Tips of the trade for the new hygienist
By Nicole Giesey, RDH, BSDH, MSPTE
Looking at your daily schedule is a good way to prepare yourself for the various procedures in your day. Sealants are always interesting to complete. One never knows just how the child or young adult will respond to the procedure. Typically, the procedure runs smoothly; it takes longer to set up and disinfect the room than it does to actually complete the procedure itself. But every once in a while, the sealant procedure can become challenging. There is always the fidgety child who has enough saliva flow to fill the biggest river, no opening capability, and a tongue with a mind of its own. These are just some of the obstacles an unassisted hygienist may encounter. Even with an assistant, there are still hurdles to leap over to achieve a nicely sealed tooth.
Sealants are very important in the fight against tooth decay.1 Ever since their introduction in 1967 by Dr. Michael Buonocore, sealants have evolved in composition and ease of placement.2 One way to avoid complications is to be prepared for the procedure. Having a backup of everything is always a good idea.
Having a well-organized tray and a fully charged curing light within reach is a good starting point. Let’s review which items are handy to have on the tray table. Your instruments should include a mouth mirror, explorer, scaler, floss, etchant, sealant material, drying material (if preferred), cotton rolls, cotton roll holder, bite blocks, triangles, articulating paper, and post-treatment patient education forms for the patient and guardian.
Many times, the dental hygienist is responsible for ordering sealant products. With so many choices in product catalogs, how do you know which one is right for your patients? Since there are so many different product lines, it is impossible to research them all. Where do you begin to search? Attending your state or national dental hygiene annual session or walking through the RDH Under One Roof exhibit hall is one way to gain access to the latest products and collect samples.
If you are not able to attend these meetings and conferences, where is the next best arena for product information? One good way to learn about a product is to listen to the sales representatives who come into the dental office and ask them some questions. I know they are biased about their products, but if you can take in all of the statistics and evidence-based results from them, at least you are getting current research for each individual product. You should be able to request evidence-based research literature from the sales representative. The sales reps have all the current research on their products and may also offer samples of their products to try before buying.
Speaking of samples, if you are interested in a particular product, call the company and ask for samples before you buy. Most companies will be more than happy to provide samples in hopes that you will place a future order. Other sources for current information are continuing education seminars, RDH magazine product ads, RDH blogs, and social networking websites. If you sign up or “like” product websites, you will receive information about their products. The Web is an excellent, easy, and fast resource to use when researching the newest product information.
Now that you know where to look for product information, which product will you choose? Are all sealant materials alike? Here is a brief overview of the categories and differences in sealant material.
According to Wilkins, one way to categorize sealants is by the type of fillers. There are both filled and unfilled sealants. Why do fillers matter? Fillers are present to provide hue, strength, and increase wear resistance. A sealant material that is filled is generally opaque in color due to its filling composition of glass and quartz. A clear sealant material is an unfilled material since it does not contain any particles. The unfilled materials typically do not require occlusal adjustments, which make them ideal for the public health setting where multiple sealant placements are completed. There is no difference in retention between filled and unfilled sealant products.3 An example of a filled sealant is the VOCO Grandio sealant material, and an example of an unfilled sealant material is 3M ESPE Clinpro sealant. The MSDS sheets and product information on these products are online and can also be obtained through the manufacturers. Once the sealant material is chosen and the operator is confident with the choice, the details in preparation can really save time and frustration.
When working alone, planning ahead for the sealant procedure is a must. A nice little helper is the Blue Boa suction. This suction is excellent for sealant placement. It works in conjunction with the high-volume suction tip. The Blue Boa provides retraction of the cheek and also suction. When using it for sealants, you must have two high-volume suctions, since it connects to the high-volume suction tubing. When suctioning etchant off the tooth, the high-volume suction tip is used and the Blue Boa is used as a saliva flow controller for the rest of the appointment. To see the Blue Boa in action, you can watch the product video on their website, www.theblueboa.com. A tip for the high-volume suction is to cut the disposable high-volume suction in half when operating alone. (This tip is also nice when using the ultrasonic scaler if a Blue Boa is not available.) Cutting the high-volume tip in half helps control the suction and allows for more accurate suction placement. Controlling saliva flow is crucial to sealant placement success, since the field needs to be dry for most sealant materials.
Using cotton aids is another way to control decontamination from saliva. Cotton rolls and cotton roll holders are standard when placing sealants. Some hygienists prefer the triangle cotton aids, which are really convenient as they cover the parotid salivary duct to absorb the saliva. All saliva control aids are helpful; the best advice is simply to try everything and see what you are most comfortable with. If you have never tried cotton roll holders, I highly recommend checking them out. They typically hold up to four cotton rolls safely in place. They also act as tongue and cheek retractors. When placing a cotton roll alone without the holder, dental floss is great to use as a safety net. If a patient accidentally swallows a cotton roll, the floss is there to quickly retrieve the cotton roll without further emergency. As many hygienists already know, a cotton roll saturated with saliva can be a slippery little bugger. One can easily be swallowed, so safety first!
A bite block is another useful aid when applying sealants. After completing two sealants, patients may start feeling fatigued from keeping their mouths open. They do not realize they are closing their mouths and sometimes need a little help in this department. The bite block allows the patient to comfortably stay open. A child-friendly term for the bite block is a pillow. Even the toughest patient appreciates the comfort of a bite block. Allowing the patient to take a break in between sealants allows the joint to rest. After placing the sealants, the contacts are checked. This is a really good time to give a floss demonstration and show off the new sealants. Give your patients a mirror and have them watch your flossing method while explaining the proper way to floss. You can also offer patient education on sealant care at this point. Patient education sheets can be personalized and downloaded on the Crest website, www.dentalcare.com. Click on the patient education tab. A list of topics is available to choose from. There are also free publications on sealants and other topics available from the National Institute of Dental and Craniofacial Research website, www.nidcr.nih.gov/orderpublications. Of course, the American Dental Association has some wonderful patient education brochures that you can order as well.
Sealants are fairly easy to complete. Every once in a while a problematic tooth will give you a run for your money. Hopefully these tips will help you through a perplexing situation or inspire you to start placing sealants if you are not already doing so. If you are not currently placing sealants, I assure you that sealant placement is a lot easier than it used to be due to the innovation of new products. After all, sealants are very helpful in caries prevention, and they are also a pleasant change from the typical prophy appointment. As prevention specialists within the dental field, sealant placement is a good skill to master for the preventive health of our patients.
Nicole Giesey, RDH, BSDH, MSPTE, practices clinically in Ohio. She is president of her local Tri-County dental hygiene association and has received the Proctor & Gamble Community Service award. She has a strong passion for dental hygiene education, writing, and research.
References
1. National Institute of Dental and Craniofacial Research. What are Dental Sealants? Retrieved Dec. 20, 2011, from www.nidcr.nih.gov/orderpublications.
2. Lesser D. An overview of dental sealants. Access, July 2001.
3. Wilkins EM. Clinical Practice of the Dental Hygienist (10th ed., pp. 60-64). Baltimore: Lippincott Williams & Wilkins, 2009.
Past RDH Issues
