By Dianne Watterson, RDH, BS, MBA
Recently, I posed a question to two large online groups of hygienists on Facebook. The question was: What is the one thing you would like for your boss to purchase that would improve your work life? I received a variety of answers, but there were four answers that stood out, namely (1) new/sharp instruments, (2) power scaler inserts, (3) loupes/headlight, and (4) x-ray sensors. I can relate to all of these.
Can You Sharpen Effectively?
The necessity of high-quality, sharp instruments cannot be overstated. My favorite dull instrument analogy is like trying to scrape paint off the barn with a football. Yet, many hygienists work with dull, worn-out, and substandard instruments.
Why? It may be because the doctor is reluctant to purchase new instruments. All instruments wear out with use, so it is important to make sure you have the tools needed to do the job. Sharp instruments remove calculus better, decrease hand fatigue, and increase patient comfort.
Another reason for working with dull instruments is that many hygienists and doctors have difficulty with sharpening. Over the years, various sharpening methods have been developed, but this skill remains elusive for many clinicians. When I was in hygiene school, we were taught a method where the stone was flat on the table, and we swiped the instrument against the stone. Truly, it was not a good way to sharpen, because there was no good way to assess the angle of the instrument to the stone. It's no surprise that my instruments were never very sharp.
Later, another sharpening method was developed and implemented in most hygiene programs. The "moving stone" technique involves holding the instrument in one hand and moving the stone against the blade. The problem is that it is difficult, if not impossible, to maintain the correct angle of blade to stone with each successive stroke. Also, hygienists remove more of the blade than is necessary, given the large size of the sharpening stone. Most instruments are dull from 1-4 mm from the tip of the instrument, but the moving stone removes metal the full length of the blade.
A few years into my career, I learned how to sharpen with a high speed handpiece and a small friction-grip stone (Shofu.com). This method was far superior to anything I had ever tried, including automated sharpening devices. Needless to say, learning how to sharpen effectively changed my life (see wattersonspeaks.com/the-better-way-to-sharpen-dental-instruments.html).
Loupes and Head Lights
The addition of loupes (and later a head light) was another game-changing milestone in my clinical career. Not only could I see better in my patients' mouths, but loupes helped me see the dull edge on my instrument, thereby showing me exactly what to shave off. Magnification aids sharpening precision so that only the dull edge is being removed.
Sharpen-free and high quality stainless steel
Another way to overcome the problem of dull instruments is to use "sharpen-free" instruments that are lightweight, ergonomic, and have thin working ends that make scaling a breeze. Another option is stainless steel instruments that are made of high quality stainless steel, but do require periodic sharpening.
Equally important for hygienists is a high-quality power scaler. A power scaler is just as important to a dental hygienist as a high-speed handpiece is to the dentist, and I can't imagine working in dental hygiene without the use of a power scaler. Wonderfully thin inserts allow the hygienist to debride pockets much more efficiently than with hand instruments alone. Periodontal debridement and maintenance procedures should be performed with liberal use of power scalers in addition to hand scaling.
However, many hygienists complain that they don't have enough inserts, or the ones they have are worn down. All inserts wear down with use, and when 2 mm of metal is lost from the tip, the efficiency is reduced by 50%. To ensure power scaling efficiency, it is essential to have a good power scaler and the proper number of power scaling inserts/tips to enable thorough instrumentation.
Not Enough Sensors
Another problem in many offices is not having enough x-ray sensors of a variety of sizes for the office. When the office has an inadequate number of sensors, staff members will waste time waiting for a sensor. Hygienists may be forced to delay or dismiss taking necessary radiographs, simply because of sensors being unavailable.
Here are a few more items that hygienists wish their doctors would purchase:
- A hygiene assistant
- Cordless handpiece
- Ergonomic chair or new patient chair
- Intraoral camera
- Voice probe
- Health insurance
- An office cruise
- Digital x-ray
- Beer/wine fridge
- New office manager
- A new personality
How to Get What You Need
The question I posed to the online groups asked for hygienists to name one thing they need to improve their work life. There were hundreds of responses-some serious and some humorous. So how do you approach this issue with the boss?
First, I think you have to decide if this is a true need, or is it just something you'd like to have. There are certain pieces of equipment and instruments that you need. Without those items, you cannot provide optimal care. So, for necessities, the best way to begin the conversation is to say, "My goal has always been to treat our patients with the best care possible. Just like you need good sharp burs to cut through tooth structure, I need good sharp instruments to do my job well. I've made a list of the instruments I need."
When making requests for items you need to do your job well, the cost/benefit ratio should be considered. Can you show the doctor how the purchase of certain items might increase productivity or case acceptance? For example, an intraoral camera makes a good communicator become a great communicator when you can show the patient his/her dental needs on a computer screen. IO cameras will often pay for themselves in a short time.
For magnetostrictive inserts that are worn, it might be possible to rebuild rather than replace. A service that offers rebuilding of inserts is Madultrasonics (madultrasonics.com) in New York. Owned by Madalyn Rosenbluth, RDH, this company not only rebuilds but recycles worn out or broken inserts. They use only the highest surgical grade stainless steel.
Since magnification is a custom-fitted piece of equipment, it is appropriate for hygienists to purchase their own. Consider it an investment in your career longevity. All the same, I've known some generous dentists to purchase loupes or pay 50% of the cost to help the hygienist.
Magnification for the dental hygienist is essential equipment. Hygienists who do not wear magnification but work for dentists who do wear magnification have no idea what a disadvantage they place themselves. Clearly (no pun intended), the dentist with loupes can see far more than the hygienist without loupes.
X-ray sensors are extremely expensive. Sometimes, the doctor just has to bite the bullet and purchase more when the need become critical.
The best approach is one in which you can show the doctor how those things you need will benefit the patients and the practice. The secondary benefit is the improvement in your work life. RDH
All the best,
DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is an award-winning speaker, author, and consultant. She has published hundreds of articles, numerous textbook chapters, an instructional video on instrument sharpening, and two books. For information about upcoming speaking engagements or products, visit her website at www.wattersonspeaks.com. Dianne may be contacted at (336)472-3515 or by email [email protected].