Trisha E. O?Hehir, RDH, BS
Hygienists are in the midst of a major transition in how we deliver our services. In the past, hand instruments were the primary tools for instrumentation, with power scalers assigned an adjunctive role. Today, those roles have been reversed. Power scalers now are the primary instruments and hand instruments are adjunctive. Talking about this transition is easy ? making the transition is something else!
For many of us, our dental-hygiene education did not include instructions or adequate clinical experience to develop a proficiency with power scalers. The thought of trading our curettes for a power scaler is frightening. To make the most of this transition, we need to rely on our established skills with hand instruments, available textbooks, literature, and hands-on courses. These resources will enable us to make the transition with skill and confidence, rather than having the transition forced on us without adequate preparation.
Years of hand instrumentation with both curettes and scalers provide a strong foundation for power scaling. Our knowledge of root anatomy is essential. Highly-developed tactile sensitivity will assure our success maneuvering subgingivally with the new sonic and ultrasonic tips. The use of brute force to remove deposits will be replaced by careful, delicate movements with instruments that do the work for us if we let them. Just as it took time and practice to develop and refine our skills with hand instruments, so, too, will our proficiency with power scalers be a gradual process. Since we already have instrumentation skills, developing power-scaler skills will be considerably quicker.
However, more important than deposit-removal skills are detection skills. Detecting calculus is essential for effective removal, no matter what instrument is being used. Since power scalers make deposit removal easier and less strenuous on hands and arms, there will be a greater focus on detection and evaluation. The time and energy saved by using power scalers can be devoted to thorough evaluation.
In addition to our clinical skills, textbooks and journal articles provide current information, as well as history and background on this subject. However, too few textbooks on power scaling are available. One of the first, if not the first, was written in 1968 by Dr. Sol Ewen, then a professor at New York University. Currently, Dr. Ewen is a retired periodontist, AAP Diplomat and now an accomplished and award-winning computer-graphics artist. His 120-page text was intended to be a Ohow-to-do-it manualO for periodontists, general dentists and dental hygienists.
At the time this book was written, only three ultrasonic units were available. Despite what we have heard in the meantime, ultrasonic use was advocated both supragingivally and subgingivally in 1968. Local drug delivery, instead of water as the fluid lavage, was advocated using a separate, pressurized tank. Many inserts were described and pictured in that text, including an ultrasonic knife for surgical procedures, diamond-coated inserts and operative files for overhand removal. Detailed instructions, complete with diagrams and clinical photos, were provided for scaling, root-planing, soft-tissue curettage, surgical procedures, overhang removal and drug administration.
What seems to be new technology today actually was presented in great detail several decades ago. This is a text well worth reading for its application to current practice, as well as its unique historical perspective. This textbook may be 30 years old, but the information is timeless. Unfortunately, this text is out of print. However, the publisher, Charles C. Thomas, Springfield, Ill., will print special orders of at least 10 books.
To further enhance power-scaling skills, we need hands-on instructions with either patients, extracted teeth or mannequins. Some will need only to try out various machines and tips on extracted teeth, while others may need to seek out a hands-on course to complete the transition from hand instruments to power scalers.
To set up your own lab exercises, collect a few extracted teeth and set them in plaster. An easy way to do that is mix up enough plaster to fill a paper cup just two inches full and then set the tooth roots in the wet plaster, leaving several millimeters of exposed root surface around the cemento-enamel junction. When the plaster dries, peel off the paper cup. To simulate calculus, coat the exposed root surfaces with nail polish, immediately followed by dipping the crowns in corn meal or salt. Now, you have a few test surfaces on which to try various power scalers and compare the effectiveness of their tips.
Several educational and products companies offer one-day courses devoted to power-scaling. As a result of these courses, a few video and audio tapes also have been made available. Audio and video tape sources include: the American Academy of Periodontology, the American Dental Hygienists? Association, the Academy of General Dentistry, the Perio Institute and individual product companies.
Our challenge will be to take advantage of this technology and use it to our benefit. Many dental hygienists who have made this transition actually have added days to their work week, while eliminating hand, arm, neck and back pain associated with hand instrumentation. Remember, it is a slowly evolving process. We aren?t giving up our expertise with hand instruments; we are just transferring those skills.
Your skills with power scalers gradually will increase and actually surpass your current expertise with hand instruments. Rather than viewing this transition with dread, focus on the advantages and you will be surprised at your own technique development!
* Ewen, Sol, Glickstein, Cyrus, Ultrasonic Therapy in Periodontics, Charles C. Thomas Publisher, Springfield, Ill., 1968; telephone (217) 789-8980.
Trisha E. O?Hehir, RDH, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. Her e-mail address is [email protected].