Kelly Divito, RDH, MS
Kelly is a clinical dental hygienist who believes in enthusiastically treating every patient as if they were family. She is a CE author, clinical educator on behalf of WaterPik, spends her free time volunteering, and loves traveling with her family. She can be reached at email@example.com.
You know what makes me cringe and shake my head?
When I hear about hygienists working with substandard hygiene instruments while still being expected to remove calculus and stain on every tooth surface efficiently enough to stay on time.
I've been filling in as a guest hygienist for almost 15 years, and sometimes the experience is fantastic, and sometimes it leaves much to be desired. When filling in, the worst things to discover are broken instruments, bent probes, scratched mirrors or worse – just one ineffective Cavitron or Piezo insert for the day.
Here's what I’ve done to combat the instrument pack nightmares: I purchased a self-contained reservoir Cavitron unit and tips that travel with me to all the offices where I work.
I bought this unit secondhand from a hygienist who used it for her out-of-state boards, only, and then didn’t need it when she entered private practice. When that alone became insufficient and I could not further compromise my ergonomics, patient comfort or treatment of patients, I decided to place an order to build my cassettes with my own money.
Fortunately, several dental companies allow dental hygienists, with proof of licensure, to open accounts and purchase what they need. Within a day, I had spoken to Young Dental and Darby Dental, both of which had professional sales representatives who were happy to assist me in starting an account so that I had direct access to their ordering catalog. Two days later, I got my first shipment of instruments. I purchased metal cassettes to contain them and had them ready to go.
Bringing Them to Work
I plan to sterilize the cassettes and exclusively use them with my Cavitron in offices to ensure safety and sharpness. I'll have pictures of the inventory and receipts should anything go missing or break. I’ll let the offices know I am bringing the cassettes and have a pink toolbox to transport them safely.
I will also ensure everything is in the autoclaved before my last patient and use one of their cassettes on that patient so that everything is sterile when I leave if I’m not coming back the next day. I cannot tell you the relief I feel knowing I’ll have the sharp instruments I picked out, and I won't be forced into using substandard instruments with instructions to "do my best."
I intend to purchase more instruments and setups for scaling and root planning next. As the instruments wear down or become un-sharpenable, I will replace them because I no longer want to compromise my body or patient comfort and care.
Working Sharper, Not Harder
The excitement I feel knowing I will have control over a critical portion of my career – my instruments – has renewed my enthusiasm for clinical hygiene. Like most hygienists, I hold a high standard when providing patient care. Sharp instruments give me more time for oral hygiene instruction, reviewing treatment needs and answering patient-specific questions.
Ownership over instrument purchasing and maintenance is significant because it can lengthen my career by preventing operator fatigue from repetitive motion and can also increase patient comfort due to the sharpness of an instrument, which has brought me greater job satisfaction (Wilkins, 2017).
Further, I have less wrist and back pain from grasping older, less effective instruments; I don’t feel stuck using those instruments; and I have a greater sense of ownership of my professional obligations to the patient.
But Shouldn’t the Dentist Be Doing That?
While some may argue it’s the dentist owner's responsibility to purchase instruments, I want to share why I chose to do this.
It was for me.
Investing in myself has been rewarding and has produced an immediate return on investment. I am no longer frustrated with the lack of appropriate and effective instrument setups. I maintain my accounts with dental dealers so I can easily order what I need, making it easier to take advantage of sales and save all receipts to uphold warranty agreements.
My relationships with those organizations have led to their representatives sharing specials and deals with me since they know I’m supplying my kits. I appreciate their consideration regarding cost, and I love the ease with which I can order when I need to.
Purchasing personal dental instruments may not be a financial reality for all hygienists. I can relate and have been in those shoes early in my career. I propose you work with your owner dentists to maintain what can be maintained and work collaboratively and in phases to replace what critically needs replacing today. Then establish a goal for future additions to replace in smaller but manageable batches, and search for specials within companies to save money.
Instrument maintenance will be vital to the clinician and patient comfort, and also to the boss's pocketbook.
So, Is It Really Worth It?
Purchasing new instruments is not inexpensive, but it’s worth the investment in injury mitigation, career longevity and job satisfaction. I’m protecting myself and my patient from injury, ensuring a greater likelihood of thoroughly removing calculus and biofilm without compromising ergonomics, while also decreasing my risk of burnout.
I would love it if more dentists saw the benefits of providing hygienists with the instruments they need, not only to provide thorough care to patients, but also to decrease clinician fatigue and boost morale. However, I can no longer wait for someone else to provide this for me.
I encourage you to reach out to the resources I have listed if you would like to take control of your instruments, protect yourself from musculoskeletal damage, and increase your career longevity and job satisfaction. Hygienists with independent practices already do this. Let's join them.
The total cost to make my initial purchases for prophy kits was equivalent to approximately two days of hygiene wages. Here are the quantities of what I purchased:
(20) American Eagle XP Sharpen-Free instruments
(10) Mouth mirrors
(10) Shepherds hook/probe combo
(10) 11/12 explorers
Additionally, I purchased:
Knowing my setups are as sharp and effective as possible for me and the patient is priceless.
Here are some dental companies that allow actively licensed hygienist clinicians to make an account to purchase instruments and supplies:
Smith, D. (2018). Maintaining the Edge of Dental Cutting Instruments. Dimensions of Dental Hygiene. February 2018.
Wilkins, E. (2017). Clinical Practice of the Dental Hygienist. 12th Ed. Philadelphia: Lippincott, Williams & Wilkins.