re being scrubbed down with household cleaning agents.

Myth #3: Air polishing doesn’t clean as well or feel as clean as prophy paste.

These should probably each be their own myths, but since they’re related we’ll keep them together. While prophy paste spins around in circles and does smooth the teeth nicely, guess what? Polishing paste also has a way of exaggerating the feeling that the mouth is dirty. Maybe your patient experiences this:

  • Prepolish:“My teeth feel normal—a little grimy, but nothing I can’t handle.”
  • Midpolish: “I have a mouth full of soul-crushing tiny rocks and sand that will kill me if I swallow.”
  • Postpolish: “Wow, smooth teeth! What a relief that’s over. Much better than grit!”

It’s interesting how perception can be shaped by going to extremes. This same contrast is what makes people think that black charcoal toothpaste makes their teeth whiter. There’s not much of a “midpolish” grit with air polishing if you’re using sodium bicarbonate, however, because it has low abrasiveness—especially compared with pumice. Also, because it can be directed into pits, fissures and interproximal spaces, air polishing cleans at least 30% more of the tooth surfaces than rubber cup polishing. Be honest: How well do you polish the occlusals of molars with a prophy angle? You may be surprised at how often you’ve been neglecting certain areas of your patients’ teeth after you’ve switched to air polishing for a while.

Myth #4: Air polishing will make sensitive teeth more sensitive.

The opposite is more likely, actually. Every once in a while, I’ve encountered a patient whose roots were too sensitive for the air polisher, but the vast majority of patients with sensitive teeth do better than expected. This is likely because bicarbonate crystals are capable of blocking the openings of the dentinal tubules. Just be cautious not to hover over individual root surfaces for very long and you should be fine.

As an alternative to the Prophy Jet, there are air polishers that utilize glycine powder or erythritol. These newer powders are not only friendly to sensitive root surfaces, but they are also gentle enough to use for subgingival biofilm management.

Myth #5: The aerosol created by air polishing creates excessive contamination.

That’s why preprocedural rinsing is recommended as a universal precaution to reduce airborne bacteria—not just for air polishing, but also for ultrasonic scaling and even for prophy cup polishing. While it is true that jet polishing creates more aerosol than prophy angles, there’s not a significant difference in bacterial overspray caused by jet polishers versus ultrasonic scalers.

Myth # 6: Air polishing is more expensive.

Economics is certainly a consideration when it comes to implementing any technology. The initial setup cost for a quality jet polishing system, including an adequate number of inserts to maintain proper sterilization, can be daunting. However, once the equipment is in place, there’s much less waste compared to disposable prophy angles and single-serve prophy paste cups. The polishing powder is the only recurring expense once the system is in place, and you’ll find that the cost of it can be significantly less than polishing paste. My favorite sodium bicarbonate powder is supplied in simple tear packets by Young Dental and has excellent consistency and flavor, in addition to being affordable.

Probably the best reason to implement air polishing, however, is because in the long run it’s going to be less expensive for the practice in terms of efficiency. A patient with moderate staining takes less time to polish with an air polisher than a patient with light staining and a prophy cup. This means less operator fatigue, especially if you begin mixing up your routine and becoming flexible as to when you polish during a prophy. It doesn’t need to be at the end to be thorough, or even to gain patient acceptance.

The challenge

Even if you often still reach for the rubber cup at the end of an appointment, you will find that having strong air-polishing skills will help you better tailor the care you provide to meet each patient’s needs, instead of feeling like you’re running each mouth through the exact same routine, all day, every day. I didn’t even go into depth about the newer types of air-polishing systems available out there for you to try! But that’s because the first step you need to make is the step away from your prophy angle. Do it for a week, especially if you already have a neglected air polisher somewhere in your office. Dust it off, be patient, and rise to the challenge that you’ve made to yourself to change this one thing for a bit. You will be a better clinician for it.

Trish Walraven RDH, BS is a dental hygienist who lives in the suburbs of Dallas/Fort Worth. She was very reluctant to move all of her patients to jet polishing when her co-hygienist first suggested the change, but is very grateful to her and to all the patients over the years whose encouragement and feedback helped her realize that there was no going back to prophy cup polishes.

Ready to roll? Here’s a video tutorial from Dentsply to get you started:

Filed Under: Featured, Hardware, Instruments, Operative Dentistry Tagged With: air polishing, baking soda, dental cleanings, dental hygiene efficiency, Dentsply, Prophy jet, sodium bicarbonate

Future “drug” for dental phobics

April 12, 2013 By Trish Walraven 2 Comments

It looks like virtual reality may actually be almost Matrix-quality in a few short years, and our patients will be able to immerse themselves fully in another world while they’re getting their dental work done. But because there’s a lot more money to be made in gaming (and there’s a MUCH wider customer base) don’t expect that this technology will have a dental application any time soon. Here’s a decent introduction to the concept featuring Palmer Luckey, the originator of the Oculus Rift headset:

These sorts of glasses have been intriguing to me for years, but all the previous versions mentioned here on DentalBuzz basically make it seem like you’re watching a TV screen from a distance. Oculus Rift is different. Users have described the feeling as being totally disconnected from reality. And isn’t that what recreational drugs do? Isn’t that what dental sedatives do?

Imagine a dental appointment where a fearful patient is allowed to slip into a virtual playground where they don’t even need to move their head much in order to initiate the immersive feeling of being elsewhere while they hold their totally oblivious mouths open. Patients’ ears will hear the sounds of their “other world,” letting them slip away from their bodies for a little while so that you can manage all the dental unpleasantries for them.

Here’s another preview of Oculus Rift:

There are many software developers in dentistry that are in search of the next big thing. The 3-D milling technology is pretty awesome these days, but indirect dental software such as patient education, practice management and the like are also looking for the leg-up. Oculus Rift is looking for developers right now, and my guess is that they haven’t even imagined its application in dentistry.

But that’s because you haven’t yet picked up their development kit to make it happen.

Here ya go, and good luck:

 

oculus

 

DBSmile1

Filed Under: Hardware, Operative Dentistry, Products, Research, Software, Technology Tagged With: dental phobia, fear of dentists, Oculus rift, patient comfort, patient sedation, virtual reality, VR glasses

Suction supermod

April 4, 2011 By Trish Walraven 4 Comments

by Trish Walraven

Rubber dams, meet silicone simplicity! Awkward assistants, take your cheek retraction and spit-sucking attempts elsewhere. You have both been banned from the operatories where isolation mouthpieces rule supreme.

First brought to market in 2005, Isolite™ Systems originated the idea of combining dryfield illumination and isolation in a patented product called the Isolite, which costs about $1700 per operatory to set up. Whoa, steeeeep. The tubing and LED Smart Stick sure isn’t their loss leader, now, is it? Then you still have to buy a $2.50 mouthpiece for each patient because they’re not sterilizable. All of it together is still easier and less expensive than your assistant.

But what if you want to keep your assistant, even though she kicks you under the chair all those times you say something stupid to a patient or start getting all OCD over a procedure? You’ve already ditched your overhead lamp for loupe-mounted headlights, so maybe you don’t even need the Lite part of the Isolite.

About a year ago, Isolite™ Systems indroduced a non-illuminating version called the IsoDry that runs a little less than half the cost of the original product. Both systems come with extra tubing. Tooobing. Makes me want to laze down the Guadalupe River with a six-pack in a styrofoam cooler. Don’t we have enough tubes and hoses to twist around each other already?

This brings us to the essence, the soul, the very magic of what makes the Isolite System the game-changer that it has become. It’s all about the mouthpiece. This transparent, comfortable, easy-to-insert soft piece of silicone not only attaches to high-speed suction to create a dry field, it replaces bite blocks, throat packs, cotton rolls, drying angles, and everything else that you used to cram in your patient’s mouth to create a perfect restorative environment.

But in order to use the mouthpiece, the rule is, you have to buy an Isolite or an Isodry. You can’t just stick it onto your high-speed suction and use it solo.

Or can you?

Mark Frias, RDH, can hook you up to go commando. Literally. He’s invented a hook-up mod for the Isolite mouthpieces that must have been driven by the frustration of trying to keep a squirmy six year old’s teeth dry for sealants with traditional isolation. You can see the differences between his design and the original Isolite on the left. It’s not sleek and sexy, but from a cost perspective this little adapter is a no-brainer. Mark calls it the Kona Adapter. Why? Is he an Ironman Triathlete from Hawaii? Actually, I think he named it after his dog.

Whatever the case, the ingenuity here is striking at a great moment. Mark is having difficulty keeping Kona Adapters in stock if that’s any indication of its demand.

For those who are concerned about taking business away from Isolite, Mark suggests purchasing a single system for one of your operatories and fitting the rest with Kona Adapters. This will give you the privilege of being an official Isolite customer so that you can be assured that you aren’t buying mouthpieces on the down low.

And everyone really wins here. Isolite could give the system away like Gillette gave away razor handles to sell you the blades for the rest of your life, or use the printer model: sell the hardware cheaply to lock you into high-priced ink refills. It’s not like Isolite Systems is exactly losing money on the mouthpieces. With this new adapter, Isolite can now make money from the dental practices that may have not been able to justify a whole-office use of their product.

So slippery-gripped assistants everywhere: Ding! You are now free to move about the office. Your hands have finally been relieved without a significant lightening of your employers’ bank accounts.


Filed Under: Hardware, Operative Dentistry, Products, Research Tagged With: Isodry, Isolite, Kona Adapter, linkedin, Products

Ready for Windows 7?

October 8, 2009 By DentalBuzz Staff Leave a Comment

Are the computers in your practice ready for Windows 7?  You are most likely still running Windows XP because  your practice management and digital radiography software/hardware was not compatible with Vista.

Now is a good time to look at some computer upgrades and prepare yourself for Windows 7. A good way to start this process is to look at refurbished equipment. While many of the top manufactures offer refurbished equipment none do it better than Dell. To help you get started we are including a few links and couple of newly minted coupon codes, but you better hurry the deals and codes won’t last forever.

[Read more…]

Filed Under: Hardware, Money, Practice Management, Technology

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DentalBuzz explores rising trends in dentistry with its own slant. The speed at which new products and ideas enter the dental field can often outpace our ability to understand just exactly the direction in which we are heading. But somehow, by being a little less serious about dentistry and dental care, we might get closer to making sense of it all.

So yeah, a tongue-in-cheek pun would fit really nicely here, but that would be in bad taste. Never mind, it just happened anyways. Stop reading sidebars already and click on some content instead.

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