Some 'tricks' of the hygienist's trade

... How could they always find calculus after I worked so hard and so long to remove it all?

... How could they always find calculus after I worked so hard and so long to remove it all?

When I was a dental hygiene student — so long ago that many of you weren't even born yet — I was sure the instructors actually had pieces of calculus attached to their explorers! Otherwise, how could they always find calculus after I worked so hard and so long to remove it all? To always find calculus, I was sure the instructors must have been cheating! What did they know that I didn't know? I was too timid to ever ask about this, but I did wonder. It was a mystery to me! Of course, I also was sure all my classmates knew the secret, too, and I was the only one who didn't.

Other hygienists have told me similar stories. Did this ever happen to you? After working for a grueling three hours, fingers numb, back aching, the instructor told you to re-instrument an area because you missed some calculus. Obviously, you couldn't feel the calculus and didn't know it was there or you wouldn't have asked the instructor to check it.

How do you remove calculus if you don't know where it is and what it feels like? You either put the instruments in and moved them around a bit, hoping for a miracle, or not knowing what to do, you just went to the bathroom and cried, coming back just in time for the instructor to re-check the area.

That's when you really experienced a miracle. The instructor rechecked the area and said, "That's much better," when, in fact, all you did was go to the bathroom and cry!

Later, during my years as a dental hygiene instructor at the Universities of Minnesota, Washington, and Arizona, I found myself in the reverse position. By then, of course, students were bolder and actually said what they were thinking — at least some of the time. On more than one occasion, I was accused of cheating when I dried off the teeth to check for calculus.

These students somehow felt that using air to check for calculus was an unfair advantage on my part. I assured them that they, too, could use air, any time they wanted. After all, it was a part of their dental unit and not something to which only instructors had access.

Another "trick" I use to check for calculus is unwaxed dental floss. After instrumentation and before polishing, I use unwaxed floss to check for missed deposits. I'm sure you do, too. I'm repeatedly amazed to find missed pieces of calculus, especially between the lower anterior teeth.

This approach really works! Remaining pieces of calculus are easily felt with the floss. Besides providing feedback on effective calculus removal, it removes interdental plaque biofilm and teaches the patient what the dental floss squeak sounds like.

I still floss after polishing, though, preferably before rinsing out the prophy paste. This time, I'm not looking for calculus, but polishing the proximal surfaces. With some remaining polishing paste, the floss — especially the newer designs consisting of multiple fibers — can polish subgingival and proximal surfaces.

At the end of the appointment, I always go around all the teeth with air to check for deposits and get a better look at the margins of all restorations. Air is much less harmful on a demineralized tooth surface than a sharp explorer when evaluating that surface for decay.

Magnification also helps. I wear a jeweler's loupes when I work now. If I worked more than occasionally helping out, I would invest in prescription magnification. Not only does it dramatically increase vision, it also ensures proper posture. Too bad we didn't have magnification back in the 1960s when I was a student and developed all those bad habits.

It's not cheating to use all of the tools available to us, even though I thought it was when I was a student. To increase your success, use magnification, air, and floss when checking for calculus. It's good practice!

Trisha E. O'Hehir, RDH, BS, is a senior consulting editor of RDH. She also is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics. The Web site for Perio Reports is www.perioreports.com. She can be reached by phone at (800) 374-4290 and by e-mail at trisha@perioreports.com.

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