Hand instruments: Easy does it

April 1, 2006
Clinical dental hygiene puts all of us at risk for developing some type of repetitive stress disorder.

Clinical dental hygiene puts all of us at risk for developing some type of repetitive stress disorder. The risk goes up every day you practice. Multiply the days by years. Add in days filled with too many patients per hour or too many clinical hours packed into one day. The long-term, cumulative effect of continuous repetitive microtraumas is not simply additive but rather exponential.

One of the biggest, and often ignored, contributors to microtrauma is the hand instruments we use every day. Even though more clinicians are using power scalers than ever before, it is impossible to imagine dental hygiene practice without some type of hand instrument. At the very least, we still need mirrors, explorers, and probes.

For years, there was little innovation in the design of hand instruments. Instruments were skinny, heavier than necessary, and handles were either smooth or had just a lightly textured surface. While these designs are still available, instrument designers over the past decade have paid considerable attention to ergonomic issues, and we are the lucky recipients of their innovative ideas.

Today, we can select instruments in a variety of handle diameters. It is much easier to hold a larger diameter hand instrument than a skinny one with a light grasp. The lighter the grasp, the lower the force of the pinch grip, which results in less hand fatigue and improved tactile sensitivity. It is nearly impossible to feel small subgingival deposits, slight anatomical irregularities, or subtle restorative discrepancies when holding onto a hand instrument with a death grip.

The handle surface is important as well. Since texture equals traction, especially in a moist environment, are your instrument handles helping you as much as they can? Most of the instruments on the market now feature some type of comfortable, textured handle. Textures range from crosshatch designs to striations and from rippled, dimpled silicone grips to contoured surfaces, which determine actual finger placement. Some handles are made with medical grade silicone grips to give the user a softer surface to grasp.

Instrument handles also vary in length. This is particularly important from the standpoint of balance. A short-handled instrument is not the ideal choice for a clinician with medium to large hands. An instrument that does not feel balanced is uncomfortable to use, and there is a tendency to tighten down on the handle to maintain control.

The overall weight is determined by the size, design, and type of material used in the fabrication of an instrument. Plastic mirrors and periodontal probes, as well as graphite implant scalers, are the most lightweight devices in our armamentarium. A growing number of instruments have all-resin handles, which dramatically reduce weight. Clinicians who experience hand and forearm pain often find that lighter weight instruments help ease discomfort. Some hybrid instruments combine resin and metal components, a marriage of materials that yields lighter instruments. Most all-metal instruments are now lighter weight because of the hollow handles.

Mirror handles are famous for sticking around forever. I’ve seen them last for more than 30 years. There is an answer for those of you stuck with those skinny-handled wonders. Purchase some after-market, autoclavable, medical-grade silicone grips. These inexpensive add-ons, created by clinical dental hygienists, improve texture and diameter, reduce hand fatigue, and come in a choice of colors. The inventors knew there had to be a better and safer way to hold on to an instrument.

Mirrors not only provide visibility and, at times, increased illumination in the oral cavity, but they are also used for tongue and cheek retraction. It is important to keep one’s grip light on the mirror handle. A tight grasp can cause a great deal of tension in the clinician’s hand, forearm, shoulder, and neck muscles.

Double-sided mirrors are an interesting configuration that allows clinicians to see the working field more clearly during retraction. In addition, the screw-in mirror stem is not straight but features a small bend, which keeps clinicians’ wrists straight during tongue retraction. Another interesting variation are the mirrors equipped with suction to help maintain a clear, dry field of vision.

Some implant scalers have replaceable screw-in tips. A variation on this theme is a periodontal probe with plastic color-coded tips that are easy to replace when the probe markings wear off. Several brands of conventional scalers and curettes also feature screw-in tips. This allows clinicians to custom-build their own unique instrument or easily replace a broken or worn-out tip.

Recent advances in metallurgy and material coatings translate into scaling instruments that remain sharp over a prolonged period, even over a month’s worth of heavy use. Sharp instruments are more efficient and result in fewer strokes for effective deposit removal. It takes time to keep scalers and curettes sharp and ready to face their clinical challenge. Since time is money, it makes more sense to spend valuable time with a patient in the chair vs. sharpening hand instruments. If one examines the numbers, instruments designed to stay sharp longer are much more cost-effective than those of traditional design.

It is critical to have enough instruments to make it through a day. In multiple-clinician practices, it is also important for each hygienist to have his/her own set of instrument packs. We each have our own personal favorites and everyone’s sharpening techniques vary. As dental hygiene professionals, we should strive to build our own personal arsenal of quality hand instruments so we can practice in the comfort zone. Clinical dental hygiene is hard work, mentally and physically. Our thoughts should be free to focus on the patient in our chair, not on whether we have the right hand instruments.