Air-polishing devices – are there any risks?

PD Dr. Kristina Bertl, PhD MSc MBA

The previous article ‘Air-polishing devices in periodontal treatment’ has already discussed the effectiveness of air-polishing devices and the importance of using the right powder to avoid damaging the hard and soft tissues. But what else needs to be considered when using these devices?

One of the most frequently discussed risks is the possibility of inducing emphysema during treatment. Subcutaneous emphysema or soft-tissue emphysema refers to an unphysiological accumulation of air in the subcutaneous or soft tissues. Typical symptoms include crepitation and the ability to squeeze away the swelling in the skin.

A review of all cases described in the literature up until 2018 (Lee 2018) revealed 9 documented cases in which subcutaneous emphysema occurred after treatment of teeth or implants. Antibiotics were prescribed in 6 cases (intravenously in 4 cases), but severe complications did not occur in any of the cases. Depending on the extent of the emphysema, and if there is a risk that emphysema in the jaw could spread to the mediastinum, more caution should be taken. In the event of doubt, the patient should be transferred to the nearest hospital, where they can be monitored and given intravenous antibiotics if required.

More caution should be taken in the following clinical situations, in which emphysema may be triggered more easily:

The video shows a patient with minimal air accumulation in the vestibule during treatment. In this case, however, the patient did not develop ‘persistent’ emphysema; the swelling disappeared completely immediately, and no crepitation could be heard. Accordingly, no antibiotics were prescribed. However, this case does show how important it is to keep an eye on the surrounding tissues (mouth floor, vestibule etc.) during treatment, in order to be able to react quickly if required.

Finally, it should be pointed out that emphysema can also occur after other dental treatments and that this complication is not solely associated with air polishing devices.

Reference

1. Lee ST, Subu MG, Kwon TG. Emphysema following air-powder abrasive treatment for peri-implantitis. Maxillofac Plast Reconstr Surg. 2018 May 13;40(1):12. doi: 10.1186/s40902-018-0151-7. eCollection 2018 Dec.