Variety is the Spice of Life Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

In speaking with different hygienists throughout the country, I’ve learned the brands of curettes and scalers you use in practice are probably what you used in school, or are just what the office orders. Instruments are critical to your success, so making informed purchasing decisions is essential.

I encourage you to expand your instrument horizons. Break away from your collection of school-based instruments and what is ordered in the office. Compare instruments in your hands to determine what works best for you and your patients. It’s difficult to tell how comfortable and effective an instrument is going to be simply by picking it up at a dental meeting. I know, I’ve tried it. This time, endeavor to purchase a variety of instruments from a variety of manufacturers to compare in your hands, in your office.

I don’t want to hear you say, “The dentist won’t let me buy….” Instead, have a talk with your dentist employer. Explain that you want to provide high-quality care for the patients and to do that, you need quality instruments and equipment. Rather than having to continually ask permission to buy the necessary instruments and equipment, suggest that eight to 10 percent of dental hygiene production be set aside for instrument and equipment purchases. With a budget for these things, responsible purchases can be made.

The variety of instruments available to clinicians is huge, and may seem overwhelming at times. Just look at one instrument at a time, but remember, variety is the spice of life. A variety of instruments offers more options when treating your patients.

Craftsmanship

Without understanding the instrument manufacturing process, you might think the curettes and scalers you use every day are made by simply pouring molten metal into a form. That would be much easier than the hand sculpting of a stainless-steel rod that makes up the actual process. In fact, each curette and scaler can require as many as 30 steps performed by highly-trained craftspeople.

Instrument companies all start with similar material, buying stainless-steel rods of differing diameters from various suppliers. A specifically sized steel rod is selected and then each bend and/or turn is added. The blade is cut into the rod and the edges sharpened and polished. It sounds simple, but these artisans are trained for several years. Those who have been around long enough are capable of completing all the steps from start to finish. New trainees begin with just one of the steps and build on their knowledge and skills to eventually handle the entire process. In talking with instrument manufacturers owners/managers, I was impressed with the companies’ dedication to quality craftsmanship and customer service. Each has their own unique business niche, but all are working hard to provide the profession with quality products. All of the companies have a dedicated following and provide unique instruments to make the hygienist’s job easier and more efficient.

Blade Sharpness

Subjecting the metal to extreme temperatures is the tempering process used by manufacturers to achieve desired metal strength. Blade hardness is created by heat treating the instrument after the blade is cut. It is the hardness of the metal that determines how long the instrument will hold its edge. Cryogenics using gases to significantly lower temperature, are also a part of the process. Lowering the temperature of the metal forces the metal molecules to line up evenly, creating a sharper edge. Heat and cold will enhanced the sharpness, but the initial cutting of the blade, and the polishing and finishing after these treatments will determine the quality.

Types of Steel

Two types of steel are used when creating curettes and scalers: carbon steel and stainless steel. Carbon steel offers a blade that holds an edge longer, but carbon steel will corrode when sterilized in an autoclave. To avoid this, simply use anti-corrosives when sterilizing. Just looking at it, I can’t tell the difference between stainless steel and carbon steel. However, in the hands of clinicians, they are different. Some clinicians swear by the cutting edge of carbon steel and the extra step in sterilizing is worth it to them. New approaches also have been introduced that combine metals such as titanium and stainless steel. It’s all about personal preference.

Handles/Ergonomics

Instrument handles come in a variety of sizes, shapes and materials. Varying the handle size during your workday is good for your hands. Instrument handles don’t require the same grade and quality of stainless steel as the blades. They can be made from a mixture of various grades of steel or plated brass. These materials are easier to machine and cheaper than the high-quality stainless steel used for blades. Some handles are hollow and many now are made of lightweight resins or silicone.

Made in the USA

From my estimation, there are only a few dental instrument manufacturers in the country actually making their instruments entirely in the United States from US materials. Resellers, companies that buy instruments from China, Pakistan and South American countries; simply attach their name to an instrument. Some companies buy their material elsewhere and only assemble the instruments in the US. When you buy instruments, ask if 100% of the components and manufacturing are done in the US.

Conclusion

Remember, it’s important to compare all the options you have available. Experiment with different handles. Discover how long cutting edges stay sharp when you use the instruments. The companies offer full guarantees on their instruments. If you buy it and find you don’t like it, you can return it. The manufacturers want you to be happy and work effectively with their instruments.

Dental instruments are like skates or skis to Olympic athletes. Select your curettes and scalers with the same focus on quality, workmanship and end result when used clinically. This is an investment in your treatment success. “Go for the gold”… oh, I mean “Go for the steel!”

My Foray Into Instrument Design & Development

By Trisha O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

Have you ever had trouble getting a curette blade into a deep pocket with enough room to actually adapt the blade and then activate a working stroke? My frustration with this, especially in furcations and deep, narrow pockets led me to sneaking the spoon excavators off the restorative trays, much to the dismay of Dr. Paul Spaeth, my employer at the time. (I know I’m not the only dental hygienist to use restorative spoon excavators.) When Paul’s patience wore thin, with missing spoon excavators, he told me to get my own instruments.

What I really wanted was a small disc blade, like having the toe of the curette without the unused portion of the blade. The entire outline of the spoon blade serves as a cutting edge for push or pull strokes, without requiring specific adaptation. To reach deep areas, furcations and interproximal surfaces, the shank of the Hirschfeld files seemed ideal. I asked a few instrument manufacturers and Thompson Dental (now a part of Miltex Inc.) agreed to make them for me. Tom Thompson, Sr. said he couldn’t imagine how I’d use them, but two weeks later the instruments were in my mailbox. Just what I wanted! It was quite exciting to solve a problem with a new instrument design and have a manufacturer make them for me. I do appreciate the efforts of Thompson Dental those many years ago.

The set of four tiny spoon tips are made by Dental USA, Hu-Friedy, G. Hartzell and Son, Zoll Dental, Miltex Inc. and Paradise Dental Technologies. Hartzell recently introduced the Suvan-O’Hehir implant curettes at the request of Jean E. Suvan, RDH, MA who works at the Eastman Dental Institute in London. She requested that the instruments be coated with titanium for use on implants. She’s completed photographs to determine the effect or rather the lack of damaging effect these curettes have on implants. (Publication of her findings is pending.)

If I can design instruments, so can you. What problem would you like to solve?

The Gracey curettes are nearly 100 years old. It’s time for curette redesign with the goal being to gently remove bacterial contaminants with greater access and more efficient blades. Many of the manufacturers take special orders; however, don’t quit your day job if you think instrument designing might be right for you, my reward is not financial, but it is fun to have my name on instruments.