The gripping details

Jan. 1, 2002

Recent innovations for dental instruments can provide you with more than a comfortable grip — they can help you avoid injury and comfortably extend your career.

I'd like to think that it was a fortunate accident that I became a hygienist. I have loved my career and enjoyed the constant challenges that hygiene presents. Could I have been happy in another career? I think so. Occupational therapy would be high on my alternate list. Occupational therapists are neat people. They are problem solvers and I like that. They teach normal daily living skills and help people learn to get along in life, using what they have, despite a disability. Occupational therapists help people live productive lives.

Hygienists have occupational-therapy brains. We are always looking for just the right home-care device for our patients. For example, we learn to give very small brushes to patients who have very limited openings so that they can be more successful with their oral care. We all have patients with serious arthritis crippling their hands, making every attempt at oral care painful and inefficient. We know to recommend a larger-handled toothbrush with a textured grip or perhaps a power brush.

Do we apply the same kind of critical thinking to our own tools? What if all of your hand instruments have the old skinny number 2 handles, would you know how to enlarge the instrument shaft to improve and relieve your grasp? Some hygienists use re-tipped scalers and curettes, either by choice or economic necessity. While this discussion is not a forum to debate the relative merits or demerits of re-tipping hand instruments, many of the instruments that are being re-tipped have the older, thin handles. Here is another issue: What if the handpiece on a diagnostic or therapeutic machine is just too skinny or perhaps too smooth compared to all of today's new instruments?

Do you think your only choice is to work with these antiquated designs until you are able to order some of the innovative and improved designs? Are you stuck using hand instruments or other devices that cause you to exert excessive pinch/grip? Remember, the more you pinch down on the instrument handle, the more tactile sensitivity you lose — not a very good trade-off just to be able to hold onto your tools.

Two dental hygienists suffered pain and repetitive stress injuries from using less-than-ideal ergonomic instruments — instruments with small-diameter handles. Their pain and frustration forced them to think like an occupational therapist. Both were driven to solve their own pain issues. In the process, each one invented an adaptive device designed to help other hygienists avoid a similar fate. Let me introduce you to the Acushy™, the Chub-Eze, and the Surgi-Chub — catchy names for very clever products.

Until recently, all mirror handles were very, very slim. Unless you are using a disposable mirror, your dental practice probably has used the same mirror handles for decades. Have you ever seen an all-metal mirror handle wear out? The mirrors, yes; the handles, no. Slender handles require a much tighter pinch/grip, which can lead to all kinds of ergonomic problems and possible injuries.

It may strike you as unimportant to pad a mirror handle. After all, most of us use the mirror in our nondominant hand. How could this possibly cause a problem? The mirror is a double-duty device: we use it to see what we are doing in the reflective surface as well as using it as a retraction tool. Imagine how hard it would be to move a tight cheek out of the way to see the facial of tooth number 14, or to tame a wiggly, slippery tongue if we didn't have a mouth mirror. But it is just these types of forceful retractions requiring an extraordinary amount of pinch/grip that can lead to injuries in our hands and fingers.

In fact, Theresa Forgy, RDH, inventor of the Acushy mirror grip, suffered permanent damage to her thumb joint from just such activities, as well as carpal tunnel syndrome in her other hand. Her clinical career ended abruptly after only seven years, but she now is focused on developing products that will help to extend the careers of other clinicians.

The soft, disposable Acushy [(800) 292-9140] is shaped like a slim cigar that's been hollowed out to just the right size to fit over a mirror handle. It feels like a foam pillow allowing for a much lighter modified "pen" or palm grasp. The Acushy grip is fabricated from an FDA-approved material. It slips easily over disposable mirror handles as well as most thin metal handles, and is available in a medium blue or black. Autoclavable Acushy grips will be available in the future.

Shari Williams, RDH, suffered from carpal tunnel syndrome and Dequervain's syndrome. She discovered that larger instruments eased her finger and hand pain, so she developed Chub-Eze and its sister grip, Surgi-Chub [(800) 665-6764], to help herself and other hygienists. These textured silicone grips were designed to improve the grip of hand instruments in addition to increasing the diameter of the handle to 12.5 mm.

Both are autoclavable and feature a comfortable ribbed surface. The Chub-Eze grips are a bit firmer to the touch and come in a variety of colors which can function as instrument color-coding devices. Surgi-Chubs grips are softer and more flexible; they can be stretched to fit a wide variety of other instruments. However, they are only available in basic black.

Let me give you an example of how I solved an ergonomic problem with a Surgi-Chub. The Diamond Probe is an excellent diagnostic and educational device. It has helped me discover active periodontal sites long before conventional methods would have revealed pathology. Patients are really tuning in as I explain how the presence of volatile sulfur compounds is an early indicator of periodontal disease activity. They are committing to treatment in a way I never thought possible.

But here was the problem: the autoclavable Diamond Probe handpiece is very smooth, fairly small in diameter, and so lightweight that it was difficult to determine exactly where I was maneuvering it.

I might be the only hygienist on the planet who would feel this way, but I really wanted to be comfortable using the probe. So I slipped a Surgi-Chub onto the handpiece, and voilà! I could feel what I was doing and where I was going! My tactile sensitivity was back and now I can use the Diamond Probe without dreading its small, smooth handle.

Can you imagine all of the creative uses for the Acushy, Chub-Eze, and Surgi-Chubs in your dental office?

And if you really let your imagination go wild, I'll bet you can come up with some other great uses for these clever products.

Just tap into your occupational therapy brains and you'll be amazed how such simple and cost-effective devices can have so much impact and allow us to spend our day 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 ( She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].