Instrumentation study with students offers a different perspective on sharpening
BY EILEEN MORRISSEY, RDH, MS
No disrespect intended by the title! This article describes and summarizes an educational activity that took place during the 2013-2014 academic calendar year for 11 second-year dental hygiene students throughout the United States. The program was sponsored by American Eagle Instruments, Inc., the manufacturer of XP Technology instruments.
The purpose of the activity was to allow the group of students the opportunity to experience the use of XP Technology instruments during patient treatment in the teaching clinics. Their experience with the technology would be assessed via a written survey during the academic semester.
Nine dental hygiene program directors chose to be involved, and 11 students participated in the activity. Two programs enrolled two students in the study. The directors chose the students who would participate.
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I have a special interest in this project for two reasons. First, I am a clinical instructor at Burlington County College in New Jersey, which was one of the participating programs. I had the opportunity to observe and discuss the instrumentation with our student. Secondly, I provide continuing education seminars where licensed hygienists learn about XP Technology instrumentation during hands-on activities. I make no bones about the fact that I have an unabashed enthusiasm for American Eagle's XP (sharpen-free) Technology. I am in private practice two days each week, and have been using these instruments since June 2013. Yes, scaling is fun again because I am working with exquisitely sharp instruments that never need sharpening.
The fascination for me was observing how the hygiene students vs. experienced hygienists from the hands-on seminars responded to XP Technology - hence my title referring to "babes." It is a pleasure seeing the commentary of the students, as they have an open, unbiased perspective common to being in the early stages of dental hygiene learning.
A variety of learning options may exist within a dental hygiene curriculum. For example, at Burlington County College's program, our students first learn ultrasonic scaling with conventional, magnetostrictive Cavitrons. As they get to their third semester in clinic, they are instructed in how to utilize piezo units for a different ultrasonic experience. This also happens with radiographs. Students learn conventional methods for taking films, as well as digital radiography.
It can only be valuable for students to be exposed to different options during their learning period. They are better prepared to enter the dental hygiene workforce after a variety of experiences.
XP Technology is a patented surface engineering process in which the metallurgical composition of the instrument's surface is enhanced. The material is now significantly harder, giving it more durability. An edge is created that eliminates the time-consuming and often imperfect process of sharpening instruments.
Because the blades are designed never to be sharpened after leaving the manufacturer, American Eagle fabricates the instruments to be as thin as possible. These blades allow for easier access into interproximal areas and periodontal pockets, which enhances patient comfort. There is less chance for tissue trauma, thanks to a rounded opposing edge.
XP Technology instruments are designed to be comfortable for the clinician. The increased sharpness and thinness of the blade improves tactile sensitivity, which allows for a gentler grip. Minimal pressure is needed to remove calculus; therefore, modification in traditional scaling technique is important. Lighten the grasp, and shave the deposit rather than popping off calculus.
How students viewed sharpening
The study was an opportunity for the participating schools to learn more about XP Technology via the students and the clinical instructors who oversaw them. They might then decide if it is an option they would like to include permanently within the curriculum.
Prior to the study, the students were emailed a questionnaire. Five students indicated they "feel the need" to sharpen instruments after "several" patients; four students sharpen instruments after each patient. The remaining two did so after "many" patients. One student made a distinction between "prophy" patients and scaling/root planing patients, recognizing the need to sharpen during scaling and root planing.
Nine of the students estimated that it took at least 10 minutes to sharpen the instruments in a kit. The study noted that students may have varying numbers of instruments in their kits.
In addition, 10 students said their hands "sometimes" or "frequently" are "tired" after scaling a patient. Another question revealed that 10 students have noted patients "sometimes disliking the noise made" during scaling. Eight students said at least seven strokes were required when "removing large pieces of calculus with your stainless steel instruments."
Students were also asked to list two characteristics that they did not like about the instruments used before the study. Some of the responses included:
"It takes time to differentiate which instrument you are looking for because all of the handles look the same."
"They are losing their shape because of how much I have sharpened them."
"The way they look after they have been in the ultrasonic a couple of times. They look very worn and old."
"Having to sharpen them and not knowing if I'm improving the instrument or making them worse."
"Sometimes I wish there was a thinner instrument to really get into the interproximal areas."
"I still have to sharpen them. Did I mention I hate that and feel like I'm just ruining my instruments?"
Effect of sharpen-free instruments on technique
After the initial survey, and prior to using the XP instruments, the students were required to view a webinar, which explained the technology in more detail, and instructed them in the modified scaling technique necessary to gain the maximum benefit from the technology. At that point, the students were deemed ready to begin.
At the close of the fall semester, 10 of the 11 participating students returned a questionnaire.
The students estimated they had used the XP Technology instrument on four to 20 patients. After rating the sharpness very highly, the students offered the following comments about the grasp used with the modified scaling technique:
"I did not have to apply very firm pressure, because I'm using a shaving stroke, which is nice since my hands don't have to work as hard. It's weird to get used to, and sometimes I revert to using them like my old instruments and have to catch myself because they aren't effective when used that way."
"I don't feel that I need to apply as much pressure when I'm using the instruments because the deposits are usually removed in no more than two strokes."
"My hand was not as tired at the end of the day when I was using these instruments."
"I am not using as much pressure or holding my instrument as tight."
"I used the same scaling technique that I always have; I just relaxed my grasp and allowed the instrument to do its job."
"When using the instruments, I use a modified scaling technique. I love the way they feel when I am scaling. I feel like I get a very good adaptation to the tooth surfaces."
Students also commented on whether patients observed any differences:
"Yes, I always try to have my patients feel the tooth surface with their tongue before I remove the plaque and calculus. Not only did they see the difference, they felt the tooth surface was smoother."
"I do not believe I have asked my patients if they could feel a difference in these instruments, but I know they have said they like the difference in the amount of noise the AEI do not make."
"Yes, they said they really like the lighter pressure, and they didn't seem to hear the scraping sound as much."
The students also offered "final thoughts" about XP Technology:
"They're a little bit of a challenge to get used to, because I have to learn to work a different way than I was taught. When you are scaling, it's hard to tell whether you are actually removing calculus or just biofilm, so you really have to use your explorer to tell where the calculus is, and then go over it with the instruments. With the old instruments, you could kind of use the scaler like an explorer as you went along if you held it lightly and you could tell when you felt calculus. I also have to be more precise with my instrumenting because it would be much easier to lacerate my patient's gingiva with these [instruments]. I love how sharp they are though."
"I absolutely love these instruments! First, the different colors of the composite handles make it easier for me to remember which instrument is which without having to look at the ends. The weight of all the instruments is significantly less, especially the composite resin ones. It feels like I'm not holding anything in my hand. Also, as I'm scaling, I can feel the instruments actually staying sharp. It's difficult to explain, but I notice that they're not getting dull, especially when I compare them to my school-issued instruments."
"I really like them but I feel scared to use them because I don't want to ruin them. How can you not use lateral pressure when you have huge chunks of tenacious calculus? I feel like I couldn't use just the XP instruments on patients with heavy tenacious calculus so I would have two sets of instruments out, which took up space and time. I would use lateral pressure with my other set to remove the large pieces and then fine tune with the XPs. However in my lower class calculus patients, they are wonderful. I loved how thin and light the instruments were which made getting under tighter, healthier tissue much easier. And it was easier to use the light exploratory stroke when the calculus was smaller and more grainy."
I reiterate my satisfaction in reporting on the unbiased perspective of students who are not yet "seasoned" hygienists. It is refreshing. I appreciate the opportunity to present the results of this educational activity to RDH readers. If you would like more information about American Eagle's XP Technology (including a video instrumentation demonstration), please visit their website at www.am-eagle.com. RDH
EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey.com.