First, thank you for taking the time to read my column on power-driven scaling in the August 2007 issue. The title, “Power-Driven Scaling - Embracing New Challenges,” addresses the core issue succinctly. Education is the key to any developing technology and the world of power-driven scaling has been evolving at a very rapid pace over the past decade, so there are bound to be some lively discussions.
Your letter to the editor that was published in the October 2007 issue contained some statements that caused me great concern. The column contained a bulleted list of techniques that could improve scaling effectiveness; however, it was merely a list of suggestions, without any mention of which could be the most or least effective. You called into question the recommendation to activate the tip prior to placing on the tooth surface. In your letter, you state that this technique will cause patient discomfort and result in broken tips.
Activating an ultrasonic insert prior to placing the tip on the tooth surface is a widely accepted technique described in all major textbooks used in dental hygiene programs in North America. This technique, recommended to improve patient comfort, also ensures fluid cavitation and allows a clinician to evaluate tip movement and integrity prior to scaling. Undoubtedly, incorrect piezo tip adaptation on the tooth surface can create significant discomfort because of the linear tip movement. In addition, it is advisable to use low power levels with today’s slim and micro-slim inserts to avoid breakage.
It can be argued that current chapters focus predominantly on magnetostrictive devices; however the just-released book by Freidus van der Weijden, “The Power of Ultrasonics,” is written primarily from a piezo electric point of view and this 2007 text does not support what you have suggested.
In addition, five major distributors of piezo electric scaling devices sold in the U.S. market and four distributors of magnetostrictive units, recommend activation prior to putting the tip on the tooth. None of these companies has a history of the type of tip breakage you reported.
Finally, our key focus should be keeping the dialogue about power scaling open in a thoughtful and respectful manner. There is much we can all learn from each other as we move forward with the numerous advances in power driven scaling.
Anne Guignon, RDH, MPH