Let your fingers do the talking

Oct. 1, 2001
Listen to your body. Learn to lighten up and trust the telegraphic messages you receive from your fingertips. These are basic rules for practicing in the comfort zone.

Listen to your body. Learn to lighten up and trust the telegraphic messages you receive from your fingertips. These are basic rules for practicing in the comfort zone.

Balance, grasp, rest, and fulcrum — four little words that can make or break your day — not to mention your hands, fingers, forearm, shoulders, back, or your career.

For decades, dental hygiene instructors have been charged with teaching students basic skills. Fulcrum ... fulcrum ... fulcrum was one concept that was drilled into our heads. But after graduation, out of sheer necessity, we broke some rules just to be able to survive the workday. Most of us developed our own style of practice.

Years ago, I abandoned the classical fulcrum position — you know, the rule that mandates that the ring finger must fulcrum on the tooth directly adjacent to the one being scaled. I felt guilty as if I was breaking some kind of sacred dental hygiene law. That type of positioning never worked well for me.

Fifteen years ago, Anna Pattison, RDH, MS, "The Queen of Curettes," absolved me. During a course that she taught, Pattison recommended using whatever fulcrum point you needed to get the job done. I left the course elated! Finally, I was free to practice without wondering if the dental hygiene police were going to swoop down and reposition my ring finger every time I picked up another scaler or curette.

Fortunately, times have changed and students are now being taught to establish a secure finger rest while trying to keep the wrist in a neutral position. Students initially still learn the classical fulcrum position. However, when they become more skilled, alternative and extraoral fulcrums are often introduced. Today, a fulcrum or rest can be either on the teeth inside the mouth, or extraorally on the facial bones. Every fulcrum also will be affected by the size of your hand, the length of your fingers, and the location of your work in the mouth.

Unless you are a new graduate or haven't practiced for a decade or more, you should be aware of the revolutionary changes in instrument design. Instrument handles are much larger in diameter and are lighter than ever. All of the new designs have a textured surface which improves grip; some are fabricated with materials that provide a cushier grip than all-metal instruments. Each of these changes improves our ability to perform quality instrumentation with a lighter grasp. A lighter grasp means less pinch/grip on the instrument handle, which is an ergonomic benefit for all of us. Textured gloves make it even easier to maintain a lighter grasp.

Now consider instrument balance. If you held on to your instrument like a conductor's baton, you wouldn't have accurate control over the working end. In contrast, if your fingers grasped the instrument on the shank, your fingers would be cramping after a few hours of simple scaling. It is important to use well-balanced instruments — ones that will balance in the crotch of your hand. This is one reason why it is so difficult to use that double-ended instrument that has one end broken off — the instrument is out of balance making it impossible to grasp it in a relaxed fashion.

In the old days, hygienists only used power-driven scalers when patients presented with oral conditions so advanced that we were forced to blast the chunks off. Or the patient's stain was so heavy that even super-sharp

hand instruments would have led to hours of hand instrumentation, not to mention hours of pain for the hygienist's body. Improvements in power-driven scalers and changes in insert designs have changed the way we practice. Power-driven scaling is now an accepted part of routine as well as complex dental hygiene appointments.

Ultrasonic scaling demands an even lighter grasp than hand instruments. Today's ultrasonic inserts are thinner than ever. If you are willing to hold the ultrasonic handpiece with a probe-like grasp, the insert can transmit amazing amounts of information to our well-trained fingertips. Lowering the scaler's power and frequency settings will result in even greater tactile sensitivity.

The fulcrum rules are different for power scalers as well. It is virtually impossible to maintain balance with an ultrasonic handpiece if you attempt to fulcrum on the tooth next to where you are scaling. Use extraoral soft-tissue rests. For example, rest lightly on your patient's lip, facial bone, or your other hand. Today's ultrasonic scalers require a feather-light touch to be most effective. All you need is stability or a finger rest, not a heavy fulcrum point. My favorite is the "pinky finger rest." Since I'm not a hand anatomy expert, I cannot tell you why this works, but if you use your pinky finger, you will not be able to tighten down on the instrument. Just pick up one of the new larger-barreled pens and practice the pinky rest on a countertop. As soon as this grip feels natural, incorporate your new skill into how you hold on to your ultrasonic handpiece.

Listen to your body. Learn to lighten up and trust the telegraphic messages you receive from your fingertips. These are basic rules for practicing in the comfort zone.

Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics (www.ergosonics.com). She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].