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Profile in Oral Health Trisha E. O'Hehir, RDH, BS Editorial Director, Hygienetown Magazine

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Valorie Hill, RDH
by Trisha O'Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

Getting your instruments sharp and keeping them that way can have a great impact on the way you practice.
Hygienists love to work with sharp instruments, but only a small percentage of clinicians are experts at sharpening and an even smaller percentage actually enjoy it. For the vast majority, sharpening is difficult and often avoided. Townie Suzanne Mann, aka "shazammer" on Hygienetown.com, sums up her thoughts on sharpening with this message board comment: "As someone who worked with a periodontist for a few years and sharpened eight trays of instruments four days a week, I'm here to tell you there are many wrong ways to do it, and I've seen hygienists do them all. Magnification is imperative, bright light is imperative. We used
a jeweler's electrically lit magnifying lamp. Instruments cannot be sharpened in mid-air. A sturdy surface is needed. For my part I never felt like I got it right even though I was working shoulder to shoulder with a hygienist who taught dental school perio. If you are starting out with brand new instruments, it is easier to maintain, but if you are trying to restore hopelessly mangled instruments that have been ruined by a previous employee - good luck."

Townie Fred Van de Perre, president of Paradise Dental Technologies (PDT) and known on Hygienetown.com as "curettedesigner," presents hands-on sharpening courses to hygienists and hygiene students across the country. Fred wrote the following message board comment: "The profession likens sharpening to rocket science, but it is all in the angles and maintaining consistency with your mechanics. The important thing to remember is that although we have three different designs to sharpen (sickle, universal curette and Gracey), they all have the same angulation off the face of the blade. By adjusting the terminal shank to bring the face parallel with the floor, you will maintain consistent stone angulation with every type of curette."

Two Essential Steps in Sharpening

Step One: Know the instrument shape and cutting edge angles.
Examine new instruments carefully before using them to understand the shape and the cutting edge angle. Check instruments for sharpness by using a testing stick or looking at the cutting edge. With gentle pressure against a testing stick, Ping Ring by PDT or a saliva ejector, a sharp cutting edge should grab the surface. No need to scrape the plastic surface, just test for grab. If the blade slides along, it's dull.

By looking at the cutting edge, it should be possible to see if the blade is sharp or dull. Without magnification and bright light, this is just a theory to many. It's difficult to really see the shiny line created when the blade is dull. What we are actually looking at when the blade is dull is a new bevel or surface between the face and back of the blade. The goal of sharpening is to remove this new beveled surface, but improper sharpening technique may actually enlarge this new beveled edge. Magnification and bright light make seeing the cutting edge or the new beveled edge of a dull instrument much easier.

Step Two: Restore the original shape of the instrument.
Focus sharpening on the back of the blade, not the face of the blade. The dull surface created by using the blade needs to be removed, by removing metal from the back of the blades, thus moving the back of the blade to again meet the face. Place the back of the blade against the sharpening stone at the original cutting edge angle. Holding the stone at this angle will allow you to remove metal from the back of the blade and re-establish the original edge between the face and the back of the instrument.

Conventional wisdom and authors of dental hygiene textbooks suggest that removing metal from the back rather than the face of the blade will maintain the strength of the blade. Removing metal from the face of the blade will lead to a weakened instrument.


Advantages of Sharp Instruments

Sharp instruments require less force to remove deposits, which cuts down on uncomfortable experiences for patients, longer time to remove deposits, and excessive hand and arm fatigue for the clinician. There are many advantages for both the clinician and the patient when sharp instruments are used. The time devoted to sharpening results in a faster, more comfortable experience for the patient and less muscle stress for the clinician. Both win with sharp instruments.

In the words of Townie Erika Feltham aka "rdh1982's" message board post, there is value in sharp instruments: "Checking daily for sharp instruments is extremely important. Knowing how to properly sharpen instruments is even more imperative! There is nothing better than a well-sharpened instrument taking a ‘sharp bite out of calculus!' Keep in mind, a lot less energy is needed when using properly sharpened instruments. Thus, less muscle strain, force, effort and total body fatigue by the end of the day, not to mention cleaner and smoother (supra and subgingival) surfaces throughout."

Sharpening Systems

Since so few hygienists have mastered the art of instrument sharpening with a stone in one hand and the instrument in the other, many sharpening systems are now available to make sharpening easier and more predictable. Townie Karen Robertson aka "kayelare" counts herself among the many who are looking for a better way to sharpen: "I know there are a lot of faculty that believe students should learn to sharpen by hand. I agree with that in theory, but some of us just don't get good consistent results and I feel a consistent sharp edge is more important than sharpening the ‘old fashioned' way. I have an annoying habit of closing the stone too much. Also, when time is short, it's too easy to make mistakes."

Kayelare, is not alone. Many hygienists want a predictable way to sharpen instruments. The PerioStar is considered the top of the line in sharpening systems since the advanced technology allows the instrument to be locked into the machine and the sharpening can be done by anyone in the office. Honing machines provide a rapidly moving stone against which an instrument is held. With steady hands and very light pressure, this method works well. There are several systems that provide guides for lining up the instrument correctly. Some are simply taped to the counter, some are battery operated and some are hand-held systems that can be easily sterilized and used chairside.

Sharpening stones come in many sizes, shapes, materials and a wide range of costs, from $10 to several hundred dollars. Stone shapes include cylindrical, conical, flat, wedge, and channeled. The Arkansas are natural stones of varying colors mined in the Quachita Mountains near Hot Springs, Arkansas. The India stone is made of aluminum oxide and ceramic stones are synthetic. The use of oil is really up to the clinician. Oil is recommended when using Arkansas and India stones, but not for ceramic stones. The oil allows the blade to slide easily and prevents the metal shavings from becoming imbedded in the stone.

The most expensive sharpening stone has a precision cut channel that matches exactly the cutting edge of the blade. Another sharpening stone is attached to a mouth mirror, to assure you have a sharpening stone on every tray setup.

Another sharpening method uses high-speed stones. Townie Dianne Glasscoe is our expert on this technique and posted this message board comment: "Sharpening systems come and go, and I think I've tried just about every one of them. And I have to admit that when I got out of hygiene school many years ago, I didn't know how to sharpen very well. However, I haven't found anything better than using magnification (either loupes or high power readers), a green or white stone, and a good light. The problem in getting a sharp blade is being able to 1. See the dull edge, and 2. Consistently maintain the correct angle of stone to blade. I learned to sharpen with a handpiece and a small stone years ago, and I haven't found anything that is faster or more efficient." Dianne has developed an instructional DVD on this sharpening system.

There are two other sharpening items that are not stones. The Neivert Whittler is a stainless steel instrument with a tungsten carbide steel blade used to sharpen the cutting edges of curved curettes and scalers. The Tang file is similar to a very narrow fingernail file and is used to sharpen individual blades on periodontal files.
Instrument Sharpening Systems
Honing Channel sharpening stones (fine and abrasive)
Cutting Edge Technology
www.cetllc.com		 $349
Sidekick
Hu-Friedy
www.hu-friedy.com		 $373.50
InstRenew
Nordent
www.nordent.com		 $409
Ultimate Edge Transformation Kit with Gleason Guide
Paradise Dental Technologies
www.pdtdental.com		 $190.39
PerioStar 3000
Kerr Corporation
www.kerrdental.com		 $1,343.80
Premier D.I.S.C. (Dental Instrument Sharpening Companion)
Premier USA
www.premusa.com		 $152.10
Remi Gripstone
Remi Dental Products, Inc.
www.remidental.com		 $19.95
Rx Honing Machine
Rx Honing Machine Corporation
www.rxhoning.com		 $670
Shofu Green and White Stones
Shofu Dental Corporation
www.shofu.com		 $19.22
for 12-pack Dura-Green
$21.49
for 12-pack Dura-White
Edgemaker 1000
Tsharp
www.tsharp.com		 $199.99
 
Instruments That Need Little or No Sharpening

Instrument companies use different grades and mixtures of metals with a variety of heat and cryogenic treatments resulting in blades that hold their cutting edges for varying lengths of time. Instruments from different manufacturers dull at different rates; some dull quicker than others. It all depends on the metals and how they're treated.

Hu-Friedy advertises Everedge instruments that need less sharpening than standard curettes due to the way the metal is treated. American Eagle advertises instruments coated with XP technology that are thinner than standard designs and hold their edge for three to four months or longer without sharpening. When they do get dull, however, they must be replaced, as sharpening is not recommended for XP instruments.

Sharp instruments make your job easier, faster and better. The experience is more comfortable for the patient, less fatiguing for the clinician and results in cleaner surfaces in less time. Keeping those sharp edges is the challenge you face every day, whether you sharpen with a simple stone or one of the many sharpening system designed to insure proper blade placement and effective removal of metal to establish and maintain ideal cutting edges.

You have the opportunity to purchase and compare instruments from a variety of companies to see which are made with metal that holds the cutting edge longer in your hands, requiring less frequent sharpening. Not all instruments are made with the same metal, so test them to determine the brand that you find works best. You might also want to try instruments designed in a way that sharpening isn't necessary. Clinicians prefer a variety of instruments and sharpening systems, do the comparisons yourself to find the ones that help you provide the best possible patient care.

Check out the many sharpening discussions on Hygienetown.com to see what other hygienists have experienced to be the best instruments and the best sharpening systems for them. Different instruments feel different in different hands. Select the instruments and the sharpening techniques that you're comfortable with and provide the best results. The choice is yours; the benefits are many.
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