Wednesday, November 25, 2015

Instrumentation




When I was just starting out in dental hygiene school, instrumentation was brutal.  They give you a HUGE variety to choose from and want you to test each one out and gain an understanding for how to use it! (YIKES!)  I felt so overwhelmed. I remember thinking I would NEVER GET IT!  I wasn't even positive on how to use our curved explorer to check for calculus.  I felt discouraged.

At first I used the least intimidating scalers...like a straight sickle.  I was hesitant to apply lateral pressure and didn't want to go subgingivally in fear of hurting my patient.  After a few months I began to realize that what I was choosing wasn't enough and I needed to be brave.  I began truly trying all of them...but I was still paranoid about "using the wrong end"!  I then was given the best advice!  The curved end of the instrument always adapts to the mesial of the tooth.  THERE IT WAS!  THE GOLDEN RULE FOR INSTRUMENTS!  "Adapt mesially".  Once this clicked I began to venture out and use all of my instruments.  Some I liked and others I didn't care for...but I was trying!  In school I very much stuck to the proper way to use an instrument and the proper place to use it...but as I have gained experienced in private practice I realize the right instrument to use is the one that gets the job done!  If I have to use the backside or the wrong end - so be it!  The key is ADAPTATION!  If you can adapt the instrument comfortably to the tooth/root surface and not cause damage to the gingiva, you're good to go.  The main objective of instrumenting is to REMOVE CALCULUS AND BIOFILM.

Of course I have settled on my favorite instruments...my personal all time favorite is the Nevi **I want to be clear that I am in no way sponsored or endorsed by Hu-Friedy and I am not being paid to mention their product...I just love it!**



I have found the Nevi to be very versatile and able to adapt to pretty much any place in the mouth that I need it for.  It removes moderate to heavy calculus and is able to fit into tight contacts or areas with tight tissues.  Although it's recognized for being a posterior scaler it is easily adaptable to anteriors!  I use this instrument on adults and children. When I use other instruments to access calculus...I always go back to the nevi to fine scale and finish up.  It's my love.  (a bit dramatic I know...but seriously...I used to bring these to offices I temped in for fear they wouldn't have any!)  Another instrument I'm growing fonder of is the Gracey 3 / 4.  But its a gracey you say!  Perio only you say!  Wrong.  Remember what I said above?  The right instrument is the one that gets the job done.  This particular gracey has a way of sweeping the gingival margin of molars fabulously and although its an anterior site specific scaler, it gets the job done!

Now aside from hand scalers I utilize ultrasonic scalers on 90% of my patients.  I use a blended approach and almost always start with my ultrasonic to remove as much calculus and biofilm as possible.  I then fine scale with my hand instruments.  Some hygienist do not believe in using ultrasonics and I think that is absolutely silly!  Your worth as a hygienist is not determined by how much calculus you remove by hand!  Especially when the research is there to prove that ultrasonic instrumentation CAN remove all calculus (when used correctly) and does a great job! I recently went to a seminar that said a hygienist could and or should be using a ultrasonic for 90% of the cleaning!  This really resonated with me!  I've always felt like ultrasonics do a fantastic job and are actually quite comfortable for my patients.  Very few feel sensitivity during the procedure.  I have found that mostly the older generation do not like them (at first) due to them not understanding the research and advances of using this technology.  They are hesitant to accept that there are newer and better ways to do things then hand scaling alone.  And don't get me started on how important ultrasonics are for the clinician...repetitive hand movements is what have messed up many-a-hygienist!  When we are seeing 10-15 patients a day WE NEED to be using this technology!!  Stop feeling like you have something to prove by hand scaling the entire mouth for every patient.  :-)

Hopefully this gives you a little insight into instrumentation.  Feel free to comment and tell me your favorite instrument, WHY you love it and WHERE you use it!

Hygiene students BE PATIENT WITH YOURSELF!  One day instrumenting will "click" for you and your anxiety will be gone as you move forward with confidence.  

6 comments:

  1. Hi jenn. Would like to know how to scale around implants

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  2. The biggest thing to remember about scaling around implants is that we, as hygienists, do NOT want to damage the implant AT ALL! You should not be using metal instruments...there are a few studies saying that titanium might be ok..but I wouldn't risk it (until further research is done). Just use the plastic scalers and do not use an ultrasonic around an implant unless you have a tip that is coated in plastic. Hope that helps! I also don't probe around an implant unless requested to do so by the periodontist (and it also needs to be plastic).

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  3. I love your blog. It is so refreshing to read for me! (A first year dental hygiene student) This is my first semester in clinic, and boy is it stressful! We have so many requirements and certain patients that we have to get. Any tips on where you found patients? I have already gotten most of my family in! haha. Clinic has been a struggle for me also! I am always having a 'calc error' and it is frustrating. But thank you for the kind words...hopefully things will get better!

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    1. Thanks for the kind words Claire! I remember being where you are. After you have seen everyone in your family (I did the same thing!) I began being brave and calling people from a list we kept in the secretaries office of people in the community that wanted a cleaning. There are people out there who don't have insurance and need a cleaning and would want to come to your school to do it.

      Don't get discouraged about calc errors. It's inevitable and it's really hard to detect calc when your first learning. Shoot! Sometimes it's hard for me now and I've been at it for 5 years! Just breathe and go easy on yourself. Good luck!

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