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Balancing the Scale(r)s

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Header: Balancing the Scale(r)s

Why hygienists prefer to use both ultrasonic and hand scaling

Header: Balancing the Scale(r)s Ultrasonic scalers remove calculus faster, easier and more completely than hand scaling, and magnetostrictive types are also touted as easily removing staining. It seems like there's only one thing that ultrasonic scalers can't eliminate: hand scaling.

Even with the ultrasonic machines' reputations for helping hygienists accomplish their work quickly and effectively, the men and women in the field aren't ready to put down their hand-scaling tools just yet.

To find out why, we quizzed five Phoenix-area hygienists: Lori Flake, Roceleigh Galano and Tiffany Jones of Chandler Dental Health, and Jaimie Carr and Brandy Young of Today's Dental.

What benefits does ultrasonic scaling offer over hand scaling?
Brandy Young: Hand scaling can leave behind bacteria at the base of pockets where the instrument can't reach. Using an ultrasonic will flush water through the pockets and help eliminate more bacteria, promoting healthier tissue.

Lori Flake: Ultrasonic dominates when it comes to removing staining.

Roceleigh Galano: Anyone in a physically demanding career needs tools that make the job easiest on the operator. The speed of an ultrasonic allows us to give patients the best cleaning we can, in the easiest, fastest, most effective manner. (Ask a carpenter if he could get his daily-requirement job without his nail gun!)

Jaimie Bartoletti: An ultrasonic tip doesn't have a cutting edge like hand instruments, which allows access to deep periodontal pockets without damage to the tissue.

Tiffany Jones: Most patients also feel that they're getting a more thorough cleaning with the use of an ultrasonic scaler.

If ultrasonic technology is so effective, why do hygienists still reach for hand scalers?
Galano: Nothing tops hand instruments for tactile sensitivity. The hollow instrument handles are like metal detectors when it comes to detecting missed calculus after a run-through with the ultrasonic.

Jones: I can get into areas with hand instruments that the ultrasonic is unable to reach, such as lower anteriors with severe crowding.

Flake: I feel like hand instrumentation allows you to roll into the interproximal space and go to the base of the sulcus and areas where the ultrasonic brings more limitations.

Young: In my experience, because the ultrasonic doesn't have a cutting edge, it won't remove all of the buildup that's present on the teeth—or along or below the gumline—like a hand instrument will.

Bartoletti: There's more visibility when using hand instruments, because there's no water spray like there is with ultrasonics.

Working on patient

During a prophy, what percent of the time do you spend using an ultrasonic?
Flake: I usually use the ultrasonic for about 25 percent of the cleaning time—maybe a little longer if a patient has heavy plaque, supragingival calculus and deeper pockets, and a higher AAP classification.

Jones: During a healthy prophy, it's about 50/50. If I'm working on perio patients, I'd spend close to 80 percent of the appointment time using the ultrasonic.

Bartoletti: I use them equally, but if there's an area that has more buildup than the rest, I'll go back again in these isolated areas with the ultrasonic.

Is there an order you usually follow?
Young: I start with polishing and ultrasonic scalers, which decrease plaque, stains and calculus more quickly than hand instruments. Then for anything left behind, I finish with hand instruments.

Bartoletti: I polish first to remove the sticky plaque layer, then go around the whole mouth with an ultrasonic, and finish by hand scaling the interproximal area. If there's an isolated area that has more buildup than others, I'll go back again with ultrasonic.

Jones: I use the ultrasonic for 10-15 minutes, then fine-tune for 10-15 minutes with hand instruments.

On an ultrasonic, which tips do you seem to reach for most, and why?
Bartoletti: I prefer the Hu-Friedy Swivel Direct Flow. Because of its swivel tip, it's comfortable for the hand, and the tip has a nice universal angle that works well on most areas. It's a thin tip, so it fits well interproximally and into deeper pockets. I use this for most patients. If it's an SRP patient who has heavy, tenacious calculus, then I like to use a 30K Cavitron insert meant for removal of moderate to heavy supragingival calculus.

Galano: My instrument of choice is the universal tip, which lets you access almost all areas. You don't have to change your tips often, which saves time.

Flake: Each insert is determined based on the amount of calculus a patient has. For a basic prophy I'd reach for a slim-line tip, but if the patient has more calculus, I have an insert that's more effective on heavier amounts of buildup.

Jones: I use thin (black) tips for prophies. For perio patients, I start with the universal (pink), then go back in with the thin tip.

Do patients ask for one or the other?
Young: We use both ultrasonic and hand scaling on about 99 percent of our patients. Patients seem to like both, mostly because they feel the ultrasonic decreases the amount of time we spend hand scaling. Patients with sensitive teeth tend not to like the ultrasonic because the water or vibration causes discomfort, and a few patients are bothered by the noise of the ultrasonic.

Bartoletti: Some patients request hand scaling only, because they're sensitive to water or cold, and some don't like the sound of hand instruments and request ultrasonic only. I try to accommodate their requests and do what makes them feel most comfortable.

Flake: Many patients also prefer hand instruments if they have to swallow frequently, or if they have limited movement as far as lying back.

Have you ever had to persuade a patient to let you use ultrasonic? If so, any tips for how?
Bartoletti: Some patients haven't experienced an ultrasonic in years, and they remember a lot of water spray and vibration.

Young: Once I explain the benefits of the ultrasonic, most patients are open to trying it. I use the ultrasonic on low and start slow so patients can get used to the sound, how it feels and the water that accumulates. Once they're comfortable with those three things, they're less bothered by it being used during appointments.

Galano: Having an honest communication will usually be enough. If patients have areas where it'll be uncomfortable to use the ultrasonic, I'm fine doing localized hand instrumentation. Most patients will tell me to do what I need to do, and use what I need to use, to get the job done.

Jones: Most patients who ask not to use ultrasonic feel like their experience with a previous hygienist was "rough." I go over the benefits of the ultrasonic—how thorough the cleaning will be—and ask if they'd be OK with me trying it that time as well, and reassuring them that if they're in any discomfort they can notify me. It usually goes well, with them saying, "That wasn't so bad."

Header: Balancing the Scale(r)s



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