Comfortable ultrasonic scaling

A couple of months ago, the following question popped up on an Internet site frequented by hygienists. "For clinicians who say ‘I can't live without my Cavitron,' ...

by Anne Nugent Guignon, RDH, MPH

A couple of months ago, the following question popped up on an Internet site frequented by hygienists. "For clinicians who say ‘I can't live without my Cavitron,' what do you do when you run into patients that are too sensitive, or hate the Cavitron, etc.? I have seen hygienists that act like a deer in headlights when they run into these situations."

Pet peeve alert! While Cavitron-brand devices are quite common, the term "Cavitron" is a brand. The term "power-driven scaler" is more precise and includes both magnetostrictive and piezoelectric ultrasonic scalers as well as sonic devices. Okay, back to the discussion at hand.

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Within days, over 47 hygienists posted their thoughts about this problem. While email and Internet discussions are really flat forms of communication -- devoid of critical communication clues such as facial expressions, tone of voice, and body language -- the general direction of the posts was really disturbing. Several common themes struck a chord with me.

Only two hygienists made any mention about trying to figure out why the patient was so sensitive or hated power scaling. One encouraged paying attention to the patient. Another poster detailed how topical anesthetic never provided any relief. Where was the discussion about the type of sensitivity and the etiology of the pain? One even said that hypersensitivity can be psychosomatic, a comment that demonstrates a limited understanding of sensitivity. Another said if a patient is going to be a PIA (her term, not mine), then she gets them numb or offers nitrous so she can make it through the procedure. Most relied on topical anesthetic to treat the sensitivity, a product that does nothing for dentinal hypersensitivity.

For the most part, their responses were defensive, focusing on how to get the patient in and out of the chair as fast as possible. Their frustration was loud and clear, but the discussions revolved around how they treated the patient, not why the patient had a problem with power scaling.

Lest you think that I have never treated anxious, tense, sensitive patients, think again. I've spent my entire clinical career in Texas, a state that does not permit me to use local anesthesia; so, short of waiting for a doctor to "rescue" me, I've had to figure out what is going on and find an effective way to provide comfortable treatment.

At the first indication that there is anything amiss, I stop and have a conversation with the patient, trying to discover what is going on. In my clinical experience, cold water or air and tactile sensitivity are the big culprits, with exposed dentin being the primary etiology. Sensitivity is on the rise for myriad reasons -- increasing consumption of erosive beverages, the xerostomia epidemic, and the rise in the incidence of GERD. A number of chemistries can be applied prior to instrumentation to occlude dentin tubules. Arginine-bicarbonate-based products work best for me chairside, but I've also achieved good results with products that contain calcium sodium phosphosilicate. Various calcium/phosphate products also relieve dentin hypersensitivity, but tend to take longer or require multiple applications. Varnishes and other surface protectants also seal off tubules.

If the issue is not dentin hypersensitivity, then what should you be considering? Sensitivity is an all-inclusive term that can be used to describe a whole range of dental issues including cracked teeth, new and recurrent caries, periodontal diseases, occlusal trauma, and poor quality or broken restorations. For many patients, anxiety is based on past experiences, perceived or real, or the fear of getting hurt. Gaggers also hate power scaling if fluid evacuation is poorly managed. Each of these situations adds layers to a patient's perception of sensitivity and needs to be addressed.

It is critical to acknowledge a patient's concern about getting hurt. If a patient says they have pain or are sensitive, believe them, even if the problem is not immediately obvious. Believe me; patients are not looking for reasons to come to see us. A gentle, caring dialogue will often reveal the source of anxiety. Once the source of discomfort is identified and treated appropriately, your once-reluctant patient may actually show up on your list of favorites. We're a relationship-driven profession, striving to provide the most comfortable care, despite the odds.

Over the past 43 years, I have learned to love treating sensitive patients. It's the ultimate clinical puzzler. The key is finding out what is bothering them and providing treatment that really gets to the root of their problem, not just glossing over or ignoring their symptoms. Helping patients get comfortable is the ultimate comfort zone. RDH

ANNE NUGENT GUIGNON, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.

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