By Tabitha Acret
I started my career with no AIRFLOW Dental Spa device and introduced the technology into a practice where I had been treating the patients for 5 years with traditional prophylaxis techniques. I then moved to a new practice that had never had a dental hygienist or an AIRFLOW. Patients had been having their teeth cleaned by the dentists for 10 years plus, again with traditional prophylaxis techniques. Both cases required change from myself and for the patient. The way you implement these changes will determine the success of your new techniques, routines and equipment.
Step 1: Clean your staff’s teeth
When I got an AIRFLOW® Dental Spa device at my existing practice, the first thing I did was block a morning off and cleaned all the staff’s teeth in the practice. It’s important that all staff understand the process that takes place in a hygiene appointment and to experience a GUIDED BIOFILM THERAPY treatment for themselves. It then helps the front desk to prepare patients prior to the appointment for those who ask and helps them speak authentically about the AIRFLOW® Dental Spa experience.
I often hear the front desk staff enthusiastically converting a dentist clean patient to myself by telling them how gentle and pleasant the AIRFLOW® Dental Spa is. Savvy patients can tell when someone is trying to sell to them or simply telling the truth and for the front desk to be able to speak from experience to the patients is worth more than you will ever make from a morning of lost production.
Step 2: Explain the procedure to patients
Many new users worry about how they will go from a traditional prophylaxis paste polish at the end to the use of AIRFLOW® for biofilm removal at the beginning and it’s all about how you communicate this vital first step to the patients.
I explain the new process to all new patients and also to the existing ones from before I got AIRFLOW®. I start by telling the patient “you probably haven’t had a clean like you’re going to have with me today before” and I explain that we have invested in the latest Swiss technology and European standards for preventative care, called GUIDED BIOFILM THERAPY.
By removing all the biofilm at the beginning with the AIRFLOW® instead of at the end, it enables me to use the ultrasonic less. I go on to explain that where I would use the ultrasonic usually over the whole mouth, now I only use it in spot areas where needed, allowing for a more gentle clean, better preservation of tooth structure long term and a quicker more comfortable experience. The water in the AIRFLOW® Prophylaxis Master heats the AIRFLOW® and PIEZON® up to 40 degrees so it’s like a warm spa bath in the patients’ mouths.
By using a plaque disclosing agent first before the AIRFLOW®, you are able to achieve 100% biofilm removal. This is close to impossible to achieve with traditional ultrasonic and prophylaxis paste cleaning. Along with the improved stain removal, patients have smooth, shiny and noticeably cleaner and whiter teeth after AIRFLOW® and they soon forget about the paste they were worried about missing out on. Again, it’s about setting patients expectations, explaining that the AIRFLOW® is the “polish” and that it will be done in the beginning and not at the end so the patient knows what to expect and doesn’t think you missed a step in the process.
Step 3: Disclose EVERY patient
The biggest worry most clinicians approach me about when starting Guided Biofilm Therapy is the use of a plaque disclosing solution for every patient. Some of the common questions I am often asked are: “do you really do it for everyone?” “...but what about for adults?” “Isn’t it messy?” “What if they have to go back to work afterwards and it stains?”
My boss was actually one of those concerned voices when I started at the practice when he realised I was going to plaque disclose every single patient. However, he was quickly converted.
So to answer your questions, YES, I plaque disclose every single one of my patients from aged 2 to 99 (I haven’t had a patient over 99 yet!). It’s all again about communication and educating your patients. I always explain first that I am going to start the clean by painting their teeth and supporting gums with a plaque disclosing solution.
I explain that plaque is almost invisible to the naked eye and by painting it, it helps reveal where the plaque is. By doing this I can see where plaque hides in the difficult to reach areas so we can work together to find ways to remove it. I have just started to use the EMS pre-soaked plaque disclosing pellets. They are quick to use, less messy than the liquid and use less waste as no application brushes are needed - you can simply use your tweezers in the tray.
I also explain to the patient how this enables me to do a quick risk assessment of their mouth. I explain the colours as “Pink” is new plaque, meaning you missed it whilst brushing today and the purple/dark blue is mature plaque, meaning you have missed it for a couple of days. Lastly, I explain that the plaque disclosing is also for me as it helps guide my cleaning - once all the colour is removed, then I know the plaque is removed and we have been able to achieve 100% biofilm removal. It’s also really important to tell your patient before they rinse that when they spit, they are going to spit blue so they are not surprised by the colour.
I have found all of my patients, no matter the age, have really embraced plaque disclosing and often say at the beginning of the appointment that they are looking forward to seeing if there is less colour on their teeth than their previous visit.
Another concern with the plaque disclosing is “what if the patient has to go back to work, won’t they still have colour in their mouth?” The answer is NO. Firstly, always apply lip balm before disclosing to stop any staining of the lips. Any disclosing left on the gingiva or tongue can be cleaned with the AIRFLOW®. AIRFLOW® is gentle enough to use on the mucosa and tongue to remove the plaque discloser so that your patients are not leaving the appointment with any colour in their mouth and surroundings.
Step 4: Set up expectations
Again it’s important to set up expectations.
I explain how AIRFLOW works, that it’s a combination of air, powder and warm water. I explain to the patient that there will be a lot of water in their mouth, that it will be suctioned up but if they need a break at any time, we can stop and have a rinse. It’s important for the patient to know there will be more water than they are usually used to and that its normal.
It’s also important for the patient to feel in control. I have found that my patients rarely need a break and I can AIRFLOW the whole mouth without stopping.
Step 5: Change your mindset
When I am lecturing about AIRFLOW, clinicians usually ask “Isn’t it messy?” “What about patients faces, make-up, clothes?”
The technology of air polishing devices has come a long way from their first commercial introduction into the market in the 1970s. Powders have been refined and particle sizes have been reduced. The direction and stream of the water, air and powder has also been improved so that the flow is more controllable with less aerosols and better projection.
Another reason why it’s become less messy is the powder technology. EMS PLUS Powder based on Erythritol is gentle on soft tissues and therefore, where we used to have to point the powder towards the occlusal/incisals and up and out of the mouth, we can now direct the powder towards the gingiva.
The combination of the high volume suction and cheeks contains the AIRFLOW. I don’t find my patients have to clean their faces or glasses after the appointment, which is a big change from when I first started using an air polishing device when I first graduated.
Step 6: You can do it
"But I don’t have an assistant”. Neither did I and you don’t need one. As mentioned before, technology has changed and the spray is much easier to control.
I also use an Optragate when I work by myself; it holds everything open, retracts the lips for you, helps the patient keep their mouth open and also helps balance the low volume suction.
I always apply lip balm before I plaque disclose so it’s already on when I’m ready to place the Optragate. If the patient feels it’s uncomfortable on the upper lips, it’s usually because they have a lower placed labial frenum and by placing a cotton role under the upper lip, it releases the pressure of the Optragate and makes it more comfortable for the patient.
Step 7: Always double suction
Research shows that with any device that creates an aerosol, both the high and low volume suction are needed.
By using the Optragate, it’s easier to balance the low speed suction and stop it from ulcerating the gingiva behind the lower 7’s. The high volume suction then follows the handpiece around the mouth, capturing the majority of the spray. “But what about the palatal of the uppers?” If you are by yourself, then clean the palatal of the uppers without looking. You know your anatomy and the AIRFLOW is gentle enough to clean the gingiva and won’t hurt the palate if you’re slightly off. Then check with a mirror when you’re finished to see if you need to go over the area again or not.
Don’t hurt your back or neck trying to get direct vision when it’s possible to do it without. And watch out for the giggle; most patients laugh during the palatal clean as they find the AIRFLOW tickles in that area.
Step 8: Educate yourself
Many clinicians feel the barrier for buying an AIRFLOW device is the possibility of subcutaneous emphysema. Subcutaneous emphysema is rare and all reported cases have been from incorrect use of AIRFLOW.
Before you use PERIOFLOW® technology, you need to have periodontal charts, x-rays and know that there is 3mm of bone from the apex of the tooth. Do not use the PERIOFLOW handpiece where infection and bone loss extend past the apex. All cases of reported subcutaneous emphysema have been with sodium bicarbonate powder. Sodium Bicarbonate is a coarse powder and is not meant to be used on the gingiva, let alone subgingivally. Make sure you are always using the PLUS Erythritol Powder when directing the spray towards the gingiva or subgingivally.
By completing one of the many Swiss Dental Academy (SDA) training courses available across the country, you will learn about when and where to use powders and the contraindications. It’s important that you have received education and know how to use your AIRFLOW device.
Step 9: Bust the myths
People assume that by adding the “extra” steps included in the Guided Biofilm Therapy (GBT) protocol that the appointment will take longer; this is a myth.
By practising GBT, you are not doing any extra steps; you are providing the patient with what really is the standard of care. You are replacing the prophylaxis paste with AIRFLOW which is faster; then by spot cleaning with your ultrasonic, you also save more time.
I found that I used to have 1 hour appointments before AIRFLOW. I quickly moved to 45 minute appointments and now book 30-40 minute appointments for regular maintenance patients.
Step 10: Use the right powder
Powders are not interchangeable and you need to know which powder to use in which situation.
Using a powder that is not recommended by the manufacturer will increase the likelihood of blockages, breakages and poor patient outcomes.
Hopefully this has helped answer some of the questions you have about introducing AIRFLOW and GBT into your practice. Remember, change can be hard, especially after many years of working one way. Stick with GBT - I promise it will be worth it for you and your patients.