Ultrasonics vs. Hand Scalers…how much time with each?

During the last month, I’ve had the privilege of working with teams in three distinct regions of the country. It is fascinating to me how every dental practice feels their challenges are theirs alone and yet I see how they actually have so much in common.

A conversation that has come up in more than one practice this month is the question of how much time to spend during a prophy with hand-scalers versus ultrasonics. This is a very important question as it affects so many areas of hygiene care- patient comfort, provider confidence, time management and even tissue response and clinical outcomes.

I’ve seen a wide variety of opinions and techniques in this area.  I experienced one team recently that spent perhaps a total of 3-5minutes with a quick supra-gingival pass with the ultrasonic. The other end of the spectrum is another hygienist who spends at least 10 minutes per quad with the ultrasonic and then follows that with complete instrumentation with hand-scalers.

They’re both wondering… ‘What’s right?’

While I will not make a blanket statement for every patient circumstance, I feel comfortable saying that the sweet spot is somewhere in the middle.

With the first scenario, the question becomes one of effectiveness. Is a quick 3-minute pass on the coronal surface enough attention to really make a difference in tissue response? Probably not.

Is a total of 40minutes of scaling as a pre-cursor to full mouth hand instrumentation necessary in a healthy patient? Probably not. And this is going to make it impossible to stay on the recommended 20-20-20 time schedule for a 60-minute hygiene visit.

Based on the studies I’ve reviewed, learning from experts in the periodontal field and anecdotal evidence, I feel comfortable making a statement to this effect:

It is appropriate and evidenced-based to use an ultrasonic instrument as your primary tool for scaling and use hand instruments as adjuncts to refine your scaling results when remaining calculus is detected.

A lot goes into that statement:

  • The assumption is that you have an appropriate sub-gingival (11/12) explorer that you use to detect remaining deposits that require hand instrumentation
  • The assumption that as a clinician you are confident in your technique and skills with the ultrasonic
  • The assumption that your ultrasonic scaling technique is extremely thorough and intentional as a primary means of deposit removal and biofilm disruption

In a study published in the Journal of Perio in 1998 entitled Root instrumentation. Power-driven versus manual scalers, researchers state ‘it appears that use of ultrasonic scalers for periodontal debridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.’

There are many other studies and literature reviews that confirm this theory and the AAP has a position paper from 2000 stating that ‘ultrasonic and sonic scalers appear to attain similar results as hand instruments for removing plaque, calculus and endotoxin‘.

So next time you pick up your ultrasonic instrument, think about the things Stacy taught you last week and ask yourself ‘What needs to happen for me to feel totally comfortable with using this as my primary scaling tool?’

I’m sure I’ll hear a lot from our readers on this topic and I welcome that. Please feel free to leave comments on our blog, to email me at Rachel@inspiredhygiene.com request a list of resource articles or to inquire about our hands-on instrumentation courses that we’re now offering.

Stay Inspired,
Rachel

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3 comments on “Ultrasonics vs. Hand Scalers…how much time with each?
  1. Elijah says:

    Hello,

    I actually have a question.
    In the past when I had my teeth cleaned by a dentist, they always used the ultrasonic scaler and I always thought that is the right way because I really thought that rubbing a metal thing, manual scaler here,over teeth will damage the enamel and predispose it to cavities later on.
    But this time the new dentist in Australia used only a manual scaler scrubbing my teeth. It took an hour and at least what I felt was quite harsh. The dentist’s response to my concern was that it is a safe procedure and that you can’t damage enamel that easily and that the ultrasonic scaler does not go under the gum as well as the manual one. She said my teeth had that much tartar because they never used manual scaler in the past. I still did not like this sharp steel thing on my teeth.
    Now, after that session, when I floss my teeth, one of the teeth catches the floss and tears it. Being so concerned, I look at it in mirror, it is the posterior side of a premolar teeth so a bit difficult to see, but what I manage to see is like a groove/cut or maybe a tiny fracture and when I touch it with my finger nail it definitely feels sharp.
    My concern here is that, do you think that the dentist has broken my teeth with the scaler? I floss regularly so if it was there before I should have noticed it. Do you think that defect on my teeth with develop in a cavity? This is really worrying me.

    Thank you

  2. Eugene Gobby says:

    When I had a standard teeth cleaning in 1992 using the then standard metal instruments, I got a heart infection (endocarditis) – not as uncommon as you might think. After 6 weeks on antibiotics (4 in hospital), I got an artifial valve. The hygienist was very aggressive and I almost asked her to stop. I turns out there is always strep bacteria under your gums. I now always have to take antibiotics for any work on my teeth. (I believe that there was also another factor. The dentist practice had always used a spit sink, but the government had forced every one to change to those suction tubes. I don’t think they were trained in sterilization them or if the design was any good. The change was because of the AIDS crisis. Evidently germs could be transferred from one patient to another because, ironically, I read, that AIDS had been transferred from an infected paitient to another and they got AIDS. My own heart sergion actually had me tested for AIDS even though I wasn’t in a risk group. Well, at least I did not have that. Now I always look for a dentist who uses a sonic scaler. On the other hand I haven’t seen any data on
    their use either. As an aside, I think that dentists and doctors should have a sort of “no fault” insurance because these complications will always be a part of medicine. That would save all sides the trama and expense of a malpractice suit. I had a bit of money at that time, but I should have sued. I have since heard that many suits are settled out of court. Anyway, I don’t let anyone near me with a sharp hook.

  3. Anna says:

    Thank you for this well informed advice and references. I’ve practiced as a hygienist for 8 years and have also worked in many different practices and provences. My current employer has questioned how much I use the ultrasonic as I love it and use it for almost every patient. I will show him your findings as well as express mine!
    Thank you again!

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