Utrasonic scaling
DH-30 Mrs. Miranda
Introduction
Ultrasonic scaling is a very effective alternative to hand scaling. It has benefits for both the patient and the clinician if performed correctly and the clinician is trained properly. Ultrasonic scalers are considered superior to hand instruments for the treatment of moderate and severe furcations. With its slim tips, be able to enter narrow furcation areas. I chose this topic because ultrasonic scalers can reduce the time needed for a cleaning, make the cleaning more comfortable for the patient and reduce work related injuries for the dental hygienist. It offers the ability to thoroughly instrument deep pockets and furcation areas, and benefits over hand scalers by improving operator ergonomics and comfort, patient comfort, as well as more efficient and more effective treatment.
Patient or Problem (P)
What is the most effective and efficient way to remove biofilm, the bacteria that cause periodontal disease and calculus?
The selected method must effectively scale the teeth but it must not make the time spent in the dental chair longer, cause discomfort to the patient or increase the risk of work related injuries for the dental hygienist.
After cleaning, a complex subgingival biofilm forms within three to twelve weeks. Periodontal disease is associated with some of the gram-negative bacteria that make up the biofilm. The patient’s body responds to the bacteria by producing antibodies that can lead to inflammation and bone loss. Calculus forms when the biofilm calcifies. It releases endotoxins that can destroy the periodontal tissues.
Scaling the teeth removes the biofilm and calculus from the surface of the teeth and from the gingival pockets. The hardest places to reach are narrow interdental gaps and the bottom of gingival pockets, especially if they are over 4 mm deep.
Intervention, cause or prognosis (I)
The main intervention method being considered is ultrasonic scaling.
There are two major types of ultrasonic scalers: magnetostrictive and piezoelectronic. Both types use electrical energy to make an insert vibrate. Both types can vibrate between 25 and 40 kHz that is the range of frequencies used for scaling. However, the tip of a magnetostrictive scaler moves elliptically while the tip of a piezoelectronic scaler moves linearly. Magnetostrictive scalers allow more flexibility of use due to the wider range of movement.
A range of tips is available for ultrasonic scalers. Standard tips are most suitable for moderate to heavy deposits. They should not be used for light deposits. Slim tips are used to remove deposits in periodontal pockets that are 4mm deep or greater. They are also used to remove light deposits from any tooth surface. Fine tips are used to reach narrow interdental spaces. Plastic tips must be added to inserts when cleaning implants or cleaning near implants to avoid damaging them. There are other tips that can be used for other specialized situations.
Comparison or Control (C)
Manual scaling was used before ultrasonic scalers were developed and it is the major alternative still.
Ultrasonic scaling and hand scaling are similar in their effectiveness in removing biofilm. However, hand scaling takes longer and skill is needed to produce the same result. Ultrasonic scaling reduces the time required for thorough scaling; increasing efficiency for the office by reducing the time patients must sit in the dental chair. In addition, hand scalers are too wide to reach the bottom of some periodontal pockets and furcation areas; for example, the minimum width of the Gracey curettes is 0.76mm vs. the ultrasonic scalers is 0.55mm while the furcation entrances as narrow as 0.63mm wide. Their positions difference for calculus removal, the scalers must be apical to the deposit prior its removal, while ultrasonic scalers the insert is positioned coronal to the deposit. The result is less tissue distension and easier application of the instrument. Hand instruments cause more root surface damage in grooves and cementum removal than ultrasonic scalers resulted in no changes to the root surface. Hand instrumentation requires highly repetitive and more force hand movements, which can be wearing, musculoskeletal injuries, and ergonomically discomfort for clinicians. When selected and used appropriately ultrasonic instruments offers ergonomic benefits and effectively and efficiently remove hard deposits and subgingival biofilm. Hand scaling can cause more patient discomfort than ultrasonic scaling.
Outcome (O)
Ultrasonic scaling removes biofilm from every tooth surface, including deep periodontal pockets. It can be faster than manual scaling. This reduces the time spent in the dental chair and improves patient comfort by reducing tissue distention with light pressure in the insert that will help patient’s perception of pain and in maintaining patient regular visiting. Using ultrasonic scalers needs less force, less bleeding, and removes less cementum than hand instruments. This promotes healing and increases the chance of smoother finish than with hand instruments. Dental hygienists find ultrasonic instrumentation less fatiguing and more time efficient. Patients find comfort during and after treatment, and it also reduces the risk of work related injuries for the dental hygienist. The removing supra- and subgingival calculus results in both types are the same so as the healing process that also need the meticulous home care from the patient.
PERSONAL REFLECTION
Since my mom has developed early periodontal disease, she often visits her dentist at least two times a year or more. She always complains about how it hurts during the cleaning procedure, the long hours in the dental chair, and the sensitivity that occurs after each treatment. She had to pamper herself by not eating hot or cold food, rinsing her mouth with salt warm water after each meal and before bedtime until the symptoms are over. But she knew she had to take care of her teeth problems so she can keep her teeth as long as she lives. One day she came home after a dental visit. She was happy and felt so comfortable. She told me that the dentist had used a new instrument called an ultrasonic scaler for her treatment. Even though it was noisy it didn’t hurt at all and also she did not have to stay there hours like before. I did not know much about dental hygiene instruments but I could see how it affects the patient physically and mentally which I believe contributes a lot to patients in maintaining their dental visits. I’m glad that my mom was determined, brave and knew how important it is to keep her teeth. As a RDA for years, I have seen ultrasonic instruments but I did not understand properly about their ability, power and functions beside it uses for cleaning teeth. I’m glad that now I have a better chance to learn more about them and know how to use them affectively, safely and ergonomically. It’s always been my dream to work in the dental field so I can help my family, others and me.
I am looking forward to working with ultrasonic scalers.
Citation:
Reynolds, E. (2008). Effectiveness and Efficiency in Ultrasonic Scaling. Retrieved from
http://www.ineedce.com/courses/1434/PDF/Effctvness_Efficncy_Sclng.pdf
www.rdhmag.com
ADDITIONAL INFORMATION
General Drisko CL, Cochran DL, et al (2000). Position paper: sonic and ultrasonic scalers in periodontics (2000). Research, Science and Therapy Committee of the American Academy of Periodontology. Journal of Periodontology. 2000;71(11):1792-801.Review.
Gehrig JN (2007). Fundamentals of Periodontal Instrumentation & Advanced Root Instrumentation (5th Edition), Ultrasonic and Sonic Instrumentation.
Periodontal Complexes Lovegrove, JM. (2004). Dental plaque revisited: bacteria associated with periodontal disease. Journal of the New Zealand Society of Periodontology 2004;(87):7-21
Socransky SS, Haffajee AD, et al (1998). Microbial complexes in subgingival plaque. Journal of Clinical Periodontology 1998;25:134-144.
Checchi L, et al (1991). Tartar and periodontal disease – a cofactor in etiopathogenesis. Dental Cadmos. 1991;59(8):80-84, 87-90, 93-95.
Periodontal Furcation Limits Bower, RC (1979). Furcation morphology relative to periodontal treatment. Furcation entrance architecture. Journal of Periodontology. 1979. 50 (1):23-27.
Rateitschak-Pluss EM, et al (1992). Non-surgical periodontal treatment: where are the limits? An SEM study. Journal of Clinical Periodontology. 1992;19(4):240-244.
Magnetostrictive and a piezoelectric ultrasonic scalers Busslinger A, et al (2001). A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument. Journal of Clinical Periodontology. 2001;28(7):642-649.
Flemmig TF, Petersilka GJ, et al (1998). The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro. Journal of Clinical Periodontology. 1998;25(2):158-163.
Flemmig TF, et al (1998). Working parameters of a magnetostrictive ultrasonic scaler influencing root substance removal in vitro. Journal of Periodontology. 1998;69(5):547-553.
Ergonomics and ultrasonic scalers Michalak-Turcotte C (2000). Controlling dental hygiene work-related musculoskeletal disorders: the ergonomic process. Journal of Dental Hygiene. 2000; 74(1):41-48.
Pollack R (1996). Dental office ergonomics: how to reduce stress factors and increase efficiency. Journal Canadian Dental Association. 1996;62(6):508-510.
Implants and ultrasonic scalers Fox SC, Moriarty JD, Kusy RP (1990). The effects of scaling a titanium implant surface with metal and plastic instruments: an in vitro study. Journal of Periodontology. 1990;61(8):485-490.
Introduction
Ultrasonic scaling is a very effective alternative to hand scaling. It has benefits for both the patient and the clinician if performed correctly and the clinician is trained properly. Ultrasonic scalers are considered superior to hand instruments for the treatment of moderate and severe furcations. With its slim tips, be able to enter narrow furcation areas. I chose this topic because ultrasonic scalers can reduce the time needed for a cleaning, make the cleaning more comfortable for the patient and reduce work related injuries for the dental hygienist. It offers the ability to thoroughly instrument deep pockets and furcation areas, and benefits over hand scalers by improving operator ergonomics and comfort, patient comfort, as well as more efficient and more effective treatment.
Patient or Problem (P)
What is the most effective and efficient way to remove biofilm, the bacteria that cause periodontal disease and calculus?
The selected method must effectively scale the teeth but it must not make the time spent in the dental chair longer, cause discomfort to the patient or increase the risk of work related injuries for the dental hygienist.
After cleaning, a complex subgingival biofilm forms within three to twelve weeks. Periodontal disease is associated with some of the gram-negative bacteria that make up the biofilm. The patient’s body responds to the bacteria by producing antibodies that can lead to inflammation and bone loss. Calculus forms when the biofilm calcifies. It releases endotoxins that can destroy the periodontal tissues.
Scaling the teeth removes the biofilm and calculus from the surface of the teeth and from the gingival pockets. The hardest places to reach are narrow interdental gaps and the bottom of gingival pockets, especially if they are over 4 mm deep.
Intervention, cause or prognosis (I)
The main intervention method being considered is ultrasonic scaling.
There are two major types of ultrasonic scalers: magnetostrictive and piezoelectronic. Both types use electrical energy to make an insert vibrate. Both types can vibrate between 25 and 40 kHz that is the range of frequencies used for scaling. However, the tip of a magnetostrictive scaler moves elliptically while the tip of a piezoelectronic scaler moves linearly. Magnetostrictive scalers allow more flexibility of use due to the wider range of movement.
A range of tips is available for ultrasonic scalers. Standard tips are most suitable for moderate to heavy deposits. They should not be used for light deposits. Slim tips are used to remove deposits in periodontal pockets that are 4mm deep or greater. They are also used to remove light deposits from any tooth surface. Fine tips are used to reach narrow interdental spaces. Plastic tips must be added to inserts when cleaning implants or cleaning near implants to avoid damaging them. There are other tips that can be used for other specialized situations.
Comparison or Control (C)
Manual scaling was used before ultrasonic scalers were developed and it is the major alternative still.
Ultrasonic scaling and hand scaling are similar in their effectiveness in removing biofilm. However, hand scaling takes longer and skill is needed to produce the same result. Ultrasonic scaling reduces the time required for thorough scaling; increasing efficiency for the office by reducing the time patients must sit in the dental chair. In addition, hand scalers are too wide to reach the bottom of some periodontal pockets and furcation areas; for example, the minimum width of the Gracey curettes is 0.76mm vs. the ultrasonic scalers is 0.55mm while the furcation entrances as narrow as 0.63mm wide. Their positions difference for calculus removal, the scalers must be apical to the deposit prior its removal, while ultrasonic scalers the insert is positioned coronal to the deposit. The result is less tissue distension and easier application of the instrument. Hand instruments cause more root surface damage in grooves and cementum removal than ultrasonic scalers resulted in no changes to the root surface. Hand instrumentation requires highly repetitive and more force hand movements, which can be wearing, musculoskeletal injuries, and ergonomically discomfort for clinicians. When selected and used appropriately ultrasonic instruments offers ergonomic benefits and effectively and efficiently remove hard deposits and subgingival biofilm. Hand scaling can cause more patient discomfort than ultrasonic scaling.
Outcome (O)
Ultrasonic scaling removes biofilm from every tooth surface, including deep periodontal pockets. It can be faster than manual scaling. This reduces the time spent in the dental chair and improves patient comfort by reducing tissue distention with light pressure in the insert that will help patient’s perception of pain and in maintaining patient regular visiting. Using ultrasonic scalers needs less force, less bleeding, and removes less cementum than hand instruments. This promotes healing and increases the chance of smoother finish than with hand instruments. Dental hygienists find ultrasonic instrumentation less fatiguing and more time efficient. Patients find comfort during and after treatment, and it also reduces the risk of work related injuries for the dental hygienist. The removing supra- and subgingival calculus results in both types are the same so as the healing process that also need the meticulous home care from the patient.
PERSONAL REFLECTION
Since my mom has developed early periodontal disease, she often visits her dentist at least two times a year or more. She always complains about how it hurts during the cleaning procedure, the long hours in the dental chair, and the sensitivity that occurs after each treatment. She had to pamper herself by not eating hot or cold food, rinsing her mouth with salt warm water after each meal and before bedtime until the symptoms are over. But she knew she had to take care of her teeth problems so she can keep her teeth as long as she lives. One day she came home after a dental visit. She was happy and felt so comfortable. She told me that the dentist had used a new instrument called an ultrasonic scaler for her treatment. Even though it was noisy it didn’t hurt at all and also she did not have to stay there hours like before. I did not know much about dental hygiene instruments but I could see how it affects the patient physically and mentally which I believe contributes a lot to patients in maintaining their dental visits. I’m glad that my mom was determined, brave and knew how important it is to keep her teeth. As a RDA for years, I have seen ultrasonic instruments but I did not understand properly about their ability, power and functions beside it uses for cleaning teeth. I’m glad that now I have a better chance to learn more about them and know how to use them affectively, safely and ergonomically. It’s always been my dream to work in the dental field so I can help my family, others and me.
I am looking forward to working with ultrasonic scalers.
Citation:
Reynolds, E. (2008). Effectiveness and Efficiency in Ultrasonic Scaling. Retrieved from
http://www.ineedce.com/courses/1434/PDF/Effctvness_Efficncy_Sclng.pdf
www.rdhmag.com
ADDITIONAL INFORMATION
General Drisko CL, Cochran DL, et al (2000). Position paper: sonic and ultrasonic scalers in periodontics (2000). Research, Science and Therapy Committee of the American Academy of Periodontology. Journal of Periodontology. 2000;71(11):1792-801.Review.
Gehrig JN (2007). Fundamentals of Periodontal Instrumentation & Advanced Root Instrumentation (5th Edition), Ultrasonic and Sonic Instrumentation.
Periodontal Complexes Lovegrove, JM. (2004). Dental plaque revisited: bacteria associated with periodontal disease. Journal of the New Zealand Society of Periodontology 2004;(87):7-21
Socransky SS, Haffajee AD, et al (1998). Microbial complexes in subgingival plaque. Journal of Clinical Periodontology 1998;25:134-144.
Checchi L, et al (1991). Tartar and periodontal disease – a cofactor in etiopathogenesis. Dental Cadmos. 1991;59(8):80-84, 87-90, 93-95.
Periodontal Furcation Limits Bower, RC (1979). Furcation morphology relative to periodontal treatment. Furcation entrance architecture. Journal of Periodontology. 1979. 50 (1):23-27.
Rateitschak-Pluss EM, et al (1992). Non-surgical periodontal treatment: where are the limits? An SEM study. Journal of Clinical Periodontology. 1992;19(4):240-244.
Magnetostrictive and a piezoelectric ultrasonic scalers Busslinger A, et al (2001). A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument. Journal of Clinical Periodontology. 2001;28(7):642-649.
Flemmig TF, Petersilka GJ, et al (1998). The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro. Journal of Clinical Periodontology. 1998;25(2):158-163.
Flemmig TF, et al (1998). Working parameters of a magnetostrictive ultrasonic scaler influencing root substance removal in vitro. Journal of Periodontology. 1998;69(5):547-553.
Ergonomics and ultrasonic scalers Michalak-Turcotte C (2000). Controlling dental hygiene work-related musculoskeletal disorders: the ergonomic process. Journal of Dental Hygiene. 2000; 74(1):41-48.
Pollack R (1996). Dental office ergonomics: how to reduce stress factors and increase efficiency. Journal Canadian Dental Association. 1996;62(6):508-510.
Implants and ultrasonic scalers Fox SC, Moriarty JD, Kusy RP (1990). The effects of scaling a titanium implant surface with metal and plastic instruments: an in vitro study. Journal of Periodontology. 1990;61(8):485-490.