The Costs for the Clinician
A literature review2 conducted by Johnson and Kanji in 2016 states that 92% of Dental Professionals reported symptoms in at least 1 anatomical, upper body region in the past 12 months with Dental Hygienists being the group most affected (see Fig 1). Work related Musculo-skeletal Disorders (MSD) in dental hygienists are often blamed on repetitive movements, awkward and static postures, pinch- grasp, forceful exertions, vibration, poor ergonomics, and insufficient breaks amongst other factors.
So how does a dull or compromised instrument contribute to a MSD?
Dental Hygienists often perform over 30 repetitive strokes per minute, increasing their risk for muscle strain 3.4 Factor in using a small diameter, a heavier weighted handle and/or a dull or sub-optimal blade results in increased pinch-force and lateral pressure required to remove deposits 3,5,6,7. Over time, the repetitive strain and cumulative trauma subsequently cause clinicians to seek out both traditional and complementary treatment modalities to manage pain, reduce their workload or in extreme cases, leave the profession due to MSD’s 8,9
And The Patient
As previously mentioned, a dull or compromised scaler can lead to increased discomfort and decreased tactile sensitivity due to increased lateral pressure and number of strokes needed to remove the deposits. The cost of burnishing calculus, resulting in iatrogenic and supervised progression of periodontal disease when patients are placing their oral health in our hands cannot be measured (Fig 3,4). Breakage of a blade in a patient’s mouth, with possible need for surgical intervention due to using an over-worn working end is a preventable situation with a simple and quick check of the working end against a template.
What can we do?
When having discussions with workshop participants, I have discovered that a large number of practitioners do not routinely sharpen their instruments on a daily basis with the most common reason being that they simply do not have the time. If sharpening is performed routinely, the process should only take a minute or two per kit at each appointment – less time than trying to removed calculus with
a dull blade. When performing subgingival debridement, a sharpening stone sterilised with the instrument setup will make it easier to debride as you go. Scalers should be sharpened before every patient for efficient and effective appointments3. To quote Periodontist Dr Victor M Sternberg, ‘Curettes should be replaced regularly and instrument sharpening is not optional to be a successful (clinician)’. Would you use a dull bur to prepare a tooth for a restoration?
Choosing appropriate instruments with considerations for the weight and handle design, wider than 11m with either a criss-cross or knurled surface reduces the need for pinch-grip and over exertion 7.
A routine, quick assessment of your scalers against a template (Fig 2) is a simple way to ensure neither you nor your patients’ health are being compromised and that you can continue to provide care in a safe and healthy environment. This check can be completed by the clinician or nurse prior to instrument processing. Scalers need to be valued as consumable stock to ensure clinicians feel confident and empowered to maintain them without the pressure to try to make them last longer.
Worried about how to dispose of your worn instruments? Hu-Friedy Australia / New Zealand have a recycling initiative conducted when attending relevant dental conferences with details emailed to dental practices prior to the events.