Instruments for Success
Using hand scalers, ultrasonics, handpieces, and lasers in concert
Joy D. Void-Holms, RDH, BSDH, DHSc
Manual and ultrasonic scalers, handpieces, and lasers are the backbone of dental hygiene, used every day. The very first hygienist was trained on a manual scaler, but today we have advanced ultrasonic scalers as well as lasers that can help provide non-surgical periodontal therapy. Understanding the features and applications of these tools is critical in ensuring that you are providing the best possible patient care.
Today's hand scalers have handles that are hollow, larger in diameter, and lighter in weight, which means less stress on the muscles. These handles are far different from what many of us used in school. Today's hand scalers also have tapering near the shank and texturing and knurling on the handle, which helps users maintain control of the handle and prevents finger slipping when working in a wet environment. All these handle features help reduce pinch force, which predisposes us to repetitive stress injuries and musculoskeletal disorders such as carpal tunnel syndrome. The ideal handle should be less than 15 grams in weight and greater than 10 mm in width. Many of the newer options on the market also include hybrid designs, combining sickle, area-specific, and universal curet features into one, which allows us to work more effectively. Some designs have extended shanks, reinforced shanks, and thinner working ends, allowing us to treat patients who present with unique anatomy and more advanced periodontal disease. With so many advancements in metallurgy and cryogenic processing, instruments are staying sharper longer. Some do not require sharpening at all. With so many new and innovative design features, there are some fantastic instruments available.
Like hand scalers, ultrasonic scalers have many unique design features as well, allowing us to choose different tips based on specific patient needs, whether you are using piezoelectric or magnetostrictive technology. For patients with tenacious deposits, you have tips with two or three bends. In cross section, these tips mimic the cutting of hand instruments, making deposit removal more effective. Many manufacturers design curved or left/right tips to facilitate adaptation to the root surface. Right and left tips are not necessarily new, but people are just learning how important they are in the armamentarium. Manufacturers have also made ultrasonic tips extremely thin; some are as thin as an 11/12 explorer, which can be useful in treating patients who have pristine health but just need biofilm removal.
The ultrasonic units have become sophisticated as well. Some of the machines have self-purging options, while others are so technologically advanced that users can pre-program their desired settings. Having a diverse armamentarium with your ultrasonic scalers, like many of us do with our hand scalers, is critical; you need more than one.
It will be interesting to see how the technology develops over the next 10 years. All ultrasonic units becoming completely cordless is a possibility. Hand scalers also may last longer in the future, whether they are sharpen-free or stainless-steel. Every instrument still has a lifespan that depends on how often and in what manner it is being utilized, so an instrument that could truly last for 2 years and remain functionally sharp would be impactful.
Perhaps the most important recent development in handpieces raises awareness of the longstanding rule mandating that handpieces and other intraoral instruments that can be removed from the airlines and waterlines of dental units must be cleaned and heat sterilized between every patient. Cordless polishers offer the advantage of an autoclavable sheath and single-use disposable barrier to protect the entire motor of the handpiece that would traditionally come into contact with microbes in the oral cavity. The motor for many of these cordless devices can be wiped down with the same product used to disinfect the rest of the clinical workspace.
The use of a single cordless handpiece with several autoclavable sheaths can provide economic advantages while helping clinicians remain compliant with infection control guidelines. Cordless handpiece devices offer ergonomic advantages by eliminating cord drag, thus reducing the muscle workload during the polishing period. Another ergonomic advantage of these tools is the option to use a cordless foot petal. Trying to reach the foot pedal while staying in position relative to the patient can be a challenge, especially for shorter hygienists.
While manual and ultrasonic scalers and cordless handpieces do an effective job with removing calculus, biofilm, and other debris in the oral cavity, lasers should be incorporated adjunctively into patient care during the dental hygiene appointment. Hygienists are routinely using lasers to eliminate biofilm both pre- and post-procedurally. When used pre-procedurally with a procedure known as laser bacterial reduction (LBR), the laser is used as a decontamination tool to reduce bacteria in the sulcus. When used with a procedure called laser decontamination (LD) or laser-assisted periodontal therapy (LAPT), the device is used to remove biofilm within the necrotic tissue of the pocket wall. Lasers also offer a host of biostimulation properties during non-surgical periodontal therapy, including increased collagen production, and fibroblast and osteoblast proliferation.
Additionally, lasers can be used to treat dentin hypersensitivity, which allows scalers and handpieces to be used more effectively with patients suffering from this oral condition, and they can be used for treating herpetic lesions. Even if a patient just feels tingling in the area, a laser can be used effectively to delay onset and decrease healing time significantly. There are contraindications for laser use, so a thorough medical history of the patient is important.
Not all lasers work the same, so hygienists need to be aware of how to use their selected brand. More importantly, it is crucial that they have a solid understanding of their state laws regarding the use of lasers by dental hygienists. Hands-on training is critical as well, and it may be required multiple times. Simply watching a video may not be sufficient to learn proficient laser use, because a viewer can't benefit from real time feedback and expert guidance.
Diversity Is Key
Patient care is not a one-size-fit-all approach. It is crucial for every hygienist to have a variety of tools to provide optimum care for patients presenting with various levels of disease. With the versatility that manual and ultrasonic instrument designs provide, along with the added benefits of incorporating cordless handpieces and lasers into the armamentarium, dental hygienists can be confident they are providing patient care at the highest level.
About the Author
Joy D. Void-Holms, RDH, BSDH, DHSc, is the founder of Dr. Joy, RDH, co-founder of Jell-Ed, and the creator of the Dental Hygiene Student Planner.