Keep Your Patients and Yourself Healthy
Instrumentation for better ergonomics and outcomes
Amanda Hill, RDH
Various innovations in both manual and power instrumentation have provided dental hygienists with a number of options for scaling and root planing. Understanding the benefits of each option for each situation is critical in developing an optimal blended approach of manual and power instruments.1 Through this understanding, both patient outcomes and the dental hygienist's own physical health can be positively impacted.
Perhaps the most significant instrumentation developments recently have involved the acknowledgement that ergonomics and their impact on the clinician's physical health are critical. A dental hygienist's instruments should be properly balanced so that they do not require extra grip or force, which causes tension in the hand and arm. A feather-light technique is ideal to avoid unnecessary fatigue. Literature suggests that the optimal weight is 15 g or less.2
In general, pencil-shaped instruments tend to be very hard on the body. The trend toward wider instruments can help hygienists preserve their health and prolong their careers; literature suggests diameters of at least 10 mm.2
Still, no one instrument is best for every dental hygienist. Similar to blue jeans, one brand might fit perfectly for one person but not for another. Clinicians need to try as many instruments as possible to see what fits best in their hand and with their techniques. Many companies offer free samples by mail, and attending trade shows can be another great opportunity to try different instruments.
One new development that can increase comfort for both the patient and the clinician is sharpen-free instruments.1 With hard coatings to preserve sharpness, these instruments need to be replaced more often, but they can permit a lighter technique. As opposed to the traditional strategy of placing the instrument underneath the deposit to pop it off, sharpen-free instruments can be used to shave the deposit off gently.
For optimal patient outcomes, recognizing that instruments are very site-specific is important. Universal instruments are often fine for standard cases, but hygienists need to consider venturing into instruments that they may not fully understand; educating themselves about these instruments is key. Situations such as furcations, strange morphologies, implants, and bulky restorations are just a few of the occasions when site-specific instruments can help provide the best outcomes.
Even a patient whose body type makes reaching the mouth difficult forces the dental hygienist to make a decision: Adapt your instrument, or adapt your body position? Hygienists need to improve at adapting their instruments so they are not hurting their bodies. Familiarizing and educating themselves on these various situations can require a significant amount of time, but it is important.
While manual instrumentation still has its place, every dental hygienist should be using some sort of power scaler. The science has clearly demonstrated that power scalers remove biofilm better than overlapping strokes with manual instruments (which can be compared to cleaning a sidewalk with a toothbrush instead of a power washer). Cavitation and streaming within the water flow increases the cleaning efficiency.3
Power scalers make removal of hard deposits easier, but more importantly, hygienists now know that biofilm management must be a high priority in keeping patients healthy. No matter how skilled they are at scaling, they will never remove every deposit every time; managing the biofilm is critical.
Similar to manual instruments, utilizing the site-specific inserts and tips for power scalers is important, whether magnetostrictive or piezoelectric instruments. These elements are designed for different purposes: universals, rights and lefts, different widths, etc. The thinnest tips have been shown to be most effective for biofilm disruption.3 No one should hesitate to utilize multiple different inserts in the same appointment; while time is always a limiting factor, using the correct insert can be more efficient and lead to a better result.
Of course, the COVID-19 pandemic put power scalers under the microscope, as many dental professionals tried to avoid them to minimize aerosols in the operatory. Even then, neglecting biofilm was a concern; dental hygienists are fully aware of the connection between periodontal inflammation and systemic health. Now, however, research has shown that nearly all the aerosols in the dental operatory come from dental unit waterlines rather than from aerosolized saliva.4 As long as these waterlines are being tested, cleaned, and shocked, patients and clinicians are not becoming infected at the dental office, and power scalers should remain part of the armamentarium.
Manufacturers continue to do impressive work in developing handles, grips, and better balance. The newest instruments can feel amazing in the hand. Sharpen-free technology can be a game-changer as well.
What will be next? As artificial intelligence makes its way into various other areas of dentistry, could scaling instruments in the future have tips that can detect calculus and alert the dental hygienists when, for example, they have not reached every part of an unusually shaped premolar? The possibilities are exciting to consider, and the most important considerations will continue to be education and an openness to try new products.
About the Author
Amanda Hill, RDH
Practicing Dental Hygienist
Educator, and Key Opinion Leader
1. Void-Holmes JD. Diversity in manual and ultrasonic instrumentation. Inside Dental Hygiene. 2020;16(8):20-23.
2. Simmer-Beck M, Branson BG. An evidence-based review of ergonomic features of dental hygiene instruments. Work. 2010;35(4):477-485.
3. Pecheva E, Sammons RL, Walmsley AD. The performance characteristics of a piezoelectric ultrasonic dental scaler. Med Eng Phys. 2016;38(2):199-203.
4. Meethil AP, Saraswat S, Chaudhary PP, et al. Sources of SARS-CoV-2 and other microorganisms in dental aerosols. J Dent Res. 2021;100(8):817-823.