Starting strong in practice: Asking for what you need to deliver optimal care 

As you begin to practice, you bring with you a strong clinical foundation and a commitment to providing safe, effective, and ethical patient care. One of the most important skills you will continue to develop, however, is learning how to advocate for the instruments, technologies and conditions necessary to deliver that care consistently. 

It is not uncommon to enter a practice where existing systems—instrument kits, ultrasonic inserts, and maintenance protocols—have been in place for years. While these systems may be familiar to the team, they may not always align with current clinical standards. Speaking up can feel uncomfortable early in your career, but both patient outcomes and clinician well-being depend on it. 

Why instrument condition matters 

Both hand instruments and ultrasonic technology rely on precision. A dull curette or scaler does not simply make instrumentation more difficult—it can reduce effectiveness, increase clinician fatigue, and compromise patient outcomes. Additionally, oversharpened or improperly maintained instruments may present safety concerns. 

Ultrasonic inserts present a similar consideration. A growing body of evidence continues to demonstrate that as ultrasonic tips wear, their performance characteristics change. Even minimal reductions in tip length have been associated with decreased vibrational amplitude and energy delivery at the working end, which may impact clinical efficiency.¹ More recent in vitro research has also shown that worn tips can produce altered root surface outcomes compared to new inserts, further reinforcing the importance of monitoring insert condition.² 

While research methodologies and technologies continue to evolve, it is important to recognize that many studies are conducted under controlled conditions that may not fully reflect the clinical environment. Variables such as saliva, biofilm composition, calculus tenacity, and access all influence real-world outcomes. For this reason, the broader body of evidence continues to support routine monitoring and timely replacement of worn inserts as part of maintainingconsistent clinical performance. 

Similarly, the effectiveness of hand instrumentation is closely tied to edge integrity. Dull instruments require increased lateral pressure, reduce tactile sensitivity, and may contribute to incomplete calculus removal or burnishing.³ Maintaining sharp instruments supports both clinician efficiency and patient comfort. 

Take ownership by creating a system 

Rather than approaching these concerns as problems, consider framing them as opportunities to support the practice. A solution-oriented mindset helps position you as a collaborative and proactive team member. 

You might consider proposing: 

• A routine inspection system for ultrasonic inserts using wear guides  

• A tracking process for instrument sharpening and replacement  

• Scheduled sharpening protocols based on frequency of use  

• Clear criteria for when instruments should be maintained versus replaced  

Establishing these systems helps ensure consistency, supports efficiency, and reinforces a shared commitment to quality care. 

How to start the conversation 

Initiating these discussions can feel intimidating, but thoughtful framing makes a significant difference. Keep the focus on patient care, efficiency, and team success. 

Consider language such as: 

• “I’ve been reviewing our ultrasonic inserts and would love to help implement a simple system to monitor wear so we can maintain consistent efficiency.”  

• “To support patient care and clinician ergonomics, could we revisit our sharpening and replacement schedule for instruments?”  

• “I’m committed to delivering thorough and comfortable care—having well-maintained instruments really supports that. Would it be helpful if I helped track this for the team?”  

• “I’d be happy to take the lead on organizing a simple system for monitoring instrument condition.”  

These approaches demonstrate professionalism, initiative, and respect for the existing workflow. 

Advocacy is professionalism 

Advocating for proper instruments is not being difficult—it is part of being a responsible clinician. Patients trust you to provide the highest standard of care, and that standard is directly influenced by the tools you use every day. 

As you begin your career, remember: that your knowledge matters. Your voice matters. And the systems you help build will shape both your success and the quality of care your patients receive. 

References 

1. Lea SC, Landini G, Walmsley AD. The effect of wear on ultrasonic scaler tip displacement amplitude. J Clin Periodontol. 2006;33(1):37-41. doi:10.1111/j.1600-051X.2005.00861 

3. Schlageter L, Rateitschak-Plüss EM, Schwarz JP. Root surface smoothness or roughness following open debridement. An in vivo study. J Clin Periodontol. 1996;23(5):460-4. doi:10.1111/j.1600-051x.1996.tb00575

4. Sabatini S, Maiorani C, Bassignani J, et al. Subgingival instrumentation: Hand versus power-driven instruments in periodontal therapy. Appl. Sci. 2024;14(5):1950. https://doi.org/10.3390/app14051950