Oral Health Group
Feature

Streamlining Instrumentation

November 13, 2020
by Kathleen Bokrossy, RDH


As we try and get used to our new normal, we need to look for ways to make our days run more smoothly and more efficiently. We need to implement processes to make our days run a little easier in the midst of so much emotion, frustration and fatigue. Figuring out a way to try and accomplish all we need to do in an appointment and then prep our op and prepare for our next client/patient has become such a challenge.

The way we used to practice is in the past. We cannot expect to move forward doing things the way we always did. As the popular quote from Gracey Murray Hopper demonstrates ~ “The most damaging phrase in the human language is ‘We’ve always done it this way’.” This was intended to reflect the need to constantly think forward, rather than look backwards, which is essential in times of disruption and change.

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Doing things the same old way is a recipe for disaster.

One of the processes you can reexamine and rethink (and easily change), is to take a look at the flow of your instrumentation. Two major changes have occurred, which makes it no longer acceptable to manage your instrumentation the “same old way”.

Streamlining Instrumentation

  1. COVID has left many dental hygienists providing non-aerosol procedures only.
  2. Due to IPAC concerns, most regulatory bodies have eliminated the ability to maintain/sharpen instruments chairside.

You have to re-think your instrumentation flow, because streamlining your instrumentation process will help you, your clients and your practice. As you think about your new process, ask yourself these questions:

  1. Do you have enough instrument kits to get you through the day?
  2. Are you compromising client care and your health by using dull instruments?
  3. Have you scheduled a time in your day to sterilize instruments, sharpen and then re-sterilize?
  4. Could you use a hybrid instrument so that you are using one instrument instead of two? This not only saves money but also is an efficient application during instrumentation.
  5. Are you using all the instruments in your kit?

Rethinking your instrumentation flow is one area of treatment care that should not be overlooked, especially during these uncertain times where many dental hygienists are providing non-aerosol procedures only and are hand scaling exclusively.

Working with sharp instruments every time is essential. We should not compromise client treatment. We should not compromise our own health.

Working with dull instruments will have a great impact on the treatment your clients receive. They will not receive optimal care; they will endure unnecessary pain and discomfort and they will spend longer time in your chair.

It would be similar to the dentist trying to do a prep with a dull bur. It can’t and shouldn’t be done. It is ineffective and inefficient, and we are not meeting the Standard of Care.

Working with sharp well-maintained instruments will also help prevent fatigue for the clinician. We have all worked with dull instruments at one time in our careers and we know the effect it has on us. If you would like to prevent major fatigue at the end of the day and prevent repetitive strain injuries, you must never compromise. Not once.

Streamlining your instrumentation will help your office save money in the long run and at the same time will help prevent fatigue and burn-out of the clinician all the while providing optimal care to your clients and patients.

Having enough sharp instruments on hand is essential. Do you have time set aside to open sterile instrument pouches and sharpen and then re-sterilize? At what time of the day are you doing this? Are you doing this at the end of a long day or are you sharpening during your lunch hour? Or worse yet, maybe hardly ever?

Sharpening instruments has now become a major task, as most provinces can no longer sharpen chairside due to IPAC concerns. We now need to sterilize our instruments, sharpen and re-sterilize prior to use. This has created another task that needs to be done outside of client care hours. It has also created a waste of sterilization pouches, cycles and Chemical Indicators; which is a waste of money and has an environmental impact.

Sharpening chairside is a thing in the past, we must move forward and look for an alternative solution.

Using Sharp Diamond, SharpenFree instruments by LM Dental, will help eliminate the task of sharpening and will provide you with all the benefits of using sharp instruments.

The LM Sharp Diamond instruments are treated with a new micro membrane coating using modern Physical Vapor Deposition (PVD) technology. This technology offers features such as being completely sharpen-free, tough but refined. The Rockwell Hardness scale is 62 which contributes to the durability of the instrument.

Studies have proven that there is an 82% decrease in wear compared to typical dental hygiene instrument material.

Should our kits be a one-size-fits all? Not at all. Why did we start off in our careers with the same instruments in every kit? Are you using every instrument, in every kit, every time? Most likely not. When we do this, we are putting the unused instrument(s) through unnecessary sterilization; thereby, shortening the lifespan of the instrument.

Many dental hygienists typically use what the office provides them and what has always been ordered.

When we look at what is in a typical hygiene kit, we often see an anterior sickle scaler, a posterior sickle scaler, a Universal Curette and 3 or 4 of the most popular Gracey’s.

From a mindset and/or engagement aspect, when we create unique tray set-ups it helps the dental hygienist get re-engaged with her/his day as well. By looking and preparing for the day the night
before or morning of and looking at what clients are coming in and preparing what type of kit will be needed, will help break-up some of the mundane tasks many dental hygienists feel when providing hand scaling every day.

Streamlining Instrumentation

Based on the Classification of Periodontal and Peri-Implant Diseases and Conditions’ we created a Decision Tree for Instrument Selection using mostly instruments that are in the Sharp Diamond line by LM Dental. This will help streamline your instrumentation protocols. See chart starting on Page 21.

The LM-ErgoMix is a great instrument series for implant maintenance. Their structure ensures excellent tactile sensitivity and optimal rigidity.

Tips are made of sensitive but still effective titanium, which will not harm the abutments. Whenever there is a need for a tip replacement the lock grip is opened, a new tip is inserted and the lock grip is closed again. No extra tools are required. This ensures that your implant instruments are in optimal condition, minimizes waste and allows you the opportunity to personalize your tip combinations.

Depending on the type of practice you are working in, will depend on the number and type of kits you will need to have available.

Streamlining your instrumentation has so many benefits. We need to look for ways to implement efficiencies into our new workplace and at the same time continue to deliver quality care and an exceptional client experience. This is the time to implement change. We work so hard at getting new clients and patients into our practice and at the same time want to keep a loyal and happy dental hygiene team, as hygiene is the backbone to a successful practice. We often create a negative experience by cutting corners and costs on what I think, is one of the most important part of the dental hygiene experience.

Transform the Dental Hygiene Experience, for your client/patients, your practice and yourself as the clinician, and implement an instrumentation protocol to ensure that your clients are receiving the best care and that your dental hygiene team are using optimal instruments.

To receive a download of The Decision Tree for Instrument Selection visit www.rdhu.ca/instruments. I recommend to print and laminate for easy reference.


About the Author

Kathleen is the president of ‘rdhu’, a Professional Development company, which provides team events, handson programs and online learning. Kathleen founded and sold a dental instrument company, had her own line of dental hygiene instruments and has participated in writing a chapter on instrumentation in a US textbook. Kathleen’s passion and vision is to help ‘Transform the Dental Hygiene Experience’ for dental hygienists, practices and their clients/patients. www.rdhu.ca


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