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Dental hand tools are not often used in routine professional hygiene today, but including them in your arsenal will lead to better quality work.
Periodontal machining is a quality skill that helps in the diagnosis and treatment of periodontal diseases. This skill uses specialized hand dental instruments to remove hard and soft deposits, such as biofilm and tartar, from the crown and root surfaces of teeth.
Usually, dentists begin to develop their skills in working with hand tools only after graduation. However, through continued practice, consolidation of basic skills, and participation in hands-on workshops that refine these skills and introduce modern techniques beyond initial training, dental hygienists can become highly skilled periodontal hand instrumentation specialists.
Modern technologies and dental instruments - such as ultrasound, subgingival air-abrasive treatment, diode lasers - reduced the interest of dentists in studying classical manual mechanical periodontal treatment. And while these advances can help improve patient outcomes, there are many situations where they can't be used, such as eye disease, cardiac pacemakers, respiratory disease, and more.
Thus, the dentist's hand tools continue to play an important role in modern dental hygiene. The key technical nuances of manual tools and other factors affecting their use are described below.
Ergonomics
Ergonomics has a vital place in practical occupational hygiene, especially in the improvement of hand tool skills. A deep understanding of ergonomics is vital to maintaining proper posture. This approach is crucial for the prevention of diseases of the musculoskeletal system and ensuring a long-term ability to work
Doctors with good posture support the natural curve of the spine, use correct posture during physical activities such as working with tools, and balance muscle function. Ergonomics is not limited to how a person sits; it also takes into account the convenience of the equipment and tools used, including hand tools. Here are some recommendations for choosing ergonomic hand tools:
- Handle width >11 mm;
- Pen weight <15 g;
- Narrowing between the handle and the working part;
- Textured and ribbed on the handle.
These features are designed to reduce the force of finger compression, which is a decisive factor that leads to the development of diseases of muscles, tendons and bones, the most dangerous of which for dentists is carpal tunnel syndrome.
Sharp instruments
The most important and significant factor that will make the work of a periodontist-hygienist more ergonomic is the sharpness of the tools and their regular sharpening. The use of sharp instruments helps to reduce the amount of lateral pressure required, offering several advantages. These include reduced grinding of mineralized deposits, reduced tissue trauma, increased efficiency and the need for fewer movements, ultimately resulting in reduced physician fatigue.
High-quality sharpening of the cutting edges of instruments does not require much effort and at the same time can save a lot of time and effort of the doctor, make scaling more efficient and predictable, and improve patient comfort during the procedure. Accordingly, checking and maintaining the sharpness of the instrument is the first priority task of a doctor engaged in manual periodontal treatment.
Fitting gloves
Correctly sized work gloves play an equally important role in ergonomics. Incorrectly fitted gloves can lead to excessive lateral pressure when working with dental surfaces, which not only increases the risk of muscle, tendon and bone diseases, but also significantly affects productivity. When choosing gloves, it's important to consider many factors, such as finger length, length from the fingertips to the cuff, the overall comfort and feel of the material, and how well the glove fits the palm.
Today there is a new polychloroprene glove that combines the softness of latex and the strength of nitrile without sacrificing comfort and dexterity. This new material is latex-free, made from synthetic rubber that is safe for people with latex allergies or sensitivities.
Dynamics of movements
The dynamics of movements emphasize the importance of preserving cementum during tooling. Some of the principles of movement dynamics include angulation, adaptation and activation, which consist of the following key aspects:
- Angulation: Ideally 70-80 degrees
- Adaptation: 2-3 mm of the working part against the tooth structure
- Activation: Short overlapping movements with an amplitude of 1-2 mm in horizontal, vertical or oblique adaptation.
These recommendations increase the accuracy and efficiency of the use of hand tools for dental hygiene. In the context of activation, it is worth emphasizing the principle of "slow down to speed up" to help doctors remember that for effective and complete removal of tartar, it is necessary to observe the amplitude of movements within 1-2 mm.
Reinforced scaling, although not traditionally taught in periodontal programs, is gaining acceptance due to its significant advantages, such as additional stability of the instrument when additional lateral pressure is applied and reduced risk of repetitive stress injuries.
Using the enhanced scaling technique, the doctor cannot hold the mirror in the non-dominant hand. At this time, the dominant hand adapts and changes the angle of the blade to the surface of the tooth, while the thumb or index finger of the non-dominant hand is placed on the shank. Both hands control the movement of the tool.
Know your hand tools
Many new tool designs take advantage of advances in cryogenic processing and metallurgy, which have made it possible to create tools that stay sharp longer or do not require sharpening. Such instruments are offered by HuFriedy Group, American Eagle Instruments, PDT, Premier, Nordent Manufacturing, LM, and others.
How long do tools last? Like stainless steel tools, tools without the need for sharpening have a shelf life. The problem in dentistry is that many doctors use tools, especially stainless steel, that are not intended. Variables affecting tool life include frequency of use, type of deposition, use of ultrasound, frequency and quality of sharpening, and whether the tool is used as intended. Traditional scalers and curettes have a lifespan of six months to one year, while scalers and curettes made with modern technology can last anywhere from 12 to 18 months.
Maintaining your skills
Periodontal manual instrumentation is a critical skill in dental hygiene and in the treatment of periodontitis. Despite the development of advanced technologies, the art of manual instrumentation remains relevant and necessary and should be honed throughout the periodontist's career. Possession of this technique can significantly improve the quality of work and the efficiency of patient care.
Although many dentists and even beginning periodontists begin their careers with a basic level of professional competence, focused practice, continuous education and hands-on training will help them become experts in their field. The focus should not only be on implementing the latest technological advances, but also on improving fundamental skills and knowing when to use them to achieve optimal patient outcomes. In a rapidly evolving field such as dental hygiene and periodontics, the importance of these skills cannot be overstated.
