True synergy comes from attaching a disposable contra prophy angle to a lightweight handpiece. The finishing touch is replacing old, worn, tightly coiled hoses with a new lightweight long straight air hose.
Anne Nugent Guignon, RDH, MPH
The early dental-hygiene pioneers manually polished tooth surfaces until they glistened, with the slow deliberate strokes of their wooden points tightly secured in their porte polishers. Either a little dab of coarse, minty polish was scooped out of a big jar, or a homemade brew of pumice and mouthwash was blended in a dappen dish. Eventually, hygienists graduated to belt-driven, slow-speed handpieces. Prophy paste packaged in individual cups was a major breakthrough in the early 1970s. Finally, we were allowed to use air turbine handpieces fitted with right-angle-designed, all-metal prophy angles.
Coronal polishing used to be as straightforward as vanilla ice cream. Hygienists meticulously polished all exposed tooth surfaces with whatever handpiece and polishing paste was at hand - the coarser the paste, the faster the job. Patients measured a hygienist`s skill solely on the ability to obliterate all traces of their personal habits. Ah, those were the days!
When I was a new hygienist, patients expected polishing. So I happily polished all day long, giving little thought to what I was doing to my body. I never thought about my wrist, my forearm, or my shoulders. Sure they ached, but I was determined to remove the dreaded stain.
Let me introduce my first handpiece to you. It was long and skinny with a large heavy motor at one end, creating a non-stop balancing act that forced me to keep a tight grip on the shaft. When the metal prophy angle was added, the entire apparatus weighed in at a hefty 9 ounces. Was this a primitive form of weight training? To further complicate the ergonomic equation, this beauty was attached to a tight, heavily coiled, short air hose. Now I had resistance training too! Despite its weight, the handpiece swiveled and the prophy angle remained locked in position. The entire polishing apparatus was attached to an adjustable-height bracket table, which could be positioned directly over the patient. I was married to this apparatus for 15 years and now understand that these few positive features prevented more ergonomic problems from occurring.
Through the years, I think I have seen every variation of slow-speed handpiece, prophy angle, cup, and paste ever invented! Hygienists frequently use handpieces and polishing products that are hand-me-downs from some long-forgotten era. Whether short and chunky, or long and skinny, many handpieces are heavy, often unbalanced, placing unnecessary stress on the wrist and forearm. If the handpiece doesn`t have a swivel mechanism, the operator`s wrist does all the twisting and turning.
A defective prophy angle-locking mechanism forces the operator to grip both the shaft and angle in order to stabilize the angle and prevent it from popping off. Outdated, heavy, short-coiled air hoses place significant torque on the operator`s hand, wrist, and forearm. Installing the handpiece in an impossible-to-reach location is the final ingredient for a polishing nightmare. No wonder hygienists who have practiced for years have so many musculoskeletal problems!
As a result of increased emphasis on ergonomics, we now have some very distinct opportunities to change our approach to polishing. Everyone from dental manufacturers to OSHA is interested in reducing repetitive strain injuries. In response to these increasing ergonomic concerns, manufacturers have developed a wide variety of polishing products, from specially designed hygiene handpieces to improvements in prophy-angle designs, cups, and polishing pastes.
Today`s handpieces feature innovative shapes, ultra-lightweight models, twist and swivel designs, and even a cordless unit. Four companies offer ultra-lightweight (3-ounce), slow-speed handpieces made exclusively for polishing. That means no more weightlifting!
The broad base of the Dentsply Midwest (800-800-2888) RDH(tm) hand-piece keeps the operator`s hand in a relaxed position and the textured surface improves the grip. Star Dental (800-275-3320) and Micro Motors (800-562-6204) offer straight-shanked hygiene handpieces. Both the Midwest and Micro Motors models are designed so that the prophy head repositions with a fingertip swivel, while the Star handpiece operates with a rear swivel mechanism. All three handpieces are fully autoclavable.
NSK America`s (888-675-1675) Taskal cordless, rechargeable polishing handpiece is another interesting product to consider. It features a contra-angle head that is fully autoclavable. The handle achieves a complete charge in one hour, but it does not swivel and must be treated with a surface disinfectant.
The cordless polisher is quite easy to use and is a welcome solution for special challenges such as a hospital or nursing home, a hygiene treatment room with the slow-speed polisher positioned in a wrist-straining location, or the practitioner wanting to eliminate the restrictions and weight of an air hose.
Operators find it much easier to maintain a neutral wrist position when using a contra-angled prophy angle. The traditional right angle requires the wrist to bend, flex, or deviate laterally in order to access all tooth surfaces. Even though some all-metal handpieces have contra-angle heads, the benefit is quickly counteracted by the increase in weight. Young Dental Manufacturing (800-325-1881) has developed a high-quality, disposable, contra-prophy angle. At first glance, the contra angle`s small bend does not appear to be that significant; however, most clinicians notice improved hand and wrist comfort within a very short period of time.
Soft, flexible prophy cups require much less pressure to adapt to tooth surfaces than firmer cups. Junior size or short, squatty cups can fit more easily in hard-to-polish areas. Access can be improved if the patient repositions the mandible laterally toward the side that is being polished. If the patient closes slightly, tight cheek muscles relax and allow better cheek retraction. This makes it easier to reach the facial surfaces of posterior teeth.
Very few changes have been made in polishing pastes over the years. Coarse grit still serves as the polishing standard in many practices. Before the discussions about selective polishing began, many clinicians approached this portion of the appointment with a "one size fits all" mentality.
Proper use of newer ultrasonic scalers results in effective stain removal and reduces the need for extensive coarse paste polishing. While stain removal is still a primary concern to clinicians - because of patient satisfaction issues - it seems unwise to subject tooth structures to extensive polishing procedures where little clinical justification exists.
Regardless of where you stand on the polishing issue, one recent change in polishing pastes may give you more clinical comfort. 3M Dental`s (800-634-2249) new Clinpro(tm) prophy paste provides a more contemporary solution to what type of grit to use, whether you polish all tooth surfaces or selected sites. Even though it begins as a coarse polish, the particles rapidly break down to form a very fine paste. The stain-removal power is there only when you need it. This polish is applied using a slightly different polishing technique, and patients appreciate the lack of residual grit.
If we are truly preventive professionals, then perhaps we should rethink how we practice. Preventive ergonomic strategies need to be applied in our hygiene treatment areas, just as our patients need to embrace the long-term benefits of their preventive measures.
Why should we give any less importance, significance, or priority to our own health and well-being?
Burnout and physical fatigue threaten the careers of so many wonderful dedicated hygienists. Technology has taken us from porte polishers to portable polishers, so consider these ergonomically developed products designed to keep polishing hygienists in the 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].
The ergonomics of polishing
* Maintain a neutral wrist position
* Avoid flexing, extending, or lateral wrist deviations
* Consider a new ultra-light handpiece
* Use handpieces with textured surfaces
* Select a handpiece with a larger diameter shaft
* Use an evenly balanced handpiece
* Keep a light grasp on the handpiece
* Limit pinching the handpiece shaft
* Reduce the amount of force applied to the tooth surface
* Select low-vibration prophy angles
* Polish with contra-angled polishing heads
* Use lightweight, straight air hoses that have adequate length
* Position the polishing handpiece in an easy-to-reach location