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The upcoming 24-hour webinar organised by EMS and the Swiss Dental Academy is a first in dental continuing education (CE). One of the speakers is Karen Davis, who, in addition to running her own CE company, works as a dental hygienist in Dallas in the US. Dental Tribune International talked to her about the advantages of erythritol, a minimally abrasive air polishing powder, and its edge over other powders, such as glycine, for supra- and subgingival air polishing.
What is erythritol, and what is its place in oral health?
Interestingly, erythritol is a sugar alternative that has zero calories and no aftertaste, and is most often derived from fermented maize. It naturally occurs in watermelon, soy sauce and pears, among others. It passes directly through the body when consumed in foods or beverages, so it is unlikely to cause gastro-intestinal upset. In oral healthcare, it has robust anti-caries potential. Streptococcus mutans cannot not digest erythritol, just like xylitol, so it cannot use it for fuel to form dental caries. One of my favourite features of erythritol is that it has anti-biofilm properties. In vitro, it has been shown to reduce the volume of mature biofilm and to reduce new biofilm formation. It is also a natural antioxidant and is antimicrobial against periodontal pathogens. From these properties taken together, it’s evident that erythritol inherently promotes a favourable oral environment.
What should a dental professional looking for a good prophylactic powder keep in mind?
In my opinion, the most important feature is that the powder does not cause damage to the surfaces it is cleaning: implants, exposed roots, delicate restorative materials, periodontal tissue, orthodontic materials, etc. We now know that polishing pastes and some powders used in air polishing devices can be highly abrasive on surfaces in the mouth. Cumulative use of pastes or powders that are too abrasive actually creates scratches that can become niches for biofilm and stain retention. Low-abrasive powders such as glycine (25 µ in size) or erythritol (14 µ in size) are the only powders safe to use both subgingivally and supragingivally, and have repeatedly been shown not to damage delicate surfaces in the oral cavity.
Why erythritol and not another prophylactic powder?
Erythritol does everything glycine does in terms of being a low-abrasive cleanser, plus it has the additional features I mentioned before. Even though the particle size is 58% smaller than that of glycine, it is 37% harder. That translates into a powder that is significantly more efficient in biofilm removal and removal of light to moderate stains than glycine is. Using the least abrasive powder on the market means it is a uniquely comfortable procedure from the patient’s perspective, and from the clinician’s perspective, erythritol powder is incredibly efficient and almost effortless for removal of adherent biofilm and moderate stains.
More broadly, does erythritol hold any systemic health benefits?
In vitro studies are fascinating regarding the potential of erythritol to help improve endothelial function. It does not raise blood sugar or insulin levels when consumed in food and beverages. Being an antioxidant, it has scavenger potential to offset free radicals systemically. It is non-caloric and, unlike many sugar alternatives, is generally well tolerated, even by those with digestive disorders. There are very few reported cases of erythritol allergies, so it can be confidently consumed or used as a prophylactic powder, leaving behind unique and potentially beneficial systemic benefits.
Do you feel that the benefits of erythritol are well known by dentists? Why or why not?
It is definitely not well known at this point in time. When speaking to groups of dental professionals, it is apparent that, while many may be aware of erythritol, the majority are not aware of its benefits in biofilm management. Supra- and subgingival air polishing with erythritol powder is still not being taught in the majority of dental and dental hygiene schools globally, and it requires the use of technology designed specifically for low-abrasive powder.
Change tends to evolve slowly in dentistry. The vast majority of dental professionals are still using abrasive polishing pastes and are not even aware of the shift to Guided Biofilm Therapy (GBT), in which polishing pastes are not necessary, since biofilm is removed minimally invasively with gentle, safe and comfortable prophylactic powder in AIRFLOW devices. Once clinicians make the shift to GBT using the erythritol-based PLUS powder, they do not go back. It is a game-changer, but like most innovative changes in dentistry, much more education is still necessary before dentistry takes full advantage of erythritol as a prophylactic powder to manage biofilm.
What have your experiences been regarding feedback from dental professionals and patients?
From the patients’ perspective, they are most surprised at how gentle and comfortable the powder feels in their mouths compared with sodium bicarbonate powders and polishing pastes. I had one patient tell me that all dental hygienists should use this technology because it feels so good, and many patients comment that they never want to go back to the “old way” of cleaning teeth. Clinicians, myself included, are amazed at how much more efficient it is to remove biofilm with erythritol powder in AIRFLOW devices, compared with repetitive strokes using mechanical instrumentation and/or polishing pastes. Leaving behind a smooth, clean surface while preserving the integrity of the surface with PLUS powder means clinicians can confidently provide a prophylactic procedure that is safe, comfortable, efficient and therapeutic.
Why should dental professionals watch your lecture on erythritol versus glycine?
Firstly, it features scientific data to give clinicians confidence in shifting to GBT with erythritol powder. Secondly, forward-thinking clinicians need to be properly informed about the most cutting-edge technologies available to manage biofilm differently than with traditional methods, now considered antiquated. Clinicians also need to understand the shift in protocols necessary to maximise these technologies. Patients deserve to be treated with the most minimally invasive, comfortable and efficient method to remove biofilm. This webinar will help equip clinicians for this change to gentle and effective biofilm management.
The 24-hour webinar will be broadcast live starting on 23 November at 1 p.m. CET. Davis will be holding a 1-hour lecture titled “Evaluating the erythritol edge over glycine for biofilm management”. Her presentation is scheduled to start on 23 November at 10 p.m. CET. During the English-language webinar, she will discuss how erythritol effortlessly removes biofilm from teeth and implants when used as a low-abrasive powder in AIRFLOW devices. Learn what is distinctive about erythritol powder, and learn about the edge it has over glycine powder for supra- and subgingival air polishing. Attendance of the webinar is free of charge and dental professionals interested in attending can register here.