By Karen Davis, RDH, BSDH

I am a born-again lowabrasive air polishing dental hygienist incorporating Guided Biofilm Therapy. I make no qualms about advocating this novel method of biofilm removal to all dental professionals. The evidence supports it and my job and the patient experience became a lot easier once I shifted appointment protocols to remove biofilm first, using low-abrasive powder to literally air polish the “enemy” away.

For years, I had “erythritol envy” of dental hygienists outside the United States who were able to use erythritol low-abrasive powder rather than glycine on their patients. Now that erythritol powder is FDA-approved and available to all US dental professionals, I’m preaching its benefits.

So what’s the big deal about erythritol air polishing powder? Some of you reading this column have already experienced EMS PLUS powder in your air polishing devices. For those of you who have not, its implications are pretty amazing! Erythritol is 14 microns in size, so by comparison, erythritol has a smaller particle size and is less abrasive than glycine. Erythritol particles are also 37% harder than glycine, so they are significantly more efficient in stain and biofilm removal than glycine. Nice. Less effort for me as a clinician! This erythritol powder includes “plus” in the name and that’s because the potential of this powder extends beyond biofilm and stain removal. PLUS powder obliterates biofilm safely and effectively but it also has anticariogenic, antibiofilm and antioxidant properties PLUS it has antibacterial potential against specific oral pathogens.

How is erythritol anticariogenic?

Erythritol is very similar to xylitol in the oral cavity with regard to cariogenic bacteria. Cariogenic bacteria like Streptococcus mutans cannot metabolise erythritol or xylitol and do not survive well in its presence. An interesting article titled, “Erythritol is more effective than xylitol or sorbitol in managing oral health endpoints,” published in 2016 in the International Journal of Dentistry reviews numerous studies comparing the anticaries outcomes of erythritol independently and compared to other polyols. Not all study designs were comparable, but the data supports erythritol’s robust anticaries impact on the oral cavity. Some studies concluded an even greater anticaries property compared to xylitol.

Erythritol influences biofilm formation

In a 2016 study, four strains of bacteria taken from a peri-implantitis lesion were added to sterile titanium disks until mature biofilm formed, then erythritol PLUS powder was dissolved in sterile saline solution and added to the biofilm mass. The erythritol PLUS powder promoted inhibitory effects against the microorganisms and reduced formation of new biofilms because of its anti-adherence property. Erythritol also has been shown to suppress maturation of gingivitis biofilms in vitro and promote biofilm composition that is more consistent with early colonisers rather than pathogenic species. Notable reductions of pathogenic species in biofilms in the presence of erythritol consumption led one author to conclude that erythritol could be used to help prevent periodontal diseases! A direct comparison between glycine and erythritol powder, in vitro, concluded that erythritol plus powder possessed greater antimicrobial properties than glycine, making it an interesting adjunct during biofilm removal for gingivitis and periodontitis patients.

Antioxidant properties of erythritol

Erythritol’s antioxidant properties make it an excellent scavenger of free radicals. Animal studies have shown erythritol neutralises enough free radicals in diabetic rats to neutralise endothelial dysfunction and a human pilot study revealed erythritol improved small vessel endothelial function in diabetic patients experiencing hyperglycemic events. In other words, chronic usage essentially reversed the damaging effects of hyperglycemia.

PLUS powder for dental spa therapy during supportive periodontal therapy

For supportive periodontal therapy patients who present with a few calcified deposits, erythritol powder air polishing (EPAP) provides equal results when compared to traditional scaling and root planing (i.e. mechanical debridement), yet is much more efficient and gentler to hard and soft tissues. While EPAP does not remove calcified deposits, it is a good alternative to the repetitive and overlapping strokes required by ultrasonic or hand instrumentation for biofilm management around implants and teeth and the comfort of this soft powder spray in the oral cavity positions it as a dental spa therapy. It’s a nice reality to have patients looking forward to their next supportive periodontal treatment, rather than seeking excuses to skip it! If you haven’t switched to low-abrasive air polishing using erythritol PLUS powder, now is the time to make the shift. You and your patients will be benefit from the comfort, efficiency, safety and efficacy of this novel powder.

Using EMS PLUS powder

Because of the micro-sized particles of AIRFLOW® PLUS powder, it can only be dispensed with an EMS air polishing unit, such as the EMS AIRFLOW® Prophylaxis Master. Trying to use AIRFLOW® PLUS with a non- EMS air polisher is nothing short of problematic, resulting, for instance, in over-dispensing of powder and clogging.