Oral Health Group
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Creating a Unique Tray Set-up, and the Evolution of Dental Hygiene Instruments

November 22, 2018
by Kathleen Bokrossy, RDH


Do you find that each of your instrumentation kits typically contain the same instruments?

Are most of your instruments similar to what you were taught in school?

I usually start my instrumentation presentations by asking the audience these two questions. More times than not, the majority of the room agrees that their kits are the same for each client with perhaps just one ‘new’ style of instrument. In dental hygiene school, we were taught to use instruments that are ‘safe’ for beginners and were introduced to the most common styles. Is it safe to have a student use a perio file or a hoe? Definitely not. But as we improve and master our skills, we need to explore new options that will help improve client care and will also help us ergonomically. As we become more proficient and confident in exploring the dentition and develope our understanding of tooth morphology with all its concavities, projections and furcations, we can expand our instrument armamentarium. We should choose instruments that have been created for advanced instrumentation.

After working clinically in a variety of offices across the country, and struggling with the instruments that the offices provided, I decided to start my own dental instrument company back in 1998. It started off as a sharpening and re-tipping company, as I had mastered the skill of sharpening and re-tipping was a new concept at the time. We grew to an international company with our own line of instruments, education and maintenance programs. I have since sold this company but still feel very passionate about dental instruments, as I truly believe that a dental hygienist can only be as good as the instruments in his/her hands! We cannot provide effective, efficient or safe care for our clients when we are using worn-out, misshaped instruments.

The designs available, the type of material, the choice of handle, and metals have greatly evolved since I started practicing back in the late 80’s. When I first starting practicing, instruments needed to be sharpened after every sterilization cycle because the process dulled the instruments. Now we have instruments that do not require sharpening as often and instruments that require no sharpening at all! Major instrument companies will use superior steel that offers greater longevity and retains its sharpness longer. One specific company, LM Dental, from Finland, has a special proprietary micro-coating over their already high-end carbide enhanced alloy, which leaves a very smooth finish that is super sharp, and maintains an edge that never requires sharpening.

Over the years, I still hear the same most common challenges and pains that many dental hygienists face. I would like to address them and offer some suggestions.

Challenge:
Many dental hygienists are using instruments far beyond the time to replace them without realizing it. This results in poor care, an uncomfortable appointment for both you and your client, decreased tactile sensitivity, increased fatigue and risk of Repetitive Strain Injuries (RSI).

Solution:
Keep a master set in your practice to use while sharpening, as a guide, so that you can maintain the original design as much as possible. This is also a great way to compare what you are currently using to what you should be using, if you need to demonstrate to your DDS or Office Manager that it is time for new instruments!

Challenge:
The office will not buy instruments for the dental hygienists when they need to, so they are using the old instruments beyond their safe use.

Solution:
Schedule a meeting with your DDS or Office Manager. Put a plan in place and set it up like a ‘Case Presentation’.

Show the practice’s current instrumentation situation:

  • cost/yearly budget (or lack thereof at times)
  • how many kits, instruments available
  • acknowledge that we can no longer sharpen chairside (due to IPAC concerns), and show how this will affect the practice
  • client response (to treatment) and complaints (do they complain to the receptionist that they no longer want to see ‘that’ heavy-handed dental hygienist and request a new one for next time – or worse…they do not want to create a scene and just find a new practice!)
  • RDH’s pain – fatigue/Repetitive Strain Injury/unnecessary pinch force and lateral pressure, etc.

Show your future plan:

  • cost, potential budget
  • number of kits required and type of instruments in each kit
  • who will take care of the ordering process
  • how the plan can be sustained
  • systemize your instrument program by frequently assessing instruments in the DH Department together, compare to Master Set, determine frequency of replacement
  • share all the benefits the practice will experience by supplying your team with sharp well-maintained instruments. i.e. efficient and effective care, increase referral, retention (happy clients and RDH’s) to name a few

If these arguments fall on deaf ears and they still will not purchase instruments for you, I highly recommend to invest in yourself and purchase your own. Keep them in your own cassettes and make sure no one else uses them. Between using ultrasonic scalers and having instruments that only you take care of, your instruments will last much longer.

We spend approximately a third of our life working. If you wish to extend the longevity of your clinical career, invest in yourself. Your clients, and your body, will thank you.

Price is always a factor, and I have a solution for you below in the “Typical Day’ section.

Challenge:
Heavy stainless instruments are being used in every kit, and pain and fatigue are starting to set in. It is especially noted during the last few appointments each day. “There may be a greater risk of developing upper extremity disorders among dental hygienists than among dentists due to the long hours of dental scaling and root planing.” (1)

Solution:
Studies have shown that lighter, larger silicone handles will help prolong your career by preventing repetitive strain injuries (RSI). The function of the larger-diameter handles is to open the grasp just enough to dissipate the mechanical forces over a larger area of muscles.

Instrument set-ups containing several styles of handles give the clinician the opportunity to rest different muscle groups while completing care, which decreases the occurrence of RSI.

Challenge:
With so many new instrument styles and designs being introduced, how can you try an instrument on a tight budget?

Solution:
There are many ways to try out an instrument without having to make a significant investment. Attend a hands-on course. Instrumentation courses are offered at dental hygiene conferences, or at RDHU (or RDHU on-the-road events). Attend a conference/exhibit floor and ask to try one on a typodont. Speak to your rep or look for specials where you can get one for free with an order, trade-in, etc.

Challenge:
Many dental hygienists struggle with sharpening and cannot achieve, or maintain, a sharp cutting edge.

Solution:
Participate in a hands-on sharpening course. If you struggle with this skill and are worried that you alter instruments from their original angle and design (which can cause harm), consider purchasing some sharpen-free instruments and eliminate that worry.

Challenge:
Many dental hygienists go through different stages in their career where they feel bored, get tired of the routine and feel that they are doing the same thing day after day, client after client.

Solution:
See the uniqueness in every client and create Unique Tray Set-ups! Reviewing your charts the night before, or the morning of, to see who is coming in and what instruments you will need can really help you get re-engaged in your practice. You will enjoy planning out your treatment kits for each client based on their specific needs.

So, let’s take a look at what a ‘Typical Day’ could look like and how you could create Unique Tray Set-ups:

1. 5 Re-care Kits: Each kit would include a Mirror, Explorer and a Probe. You could then add two instruments that could complete the entire dentition for a re-care appointment. The LM Syntette and a Universal Sickle (Sharp-Jack). For those of you who would like Sharpen-Free. The ‘Sharp-Jack’ is an option for a universal sickle along with the Syntette. The Syntette is a Dual-Gracey meaning it is a Hybrid Instrument. It has the characteristics of a Gracey with its complex shank and it has two-cutting edges, like the Universal Curette. The instrument acts as a Gracey 11/12 and a Gracey 13/14. The nice thing about this instrument is not only do you not have to switch instruments (for mesial and distal) but also, you do not need to switch ends while working on the same
surface.

2. 1 Furcation Kit: This kit could contain a Nabors Probe, two Furcation Files and a Furcator. The Furcator has a small excavator as its working end and is great to use on Furcations I and II; while the furcation files have a rough diamond coating on them for a more advanced furcation involvement.

3. 2 Gracey Kits: These two kits would contain your favourite Graceys and perhaps you add Graceys 15/16 and 17/18 for those difficult to reach molars.

4. 1 Perio Kit: With the Gracey extended shank and mini blades to access deeper tighter pockets and the PDT Queen of Hearts. The Queen of Hearts is a unique design as it has a cutting edge of 6 mm.

Reducing the number of instruments in your everyday tray, you will save money. Having specialty kits used and sterilized only when needed is much more economical as these instruments will last you longer.

Regardless of what brand you prefer, I would recommend using Sharpen-Free instruments where you can. Also, master your sharpening technique for your regular instruments to ensure that you are always using optimally sharp instruments. Your clients will thank you and your body will thank you!

By switching up your instruments and creating Unique Tray Set-ups, you will find that your Typical Day won’t be so ‘typical’ and you will be re-engaged and confident with the treatment you provide. To a master, nothing is ‘typical’.

If you cannot attend a hands-on sharpening course, and because I feel so passionate about this topic, I am gifting you a free sharpening and instrument selection online course. Visit www.rdhu.ca/instrumentcourse to receive this online course (1-hour CE) along with other resources that will help you.


About the Author
Kathleen Bokrossy RDH is the president of ‘rdhu’, a professional development company, which provides team events, hands-on programs and online learning (Dental Hygiene Quarterly). Her vision is to help ‘Transform the Dental Hygiene Experience’ for dental hygienists, practices and clients.