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.