Professional Oral Hygiene 

Professional oral hygiene is a set of procedures that removes bacterial plaque (biofilm), calculus and pigmented deposits from the teeth, including the areas a toothbrush cannot reach at home: interdental spaces, the gum line, crowded areas, and around crowns, veneers, implants, braces and retainers.

Over time soft plaque mineralises into calculus, which cannot be removed with a brush, a toothpaste or an irrigator.

Regular professional hygiene reduces the risk of caries, gingivitis, periodontitis, peri-implantitis and bad breath — it is not a cosmetic procedure but a preventive and therapeutic one.

At the Iskusstvo clinic it is performed on the Swiss AIRFLOW Prophylaxis Master unit (EMS), following the GBT protocol (Guided Biofilm Therapy).

When professional hygiene is needed

Professional hygiene may be recommended:

— for dental plaque and calculus;

— for bleeding and inflamed gums, and for bad breath;

— for enamel staining caused by coffee, tea, colouring foods or smoking;

— before caries treatment, whitening, or placement of veneers, crowns and inlays;

— before implant placement and prosthetic treatment;

— during orthodontic treatment with braces or aligners;

— when implants, crowns, retainers or removable appliances are present;

— as part of supportive therapy after periodontitis treatment;

— for routine prevention of caries and gum disease.

GBT protocol hygiene: the key difference

GBT (Guided Biofilm Therapy) is a systematic professional hygiene protocol developed by EMS and delivered on the AIRFLOW Prophylaxis Master unit. It consists of eight consecutive steps and is built around a single idea: the primary target is not calculus but bacterial biofilm, because biofilm is what triggers caries, gum inflammation and peri-implantitis.

There are three differences from the conventional protocol.

Biofilm is made visible first. The teeth are stained with a disclosing agent and the plaque shows up in colour, so both the clinician and the patient see the real picture, including the areas missed during home brushing.

The sequence is reversed. The air-powder jet removes biofilm, stains and early deposits first, and only then is the remaining calculus removed with ultrasound — selectively, rather than across every tooth.

No abrasive polishing. Pastes, rubber cups and brushes are not used in the protocol: smoothness is achieved by the air-powder treatment itself.

An important point: GBT does not eliminate calculus removal and is not "cleaning without ultrasound". Dense, long-standing calculus is still removed with ultrasound — simply in a targeted way and in smaller volume.

The eight steps of the GBT protocol

1. Assessment. Examination, probing, evaluation of the gums, enamel, restorations and implants.

2. Disclosing the biofilm. The disclosing agent makes plaque visible and provides a "map" for treatment.

3. Motivation and instruction. The clinician shows the patient their problem areas and selects home care products.

4. AIRFLOW. Removal of biofilm, staining and early deposits from teeth, restorations and implants using a jet of warm water, air and powder. The main powder is erythritol-based with a particle size of 14 µm, designed for use both supragingivally and subgingivally up to 4 mm. With heavy staining, a more abrasive sodium bicarbonate powder may be used first — supragingivally only.

5. PERIOFLOW. Treatment of periodontal and peri-implant pockets deeper than 4 mm with a flexible nozzle that delivers the powder-water mixture without traumatising the soft tissues.

6. PIEZON. Targeted ultrasonic removal of the remaining calculus above and below the gum line. Different instruments are used for natural teeth and for the implant and restoration zone.

7. Check. The clinician verifies the quality of cleaning, applies fluoride if needed and gives recommendations.

8. Scheduling the next visit. The interval is determined individually.

The AIRFLOW Prophylaxis Master unit

AIRFLOW Prophylaxis Master is a unit made by the Swiss company EMS that combines the three GBT technologies: AIRFLOW (air-powder treatment), PERIOFLOW (pocket treatment) and PIEZON (ultrasound). Three features are clinically relevant.

Heated water. The working fluid is delivered warm, with an adjustable temperature of up to approximately 40 °C. For patients with sensitive teeth this noticeably changes tolerance of the procedure: a cold jet is one of the main causes of discomfort during conventional cleaning.

The PIEZON NO PAIN module. The instrument produces linear oscillations without lateral deflection, and the power adapts automatically to the density of the deposits — this reduces the risk of damage to enamel, root cementum and the marginal gingiva.

Fine-grained powder. Erythritol is significantly less abrasive than sodium bicarbonate and can be used on enamel, dentine, root cementum, composite, ceramics and implant surfaces.

Who benefits most from GBT protocol hygiene

The protocol is suitable for most patients, but in several situations its advantages are more pronounced:

— implants, crowns, veneers, ceramics — minimal abrasiveness and dedicated instruments for the peri-implant zone reduce the risk of surface damage;

— braces, aligners, retainers — the jet cleans around brackets, archwires and bonded retainers better than a brush with paste;

— periodontitis in the supportive therapy phase — pocket treatment with the PERIOFLOW nozzle causes no mechanical trauma to the attachment;

— increased tooth sensitivity — warm water, no abrasive polishing and adaptive ultrasound power;

— children, adolescents and patients with a pronounced gag reflex — the procedure is shorter and subjectively more comfortable.

What the procedure does and does not do

After the procedure the teeth feel smooth, surface stains from coffee, tea, wine and tobacco are gone, and the enamel looks lighter because it returns to its own natural shade. Bleeding and swelling of the gums decrease if they were plaque-related, and the risk of caries and periodontal disease is reduced.

What hygiene does not do. It does not whiten teeth chemically: the natural shade of the enamel does not change — whitening protocols are needed for that. It does not replace periodontitis treatment: deep pockets and bone loss require full periodontal therapy, and hygiene becomes a mandatory part of it rather than an alternative. It does not eliminate causes of bad breath that originate outside the oral cavity.

Limitations, contraindications and safety

The procedure is minimally invasive, but the medical history is taken as thoroughly as before any intervention. Be sure to tell your clinician:

— about bronchial asthma, COPD, other respiratory conditions and acute respiratory infections — if the respiratory status is unstable, air-powder treatment is postponed;

— about kidney disease, adrenal insufficiency and a sodium-restricted diet — these limit the use of sodium bicarbonate powders;

— about a pacemaker or any other implanted electronic device — the approach to ultrasound is decided individually;

— about pregnancy and its stage — the procedure is permissible, but its scope and the timing of the appointment are planned separately;

— about allergies and individual intolerance to any of the components.

The procedure is postponed in cases of acute inflammation and mucosal ulceration, and in decompensated systemic conditions.

How often to have professional hygiene

There is no universal interval — the frequency depends on individual risk. Patients with healthy gums and good home care are usually advised to have the procedure once or twice a year. With periodontitis in the supportive phase, implants, braces, smoking or rapid calculus formation, the interval becomes shorter — often every 3–4 months. In the GBT protocol the interval is a separate, eighth step: it is set according to the condition of the gums and the rate of plaque formation, not "every six months by default".

Aftercare

There are few restrictions. In the first few hours, if sensitivity is increased, it is better to avoid very hot, cold and acidic food; if fluoride was applied, your clinician will say separately when you can eat and drink.

During the first 24 hours it makes sense to limit colouring food and drinks — coffee, tea, wine, beetroot, curry and turmeric sauces — as well as smoking: immediately after treatment the enamel takes up pigment more readily.

Home care is selected individually: toothbrush, toothpaste, dental floss, interdental brushes, irrigator. With crowding, implants, crowns, braces and retainers, it is interdental hygiene that determines how long the result lasts. If sensitivity or bleeding persists for more than a few days, tell your clinician.

FAQ

How is GBT protocol hygiene different from a conventional cleaning?

In the order of steps and the degree of impact. In the conventional protocol, ultrasound is used across all the teeth first, then Air Flow and polishing with an abrasive paste. In GBT the plaque is disclosed with an indicator first, then removed with a fine erythritol jet, and only then is the remaining calculus removed selectively. Polishing pastes are not used.

Does it hurt?

As a rule it is easier to tolerate than a conventional cleaning: the water is warmed, ultrasound power adapts to the density of the deposits, and there is no abrasive polishing. With marked gum inflammation or high sensitivity, local anaesthesia is possible.

Does GBT hygiene whiten teeth?

No. External stains are removed and the teeth return to their own shade — sometimes the difference is noticeable. But the colour of the enamel itself does not change; whitening protocols are needed for that.

Can this type of hygiene be done with implants and veneers?

Yes, this is one of the main indications. Erythritol-based powder is low-abrasive and safe for ceramics, composite and implant surfaces, and dedicated instruments and the PERIOFLOW nozzle are used for the peri-implant zone.

Is hygiene enough for bleeding gums?

With gingivitis, professional hygiene combined with correct home care is often enough, and the changes are reversible. With periodontitis, hygiene is a mandatory but only first stage: a periodontal assessment and treatment are needed after it.

Book a professional hygiene appointment

At the Iskusstvo clinic in Moscow, professional hygiene is performed on the AIRFLOW Prophylaxis Master unit following the GBT protocol. The clinician will assess the condition of your teeth and gums and determine the interval for follow-up visits.