What the cleaning is done with

Prevention essentially uses three tools. Which is used when depends on the kind of plaque and on the place where it sits. A practice that masters all three is not better equipped than another — it has the right instrument for each job.

Hand instruments

Scalers and curettes are fine hand instruments with a sharpened edge. The scaler works above the gum line; the curette is shaped so that it can be guided into the groove beneath without injuring the soft tissue.

Their advantage is the feedback: anyone working by hand feels the surface and notices whether it has become smooth. No device supplies this information. That is why hand instruments remain the method of choice below the gum line — even where ultrasound has been used first.

Ultrasound

An ultrasound device sets a narrow metal tip vibrating at around 25,000 to 30,000 hertz. Hard deposits break off as a result, without any need for scraping. A fine jet of water cools the tip and rinses away what has been loosened.

Ultrasound is fast and spares the practitioner's wrist — for large amounts of tartar it is the most efficient tool. It has its limits where feel is needed: in deep pockets and on root curvatures it works less precisely than a curette.

Anyone with a pacemaker should mention it. Modern pacemakers are well shielded against electromagnetic fields, and modern devices emit little; the practice decides case by case whether to work by hand instead.

air-polishing jet

With the air-polishing jet, a mixture of air, water and fine powder meets the tooth surface. It is intended for soft plaque and for discolouration — not for tartar. Anyone who aims it at hard deposits is wasting time.

What matters is the powder:

• Sodium bicarbonate is the classic, comparatively coarse powder. It removes discolouration reliably and belongs on the enamel, not on exposed tooth necks.
• Glycine and erythritol powder are considerably finer. They are so gentle that they may also be used below the gum line, on root surfaces and on implants.

For implants this distinction is not incidental: a coarse powder or a metal hand instrument can roughen the titanium surface, and a roughened surface is harder to keep clean than a smooth one. On implants, therefore, fine powder or instruments made of plastic, titanium or ceramic are used.

What “Airflow” means

“Airflow” is not a procedure but one manufacturer's brand name for its air-polishing devices. The term has become established as a generic name, in the way “Hoover” has for vacuum cleaners. When a practice offers “Airflow”, it means an air-polishing cleaning; which device and which powder stands behind it is the more informative question.

And the order?

As a rule: the hard first, then the soft, then the polishing. Some practices reverse the beginning and use fine powder first, because the tartar can then be seen better. Both are professionally defensible. More important than the order is that the groove below the gum line is not left out — that is where it is decided whether the cleaning benefits the gums or merely makes the teeth shine.