Most hygienists' wrists are in for a workout by scaling and polishing day after day. Even though we all understand how important it is to perform procedures with correct instrumentation techniques, are we overly focused on thorough debridement or polishing procedures at the expense of our own bodies?
What is the ergonomic toll when we don't pick up the correct instrument, thinking to ourselves, "It's just one more speck of calculus or one more spot of stain?" For example, many instruments are specifically designed for reaching challenging posterior teeth, crowded lower anteriors, and lingually inclined teeth. We have wonderful choices today - instruments with all kinds of curves and bends and ones with longer shanks to help ease our access. There is a whole world of instruments beyond the 6/7 anterior sickle or the Columbia 13/14 posterior curette.
Are you taking full advantage of the right and left ultrasonic scaler tips, the latest in ultra thin tips, or the new swivel inserts? Each insert was developed to give us better access when scaling malpositioned, crowded or splinted teeth.
The original, universal straight insert designs just do not fit many areas. Often, they are too large in diameter, or they lack the ability to adapt in areas of complex tooth morphology.
Let's take instrumentation a step further. We all encounter patients whose lower anterior teeth have a severe lingual tilt. There is not an anterior scaler designed to help you in this situation. But did you know that a posterior hand scaler, or the right and left ultrasonic tips, could be exactly what you need to keep your wrist in a neutral position? This idea applies to power-driven instruments as well as hand scalers and curettes.
Another way to approach this difficult situation is to change where you are positioned relative to the patient. Rather than trying to access these difficult areas positioned in an 8- or 9-o'clock position, reposition your operator chair at 12 o'clock, which works for both right- and left-handed clinicians. It may also help to have your patient lower his chin to his chest while you are working in this area.
How about polishing? I know you are saying to yourself, "But I only spend a little bit of time on polishing." Yes, but it is a little bit of time, on patient after patient, day after day, week after week. I'm sure you can see where I'm headed. The repetition adds up. What are the long-term effects on your hand, wrist, forearm, shoulder, and neck?
Right-angled prophy angles subject the wrist to periods of continuous bending and flexing to reach all tooth surfaces, rather than maintaining an ergonomically beneficial neutral wrist position. Contra-angled prophy angles or polishers can be the answer. The older metal latch-type handpiece, as well as some brands of newer slow-speed handpiece, are manufactured with this configuration.
The downside to these solutions is the sheer weight of the metal; however, we now have several solutions for these problems.
About seven years ago Young Dental Mfg. developed a disposable contra-angled prophy angle. Until last year, it was only available with the longer turbo prophy cup, so that clinicians who preferred shorter cups were not inclined to take advantage of the angle's little backbend. When hygienists requested a disposable contra-angled prophy angle, the company developed the new Contra Petitetrademark, which is also latex free. The smaller cup is particularly beneficial for patients with limited openings, tight buccal mucosa, or very small mouths. Now all clinicians can benefit from this type of angle design.
Reduce handpiece cord weight
Another serious consideration is the weight and tug of the handpiece cord. If the cord is heavy or coiled, consider replacing it with a newer, lightweight straight cord. This is a relatively simple solution for a very annoying problem, and, if someone in the dental office is handy in the repair department, it is fairly easy to replace the cords. Otherwise, it is a quick job for someone experienced in repairing dental equipment. Replacement cords are available through your local dental supply company or through dental equipment catalogs.
There is also another solution to the dreaded cords: a cordless polishing handpiece. Cordless devices have been available for years on many devices we use in our everyday lives. So it is natural that someone would think of applying this technology to our polishers.
Believe it or not, the Taskall cordless handpiece made by NSK America was developed more than five years ago and is one of the best-kept secrets in dental hygiene ergonomics. This polisher only weighs 3.5 ounces and is designed with a contra-angled head, which gives just enough bend in the body of the angle to facilitate a neutral wrist position. Currently, the handpiece is available with a special autoclavable prophy angle head.
A cordless polisher that will accept a disposable prophy angle should be available by the end of the year, allowing clinicians to use their favorite disposable angle.
Remember that unnecessary force increases the risk for repetitive stress injuries, so soft flexible prophy cups allow us to use much less pressure during polishing. This is also important because firmer cups increase abrasion of valuable tooth structures. According to Young Dental, more clinicians are using softer prophy cups today.
Consider anterior swivels
Many hygienists use polishing devices that lack adequate swivel mechanisms or just weigh too much. An anterior fingertip swivel puts the least amount of strain on one's hands and wrist. Good examples of this type of device are the new Benco Pirouette handpiece or the classic Midwest RDHtrademark handpiece. Both handpieces are much larger at the cord end, also reducing the problem of pinch grip.
Many of the newer polishing devices are what I term "weight-watchers." They generally weigh about 3.5 ounces and the weight is balanced throughout the entire length of the polisher.
The older handpieces can weigh nearly 10 ounces, if a metal prophy angle is used. Older handpieces also suffer from poor weight distribution, with most of the weight at the motor end of the device, so a clinician's hand and wrist are forced to support the uneven weight.
All of us know that polishing is not a therapeutic procedure, but the vast majority of patients still want their teeth "cleaned."
How can we solve their wants as well as consider our need to protect our bodies?
My answer is something I call "stealth polishing." I know many of you already practice this way, but here is the concept. Polish quickly and lightly, focusing on the areas patients see and feel. Save your hand and wrist by removing stains with your power-driven scaler, rather than relying on hand instruments or polishing.
Polishing paste options
A final consideration in polishing should be the type of polishing paste. For years, we have been polishing with pumice-based products. However, a new polish was developed several years ago that fits right in with stealth polishing. 3M ESPE's Clinprotrademark polish features integrated abrasion variability. This means it changes from coarse to fine very rapidly, even when spinning in the cup. Research has shown that this polish removes more stain than pumice-based products with less abrasion to enamel, dentin and composite restorations.
It is important to understand that pressure and speed are not necessary when you use this paste and a little goes a long way. So reduce the handpiece rpm so that you will have better control over this creamy polish. It appears that Clinpro paste produces a more lustrous tooth structure, however, there is no research to substantiate this observation.
Polishing seems like an innocuous procedure, but every time I pick up my old 9.5-ounce handpiece fitted with a metal prophy angle I remember the 16 years I tried to balance this heavyweight polisher while fighting tightly coiled cords just to remove some stain that often reappeared in just a few days.
I remember my aching wrist and tingling numb fingers that awakened me at night.
I am amazed that so many of us have survived years of dental hygiene practice, but as I travel around the country I meet many hygienists in pain. Some think that it is just part of hygiene, while others know that discomfort is a fast path to physical and emotional burnout.
Are you willing to continue your own ergonomic nightmare or are you ready to join me - practicing in a comfort zone?
Anne Nugent Guignon, RDH, MPH, practices clinical dental hygiene in Houston, Texas. She writes, speaks, and presents continuing- education courses on ergonomics and advanced ultrasonic instrumentation through her company, ErgoSonics (www.ergosonics.com). She can be reached by phone at (713) 974-4540 or by e-mail at [email protected].