November 22, 2019
by Sherry Priebe, RDH, BDSc, MSc
I recently had coffee with one of my dental hygiene classmates from the University of Alberta. We reminisced about our days of learning about the profession of dental hygiene with memories of our favourite instructors, exams, radiography labs, petri dishes and dental hygiene clinics. We shared our unique individual amazing stories of our experiences during the Outreach Dental Practicum Rotation that was held in a mobile home, serving the remote villages around Slave Lake, Alberta. Our discussions included the joys of our dental hygiene careers and how the dental hygiene profession served us and our patients so well in Canada, or has it?
People want to have healthy teeth but are often afraid to go to the dentist or dental hygienist for fear of pain during and after treatment, having enough finances to pay for the treatment, being scolded or belittled for not taking care of their teeth and finding time to do the prescribed dental treatment. For some reason, past pain during the dental hygiene appointment is often a person’s cause to not return to the dental office.
This summer, I was at my friend’s daughter’s wedding reception where I sat at a round table with some of my acquaintances and some relatives of the bride. The lady who sat beside me is a friend and member of my mentorship group, as well as a life coach to many Fortune 500 personalities. She is an intelligent and thought-provoking individual whom I admire greatly. She directed the conversation around the table asking what people did for their careers and jobs. One lady said she was a librarian. My girlfriend said that she thought technology had a huge impact on her career and completely changed how and what she did as a librarian. She continued to ask others around the table what they did and again shared how amazing technology was in their professions. However, when she came to me, she said, “Oh Sherry, technology has not influenced you in your practice of dental hygiene at all”. I was completely shocked at her comment and realized that she had no idea how impacted by technology I was. Obviously the practice of dental hygiene as a whole has not incorporated any of the amazing technology that is being introduced to make our patients’ lives more comfortable in our chairs.
Since graduating with my Diploma in Dental Hygiene from the University of Alberta, I practiced my profession based on those days of understanding the biological and scientific facts and techniques of scaling and root planing. New scientifically evidenced based discoveries and new technology has been introduced to me about why and how to ‘clean’ my patient’s teeth. While attending dental conferences, I learn about new toothbrushes that are recommended for my patients to use that are equipped with artificial intelligence and bluetooth to signal them if their plaque is effectively removed from their teeth. We have been introduced to Lasers, lights and numbers that are on indicators to identify decay and light fluoresced tissue regarding possible precancerous or cancerous tissue. Yet, my friend announced openly that she thought that technology has not affected the dental profession and specifically, the dental hygiene profession has not advanced in the way or how we ‘clean’ teeth. In fact, what she said was true, as she said we clean teeth in the same old way that has been done since the beginning of time! WOW! I realized then that she was right. We have not progressed at all in using technology for our patients’ oral health or our advantage. We have been trained in dental hygiene school to somewhat use the Cavitron as a mediocre ultrasonic cleaning device. However, most hygienists believe our hand scaler instruments are not and could never be discarded. Are hand scalers really the gold standard of dental hygiene? Is there a more technological and advanced way to remove the debris and hard and soft deposits on and around the teeth to improve our patients’ oral health?
What are we missing? As dental hygienists, we diagnose periodontal issues while charting with our variegated probes and tell our patients that we will have to make four appointments for them so we can ‘deep clean and root plane their roots’ to get their disease under control. We work very hard to get their roots ‘glassy’ smooth as that is the goal, and the patient gets upset with us that it costs so much. They complain that their gums hurt while we curette their teeth and their teeth ache for weeks after with bleeding gums. Sound familiar? I realized there is a disconnect with what we say to our patients and what we do. We tell them to use an ultrasonic toothbrush to disrupt the bacteria in their sulcus but we use hand instruments to disrupt it while they are in our hygiene treatment chair. I decided I needed to do some research on hand scaling versus ultrasonic scaling and specifically the piezoelectric scaler.
The dentist I work with bought piezoelectric ultrasonic systems for the hygiene treatment rooms. I used it and realized that the ultrasonic action and tips were uniquely activated. The action along with the water lavage improved the health of my patients’ gingival tissue. I began to investigate the variety of ultrasonic tips for more effective adaptation and fine sub- and supra- gingival removal of calculus and plaque.
My method of ‘cleaning’ teeth has changed and the understanding of the biology behind what I do and why I do it. Healing occurs in the mucosal tissue with the removal of and disruption of the accumulation of bacteria and biofilm. I can do that much more effectively with the piezoelectric ultrasonic scaler with unique fine tips that are thinner resulting in patient’s comfort and preference than using a hand instrument for many more hours. Research has changed the way that not only private dental and dental hygiene offices look at the removal of bacteria and hard deposits around the teeth. Many periodontal offices have realized the proven scientific findings and use of piezoelectric ultrasonics in their offices as there is now proof of the biology of bacteria being disrupted by the higher activation of energy. Phagocytic cells in the gingival tissues are activated to destroy and remove bacteria and unhealthy tissue by the ultrasonic action of cavitation forming bubbles that break the bacterial cell walls. Greater energy dispersion and greater tactile sensitivity is possible with the piezoelectric ultrasonic scaler as the vibration is all directed to the instrument lateral edges.
I have perfected my ‘system’ of the dental hygiene appointment. The word ‘system’, as defined by ‘Siri’ on my iPhone, is “a set of things working together as parts of a mechanism or an interconnecting network, a complex whole.” The scientific evidence that was known when I graduated provided the basis for how I performed my care and implementation of dental hygiene for my patients. I learned the anatomy and morphology of a tooth along with the surrounding tissues in dental hygiene training through learning how to scale teeth. I am not saying to ‘throw away’ the teaching of scaling in dental hygiene schools, as it serves to learn the technique of scaling and as an understanding of the feel of the tooth and the difference between natural tooth and calculus. New evidence has changed the way we name and perform periodontal disease diagnosis treatment and prognosis; new techniques of oral cancer checks are always being improved; we call our patients differently now using terms such as clients; and we use various new improved hygiene polishing products to ‘clean’ teeth better.
Hygienists using the piezoelectric ultrasonic scalers have much less fatigue in their arms and hands. Carpel tunnel syndrome is no longer the feared problem as the issue of severe and long hand scaling appointments is not necessary. Yet there is still controversy and hygienists have told me that they will never let go of using their hand scalers and that it is just not possible to do a good job with only a piezoelectric scaler regardless of varied tips.
Yes, my dental hygiene scaling and root planing clinics have served an important knowledge of tooth anatomy. I have served my patients well using my hand scaling techniques in the hygiene profession over the years. However, I know now that with using the latest technologies and proven scientific findings, my preferred way to treat periodontal disease is with the piezoelectric ultrasonic scaler as the main tool of removal of hard deposits and disruption of bacterial colonies and biofilm in the sulcus. New technology works and why would I not use it for both my patient’s and my comfort? Has technology influenced our profession? I am proving it to my patients every clinic day that using technology to our benefit in and out of the office is winning the battle of periodontal disease!
About the Author
Sherry Priebe, RDH, BDSc, MSc impacts the lives of people globally with her dental hygiene life focus to “assist people to attain optimum oral health through research, education and clinical practice”. Sherry graduated with her Dip.DH (UofA), BDSc and MSc (UBC). She has published in the Vietnam J of Med and Pharm, the Can J of Dent Hyg, the Int’l J of Dent Hyg and the Dent Health J (UK). Sherry was awarded the ‘World Dental Hygiene Award in Research’ by SUNSTAR and the International Dental Hygiene Federation for her pioneering study in oral cancer and cultural risk factors in Vietnam. She mentors UBC students in further study by taking them annually to Vietnam to learn about risk factors and oral cancer victims.