Month: November 2012

During the last month, I’ve had the privilege of working with teams in three distinct regions of the country. It is fascinating to me how every dental practice feels their challenges are theirs alone and yet I see how they actually have so much in common.

A conversation that has come up in more than one practice this month is the question of how much time to spend during a prophy with hand-scalers versus ultrasonics. This is a very important question as it affects so many areas of hygiene care- patient comfort, provider confidence, time management and even tissue response and clinical outcomes.

I’ve seen a wide variety of opinions and techniques in this area.  I experienced one team recently that spent perhaps a total of 3-5minutes with a quick supra-gingival pass with the ultrasonic. The other end of the spectrum is another hygienist who spends at least 10 minutes per quad with the ultrasonic and then follows that with complete instrumentation with hand-scalers.

They’re both wondering… ‘What’s right?’

While I will not make a blanket statement for every patient circumstance, I feel comfortable saying that the sweet spot is somewhere in the middle.

With the first scenario, the question becomes one of effectiveness. Is a quick 3-minute pass on the coronal surface enough attention to really make a difference in tissue response? Probably not.

Is a total of 40minutes of scaling as a pre-cursor to full mouth hand instrumentation necessary in a healthy patient? Probably not. And this is going to make it impossible to stay on the recommended 20-20-20 time schedule for a 60-minute hygiene visit.

Based on the studies I’ve reviewed, learning from experts in the periodontal field and anecdotal evidence, I feel comfortable making a statement to this effect:

It is appropriate and evidenced-based to use an ultrasonic instrument as your primary tool for scaling and use hand instruments as adjuncts to refine your scaling results when remaining calculus is detected.

A lot goes into that statement:

• The assumption is that you have an appropriate sub-gingival (11/12) explorer that you use to detect remaining deposits that require hand instrumentation
• The assumption that as a clinician you are confident in your technique and skills with the ultrasonic
• The assumption that your ultrasonic scaling technique is extremely thorough and intentional as a primary means of deposit removal and biofilm disruption

In a study published in the Journal of Perio in 1998 entitled Root instrumentation. Power-driven versus manual scalers, researchers state ‘it appears that use of ultrasonic scalers for periodontal debridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.’

There are many other studies and literature reviews that confirm this theory and the AAP has a position paper from 2000 stating that ‘ultrasonic and sonic scalers appear to attain similar results as hand instruments for removing plaque, calculus and endotoxin‘.

So next time you pick up your ultrasonic instrument, think about the things Stacy taught you last week and ask yourself ‘What needs to happen for me to feel totally comfortable with using this as my primary scaling tool?’

I’m sure I’ll hear a lot from our readers on this topic and I welcome that. Please feel free to leave comments on our blog, to email me at Rachel@inspiredhygiene.com request a list of resource articles or to inquire about our hands-on instrumentation courses that we’re now offering.

Stay Inspired,
Rachel

Here are a few quick tips to help you get recommitted to some of the fundamentals of ultrasonic instrumentation.

• Insert selection is incredibly important. Several manufacturers offer slim style inserts as well as standard inserts. Slim style (commonly known by brand names such as Slimline, Streamline, etc.) inserts are great for biofilm disruption. These thinner style inserts are typically not effective in calculus removal in patients with moderate-heavy calculus. Slimmer inserts are therefore best used on recare patients or perio maintenance patients. The standard inserts are your go-to choice for periodontal therapy. Check your inventory and be sure to have both types of insert.

• Being mindful of a “featherlike” grasp is key for optimum insert effectiveness. Avoid “pinching” the lower 1-2” of the insert. Instead, try resting the insert in the web between the thumb and forefinger. Extraoral fulcrums are helpful to ensure that the grasp is maintained further back on the handle, thereby decreasing the clinician’s tendency to grasp too close to the insert tip. Squeezing too hard and too close to the tip will decrease the technology’s effectiveness.

• “Featherlike” is also a great descriptor to describe the amount of pressure applied to the tooth during instrumentation. If the clinician applies too much pressure, the effectiveness of the insert is diminished. Burnished calculus is a common outcome of a clinician using too much pressure during instrumentation.

• Each manufacturer offers wear indicator guides that correspond to their particular brand. Therefore, if you have a wear indicator for Hu-Friedy brand inserts, they won’t work on your Dentsply brand inserts and vice versa. The wear indicator guides are IMPERATIVE. If you’re unfamiliar with how to use them, consult with your dealer rep the next time they’re in your office. Using inserts that have lost too much of the working tip causes burnished calculus and therefore decreases clinical outcomes.

• Inspect the magnetostrictive stack. Once the stack gets bent, the ultrasonic insert becomes significantly less effective.

• Using cassettes protects the stacks from getting bent. They’re a smart investment in protecting your ultrasonic inventory.

Inspired Hygiene offers a wide-array of coaching services, including ultrasonic hands-on workshops for your office. Please contact us for more information on ultrasonic training for your team via email info@inspiredhygiene.com or 877.237.7230.

Stay Inspired,
Stacy

Next Thursday is our monthly Hygiene Profits Mastermind call. This month Kim is going to be interviewing a very special guest on a very important topic. Learn how you can save a life while building your practice. I hope you’ll join us!

“Reduce Risks, Save Lives, Grow your Practice:
the Effective Oral Cancer Screening Examination”
with special guest Dr. Jonathan A. Bregman

Every 60 minutes one person dies from oral cancer in our country. It affects people of all ages, nationalities, and walks of life. Every year, the numbers are growing. For over 40 years, the survival rate has NOT improved. Why? Because most Americans have not been taught where to look, how to look, or what to look for when it comes to oral cancer. Also, most people do not know about a nationwide epidemic that, in the past 6-8 years, has added to alcohol and tobacco as a growing and serious risk factor for oral cancer.

Awareness and early detection of oral cancer will save lives!

What you will take away from this important call:

The four tools for enhanced oral cancer detection: the what, why, and how
The accepted protocols for enhanced detection: it is not just for those at risk
The accepted follow-up procedures upon discovery of an area of concern
CE credits are provided by Inspired Hygiene.
Inspired Hygiene is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement.
The current term of approval extends from 6/1/2010 to 5/31/2014.

If you’re not already a member of our Mastermind group, the first 2 months are FREE. Click here to sign up.

Stay Inspired,
Rachel