Alyssa Aberle RDH, BSDH, MBA

5 Things I Wish I Learned in Dental Hygiene School. Courtesy of andrey_orlov/stock.adobe.com.

As graduation season rolls around, I can’t help but reflect on my 13-year career in dental hygiene. I remember the excitement of walking across the stage, applying for jobs, and officially becoming a Registered Dental Hygienist (RDH). A blank slate lay in front of me with a million possibilities. But that excitement was paired with a feeling of being unsure of myself and whether I was really prepared to walk into the “real world” of dental hygiene. Fortunately, I quickly learned that my dental hygiene education had prepared me well. Even with that in mind, there are definitely a few things that I know now that I wish I had learned in dental hygiene school.

I recently asked in several Facebook groups what experienced hygienists wish they had learned in hygiene school. While everyone's experiences are different, some repeated themes were emerging. So, here are a few things I (we) wish I (we) had learned in dental hygiene school.

In my informal Facebook surveys, the overwhelming majority of hygienists said they wish proper emphasis had been put on ergonomics and ways to reduce health risks in our profession. I recently wrote another article that touched on many of these health risks and how to prevent them. We know as hygienists that prevention is the key, and it is no different with our musculoskeletal system.

Proper ergonomics begins with correct posture. So much of our day-to-day lives is affected by how we sit and stand, and while that seems straightforward, for many of us, it’s not. Keeping your spine in a neutral position is important all the time, not just when we’re practicing clinically.

Luckily, there are many tools available today that are ergonomically designed, many of them created by hygienists who know firsthand about the issues we face. Over the past 2 years, we’ve seen a huge increase in high volume evacuation (HVE) utilization for dental practices. Now, more than ever, we realize the need for preventing aerosols in the dental practice to help protect us and our patients, but while helping protect us from 1 thing, it has caused wrist, arm, neck, and shoulder issues. Many dental hygienists work solo and therefore are trying to figure out how to hold a larger, heavier hose for an hour (or more) at a time. Products like CordEze®, Purevac®, ErgoFinger®, Aerosol Assist, and more have been designed to help us manage the HVE while letting us maintain ergonomic positioning. Many other products on the market like newer, lighter loupes, including prismatic lenses, ear protection, and dental delivery units focused on operator positioning are all helping us start preventing issues earlier in our careers.

I feel like my dental hygiene program talked about ergonomics quite a bit. All students were required to purchase loupes in our first year and use them during clinic. Despite their good intentions, these purchases were made before we really had any clinical experience. Most of us made these purchases based on better esthetics without an understanding of our personal ergonomic issues. The average age of students in my hygiene class was probably early to mid-twenties too. So, as much as you can try to reinforce messages about the need to implement work practice controls early, it’s hard to convince younger people of the importance of these things until they learn from experience.

Calculus does not equal scaling and root planing (SRP)

This statement just makes me laugh. Of course, the presence of an irrational factor does not indicate a specific procedure to be done or a specific Current Dental Terminology (CDT) procedure code to be used, but unfortunately, many new graduates from dental and dental hygiene school think this way. We get so focused on meeting clinic requirements, checking for “clicks” of calculus, and meeting criteria for a clinical board exam that we forget that what we should be focusing on is diagnosis and treatment planning. Once you’re working, these critical thinking skills are much more important and allow you to offer something valuable to your patients and your practice.

The American Academy of Periodontology (AAP) classification of periodontitis is characterized by a multidimensional staging and grading system. Digging deeper into this system for classification and really understanding each factor for determining a diagnosis for your patient is key to determining the proper treatment options, communication with your patient, and understanding the expected outcomes and prognosis. While dental hygiene diagnosis and treatment planning is taught as part of the dental hygiene process of care, it still doesn’t seem to be the focus. So much of our clinical education is still based around mechanical removal of calculus and scaling. Even our board exams are focused on detecting and removing calculus. My hope is that as we start to rethink our curriculum and accreditation standards, we continue to prioritize the need for critical thinking skills at all steps in the process of care. Removal of calculus does not necessarily correlate with health of a patient or absence of disease, and we need to prepare our future clinicians for how to treat a patient from a more holistic perspective looking at all factors in their disease.

Another aspect to this issue is the inability of new clinicians to understand how their diagnosis and treatment plan fit within our CDT procedural codes. I am the first to jump up and say that our current coding system is flawed and need some significant overhaul, but it is the only system we currently have. After working in a federally qualified health center alongside many medical providers, I have seen firsthand how they are able to incorporate education and chronic disease management into their care for patients with conditions like diabetes, high blood pressure, mental health concerns, and more. Their coding system is much more focused on diagnosis and outcomes than on procedures. They can see patients more often, for varied amounts of time, and in a variety of settings like group care visits, to address chronic health concerns and talk about disease management. Shouldn’t we be able to do the same? We know that caries and periodontal disease are both chronic conditions and multifactorial, so why are we still trying to address them from a surgical and procedural frame of mind when it comes to treatment planning. In a world where CDT codes and insurance reimbursements didn’t exist, would we still be doing things the same way, or would we be treating the patient more holistically?

And yet, our current CDT procedural codes are what exists for now, and what we have to use in order to document the care we’re providing to our patients. While limiting, it is important that we understand the codes as they are currently written while continuing to advocate for change as well. Many new graduates, and experienced hygienists for that matter, really struggle to understand the indications and limitations of each CDT procedural code and the implications of the patient’s diagnosis on which codes can be used. For example, I can’t count how many times I’ve seen a question asked on Facebook like, “Can I alternate between a periodontal maintenance (D4910) and an adult prophylaxis (D1110) on a patient every 3 months?” The answer is clear that according to the CDT code descriptions you cannot perform an adult prophylaxis on a patient with periodontal disease and you can’t perform a periodontal maintenance on a patient with healthy periodontium. But the question itself indicates that so many of us do not understand how to use the existing codes properly and how much misuse exists because of insurance reimbursement limitations. Maybe some hygiene programs incorporate this aspect of treatment planning and billing into their programs, but I don’t remember much from my program.

As a hygienist who has gone on to complete a Master’s Degree in Business Administration, I see the importance of dental hygienists gaining a deeper understanding of how the business operates and our role as a dental hygienist in the health of our practice. Many dental hygienists shy away from getting involved in the business aspects of their practice because they feel like it makes it “just about the numbers.” They don’t consider that these “numbers” are what keep the lights on and allow us to continue providing care for our patients.

When dental hygienists invest in understanding the metrics in the practice, we can start to see the bigger picture of long-term sustainability and the overall health of the practice. We can understand where most of the money is spent (usually salaries) and contribute ideas on ways to be more efficient with finances. Contributing to the practice at this level increases your value to the practice owner because now you are collaborating to find solutions. Many of these metrics will also give insight to your individual role in the practice and allow you to measure your productivity over time. While productivity numbers are just one part of the value you offer to your practice, you can use these numbers to assess where the gaps are and where there may be opportunities for improvement.

One of the areas that always has room for improvement in a practice is accounts receivable (patient payments and third-party reimbursements). Most of the public really does not understand what dental “insurance” is including what’s in their coverage, what limitations exist, how to select a provider based on their dental coverage, or how the provider gets paid. I would argue that most dental hygienists don’t really understand it either, especially when they are recent graduates. Taking time to understand dental office operations on this level can really increase the dental hygienist’s value to the practice. By understanding a patient’s coverage and benefits, we can better communicate with our patients about their treatment plan, the necessity of what is or isn’t covered, and increase case acceptance.

One thing is certain, nobody walked across the stage at graduation as the same clinician as they are 10 years into their career. Luckily, we learn things along the way that make us better clinicians, but also more well-rounded thinkers. Experiences in our lives, both work-related and not, force us to see things from a different perspective sometime. Learning how to acknowledge when we’re wrong, adapt to uncomfortable situations, and learn from our mistakes makes us better. Unfortunately, the dental hygiene education environment sometimes doesn’t encourage us to fail. Every checkpoint and test that’s graded reinforces our desire to achieve perfection. Every course is aimed at preparing us for our board exams. I often speak to local student chapters of the American Dental Hygienists Association and when I offer some topics that I’d like to speak on, the student leaders tell me, “If it’s not on boards, we don’t get much engagement from our classmates.” I know that’s not indicative of every student, or every program, but I think the sentiment is familiar. There is so much pressure and attention put on memorizing facts for a board exam, that we lose sight of the things that make excellent dental hygienists after graduation - critical thinking, taking initiative, seeking evidence-based research, and creativity.

I know the purpose of the existing examinations for healthcare professions, but I think a much more subjective assessment would be helpful in some ways. I wish that my peers were better equipped to find and digest evidence-based research. I wish that my peers better understood jurisprudence, the licensing procedures, and legislative process. In today’s world, there is so much information at our fingertips. Many textbooks are out-of-date almost before they’re published. What’s more beneficial than memorizing facts for a test is understanding how to find the best and most current information when you need it.

All 50 states in the U.S. require dental hygienists to complete continuing education hours. But not all continuing education is created equally. It’s very easy for us to just check the box to fulfill a requirement instead of using this opportunity to really grow and teach us. There are so many dental professionals (and non-dental professionals) that offer continuing education courses on subjects that they are passionate about and learning about. We should take advantage of these courses and really lean in to learn something that challenges our current perspective. There are so many areas that we know more about now than we did even when I graduated 13 years ago. There are conversations about oral/systemic connection, airway, lasers, myofunctional therapy, biofilm management, medical management of caries, and so many other topics that weren’t even known a decade ago. It’s our responsibility to engage and continue to learn all that we can about these new ideas to better serve our patients and grow as professionals.

When people first hear that I’m a dental hygienist, they think of teeth. They talk to me about their teeth. They talk to me about my teeth. I must really love teeth. And yes, I do like teeth (as evidenced by my purses, luggage tags, lapel pins, t-shirts, etc.). But what I really love, and what drew me to this profession, was the drive to help people. My passion for dental hygiene is partly about my desire to help people improve their oral health, but it’s more about my desire to help them lead healthier and happier lives - the way I do that just happens to be through helping them understand and improve their oral health.

There are a lot of niches in the dental world. Don’t be afraid to try new things until you find something you’re passionate about. Temping as a new graduate may be intimidating, but it can also introduce you to a lot of different practice settings and environments that you would not have known existed. You may be able to find practices that focus on community health, laser dentistry, pediatric or senior populations, periodontics, prosthodontics, or a practice that includes a little bit of everything. Take risks and learn as much as you can. Eventually you will find something that connects with you and reminds you why you chose this profession in the first place.

For me, one of the greatest blessings in my career has been my involvement in professional organizations. I am a member of the American Dental Hygienists’ Association, American Mobile and Teledentistry Alliance, Organization for Organization for Safety, Asepsis and Prevention, and Dental Entrepreneur Women. Throughout my involvement in these organizations and participation in conferences and professional development events, I have met some of the most incredible people. I have been mentored by incredibly passionate and accomplished dental hygienists, and it has motivated me to continue pursuing my own passions. There is an entire community of dental hygienists at your fingertips through social media groups and online communities that are waiting to welcome you into our profession and cheer you on.

Luckily, I did learn that during dental hygiene school and I entered my profession feeling encouraged and supported. I hope that every dental hygienist can find their support system and launch into a long and successful career.

Articles

Dental hygiene school equips future hygienists in many ways, but some lessons simply come with time and experience rather than books. 

5 Things I Wish I Learned in Dental Hygiene School

Avoiding Potential Health Risks as a Dental Hygienist. Photo courtesy of Anna Jurkovska/stock.adobe.com. 


If anything has become more apparent over the past 2 years, it’s that we have come to see how crucial the role of the healthcare system and healthcare professionals are. We have seen healthcare professionals hailed as heroes while we have also seen public health experts attacked. We have seen how volatile our healthcare system is and how important it is that we support our healthcare providers to care for those in need. Unfortunately, we may be failing at this goal as we have seen many healthcare professionals leave their professions recently.

One of the many reasons we have seen healthcare professionals leave their careers, specifically in the dental industry, is because of the toll that our jobs are taking on our personal health. As healthcare professionals, it is important for us to be aware of our own needs. We are constantly caring for others and often neglect ourselves. There are many health risks in dentistry that can have both short- and long-term effects on us and affect our ability to have long and fulfilling careers and thrive in our personal lives.

I recently asked my social media networks about their perceptions of the greatest risks to our health from working in dentistry. Overwhelmingly, musculoskeletal disorders (MSDs) were the greatest concern. Especially as clinical dental hygienists, we stay in the same position for long periods of time and complete repetitive tasks that can be taxing on our bodies. Luckily there has been a lot of research on ergonomics and prevention of MSDs recently leading to some excellent products and education to help us be proactive about our physical health.

Dental loupes have become widely utilized over recent years. The first loupes were introduced to the market in 1980s and were primarily used for surgical and endodontic procedures. By providing magnification and a better angle of declination, dental professionals can maintain better posture and position patients in a more ergonomic position. One peer-reviewed study stated, “A systematic review pointed out that using loupes was found to be beneficial for reducing musculoskeletal disorders (MSDs) that are common among dental professionals, especially those in the hands, arms, and shoulders. The study found little evidence, however, that loupes were effective for easing neck pain.”

 The newer prismatic lenses also help with neck pain by allowing the practitioner to further improve posture and look straight ahead rather than tilting the head down. Loupes can also be beneficial for helping to reduce eye strain, especially in individuals over 40 years of age. Whichever style of loupes you choose, having them measured properly and made to fit you is the key according to ergonomic advocate Anne Guignon, RDH.

“A custom pair of loupes takes into consideration working distance, pupillary distance, convergence point, and declination angle.”Said Guignon in an article.

Stephanie Botts, Owner of Posture Pros which provides ergonomics assessment and coaching agrees 

“It's crucial to be measured in neutral posture!” says Botts. “If not, the loupes will be designed to reinforce unhealthy posture which will only make things worse in the long run."

I also strongly recommend that you find a light system that works with your loupes. In addition to avoiding the reach and strain for the overhead lighting system, it ensures that your light is always directed where you’re looking which helps reduce neck and eye strain.

We have also seen great improvements in seating options for operator stools. Much of what I learned in hygiene school just 13 years ago has already changed regarding operator positioning. Research supports dental hygienists working in a neutral spine position, and for each person that requires something different. Seating is an area where 1 size does not fit all. You really need to be selecting your operator seating, or positioning, based on your height, weight, hip width, and other personal factors. Many clinicians have found saddle stools to be helpful as they can encourage a neutral spine position and encourage a straddle leg positioning. 

“For most people, I recommend saddle stools. They allow the clinician to be seated much higher which is great for the hips and low back,” says Botts. “In addition, because of its design, it allows the legs to be 'out of the way' therefore allowing the clinician to get much closer to the patient (reducing the tendency to lean and reach forward." 

There are now many saddle stools available, but it is important to look at the features available and determine which one is the best fit for you. Many saddle stools on the market allow for adjustable height and adjustable seat tilt. This feature is very important when finding your optimal position.

Another option for positioning is to try standing during treatment. Botts has found that standing during treatment can help with provider positioning because you are not as limited by trying to fit your legs underneath the patient chair. Alternating between sitting and standing throughout the day can also help since you aren’t just staying in the same position all day.

"I recommend a mixture of sitting and standing when practicing,” says Botts. “This not only incorporates different muscle groups but it promotes healthy blood flow and allows us to get much closer to our patient, especially during more difficult procedures."

For dental hygienists, we don’t often have much input on the design of our workspace or operatory. As many hygienists are employed in traditional dental settings, we usually in a space that has been set up previously by a dentist, architect, or dental equipment distributor. The problem is that the needs of a hygienist during their daily workflow are different than the needs of a dentist and dental assistant during dental procedures. It is important for us, as hygienists, to evaluate our workspace and create systems and workflows that work for us and protect our health. Some things within the operatory can easily be moved or adjusted to help reduce strain and reach throughout the day. We recently reorganized all of the drawers in our hygiene rooms where I work as we realized the items we used for room turnover were on opposite sides of our room, and the items we needed during procedures were too far away. I recommend using a drawing or photo of your workspace and walking through an appointment, procedure, or your day and mapping out where you go, or reach, for items you need. By making a map of your workflow, you can see where the biggest risks for you are and determine if they can be adjusted easily. Other things like standing or adjustable computer desks, patient chairs with adjustable settings, and layout of cabinetry may be more difficult to change but might be something that can be added to plans for future office updates. Identifying the needs is the first step to creating a healthier workspace.

To best support our bodies and prevent MSDs, it is important that we prioritize a healthy lifestyle. Our muscles need oxygen and water to maintain their strength and tone. It is important that we integrate exercise into our daily lives, stay hydrated, and include stretching throughout the day. A strategy I learned from Botts during my ergonomics coaching called “microbreaks” has helped me incorporate stretching during procedures. Microbreaks short 20-30 second stretch breaks that I take several times during a patient visit, especially on more difficult procedures where I’m not moving around much. Stretching helps restore blood flow to our muscles and helps prevent fatigue and injury. These breaks are also helpful for me mentally to clear my brain, take some deep breaths, and refocus for the rest of the procedure. 

As we know, our overall health includes more than just our physical health. A recent survey showed that up to 40% of dental hygienist respondents reported experiencing burnout.

 Another study showed that 81% of the dental hygienist respondents reported having high or moderate daily stress levels, largely contributed to work.

 Mental health is part of our overall health and an important part of us being available and ready to care for our patients. Exploring new career opportunities or working in multiple settings can often help with our mental health as well as it offers variety and excites us to new potential. For me, volunteering has helped me with my mental health and helped me to prevent burnout. I have volunteered clinically at various events, volunteered with my professional association, and volunteered with causes outside of dentistry that I am passionate about. By giving back to others, I feel valuable and can see my contributions to my community in a new way.

Unfortunately, when we neglect our own mental health, we see a higher incidence of substance use disorder (SUD) as well. According to the National Survey on Drug Use and Health (NSDUH), 19.7 million American adults (aged 12 and older) battled a substance use disorder in 2017.

 We know that healthcare professionals are not exempt from these statistics and even may be at a higher risk for SUD related to our stress levels. Luckily, there is more attention on the mental wellbeing of healthcare professionals overall, specifically in the dental profession. Many states have begun implementing peer health programs which allow healthcare professionals to seek treatment for mental health and SUD in a monitored environment which ensures that they can continue to practice safely. Removing the stigma around mental health needs and SUD is important so that people can seek help when they need it and continue in their fulfilling careers.

While there are things that we cannot change about our work environments, there are several things that we can do to help with our mental health. Stretching and exercise can be so helpful for our mental health in addition to our physical health. Exercises such as yoga help us to stretch, meditate, and clear our minds to refocus on what’s important to us.

As healthcare professionals working in a clinical setting, we are also at risk of encountering and contracting infectious diseases. We have a lot of research and evidence now to support the Centers for Disease Control (CDC) guidelines and Occupational Safety and Health Administration (OSHA) standards for dental settings. The use of standard precautions includes avoiding health risks for the provider by implementing personal protective equipment (PPE) standards and implementing workplace controls. What’s even better is when some of these things also help with ergonomics and personal comfort. Especially as we come to this phase in the COVID-19 pandemic, we now have high volume evacuation products (Aerosol Assist, Cordeze, Purevac, NuBird, and ErgoFinger), face shields (Ambience, Hygienius shield, and Z Shield), and N95 masks (Readimask strapless N95) that are designed to reduce strain and improve ergonomics. Not only are these products likely to be part of our future in the dental practice for infection prevention, but allow us to still practice ergonomically and comfortably, reducing our overall health risks.

Occupational exposures ranked lowest on my social media survey concerning perceived health risks of dental hygienists. And while, it may not be the top concern for dental professionals at this time, we are learning new things every day about risks in our practice environments. Chemical exposures have been a concern in healthcare for many years. There have been some major improvements over recent years like eliminating “cold sterile” or glutaraldehyde solutions which are known to be related to respiratory and skin irritations. Many offices have moved to hydrogen peroxide-based disinfectants and other products with less health risks documented on the safety data sheets. Most offices have also moved to digital radiographs to reduce exposure to radiation for patients and professionals. There are companies that supply radiation monitoring badges which report radiation exposure over time for dental professions. This is a great way to track radiation exposure, confirm your equipment is working properly, and ensure your team is using equipment appropriately. Our office uses a handheld device for radiographs with radiation monitoring badges and we have always been below the negligible amount.

Gaining some traction in recent years, is the concern over hearing loss in dentistry. Many of the instruments and equipment we use in the dental setting produce high pitched sounds. Angela Grover RDH BASDH recently wrote in an article, “Within the dental community, generally there are not 8 continuous hours of noise levels at or above 85 dB, rather exposure to repeated smaller bursts of noises over time, therefore it is not mandated by OSHA that dental personnel wear HPDs.”

While it may not be required by OSHA, many dental professionals, including myself, have started looking into ear protection options to reduce the risks of hearing loss in the future. Custom-fitted ear protection is generally recommended to ensure that they fit well and allow only the high frequency noises to be filtered out so that you can still communicate well with patients and other team members. 

So yes, our jobs are risky. Our health is at risk every day, in many ways, but the good news is that we, as dental hygienists, are prevention specialists. We preach prevention to our patients all day and understand the importance of small steps routinely over a long period of time to reverse and prevent disease. So, let’s apply that to our own self-care. Many of these risks can be minimized or avoided with small changes to our daily activities over the duration of our careers. We chose this profession because of our passion for helping others achieve health and it’s time that we realize that helping patients with their health begins with us taking care of ourselves.

Aboalshamat K, Daoud O, Mahmoud LA, et al. Practices and attitudes of dental loupes and their relationship to musculoskeletal disorders among dental practitioners. International Journal of Dentistry. 2020;2020:1-7. doi:10.1155/2020/8828709

Guignon A. Searching for loupes? RDH Magazine. Published June 1, 2018. Accessed April 19, 2022. https://www.rdhmag.com/patient-care/article/16408107/searching-for-loupes.

Hartley M. Career satisfaction survey, part 2: What role does Burnout play in dental ... Dentistry IQ. Published March 21, 2017. Accessed April 19, 2022. https://www.dentistryiq.com/dental-hygiene/article/16365688/career-satisfaction-survey-part-2-what-role-does-burnout-play-in-dental-hygiene..

Barnard SA, Alexander BA, Lockett AK, et al. Mental Health and Self-Care Practices Among Dental Hygienists. J Dent Hyg. 2020;94(4):22-28.

Editorial Staff Drug & substance abuse addiction statistics. American Addiction Centers. Published March 11, 2022. Accessed April 19, 2022. https://americanaddictioncenters.org/rehab-guide/addiction-statistics. 

Grover A. Hearing loss in dentistry: A silent topic. Today's RDH. Published February 16, 2022. Accessed April 19, 2022. https://www.todaysrdh.com/hearing-loss-dentistry-silent-topic/.

Dental hygienists may face a variety of health risks during their careers, but there are effective ways to avoid and minimize harm. 

Avoiding Potential Health Risks as a Dental Hygienist

Since they were first introduced 70 years ago, ultrasonic scalers have become an essential tool for dental hygienists. The ultrasonic vibrations and use of water during scaling allows clinicians to remove biofilm and calculus from the entire tooth surface and below the gumline in a much more efficient and ergonomic way when compared with the use of hand instrumentation. Ultrasonic scalers allow us to reach deeper and access difficult areas such as furcation areas that we are often unable to do with hand instrumentation.

There are two types of ultrasonic scalers on the market – piezoelectric and magnetostrictive. While I’ve used both types of ultrasonic scalers, I have seen magnetostrictive units used in most offices. One of the main benefits of using magnetostrictive technology is all sides of the tip are active, meaning you can use the lateral sides, face, or back when scaling. This allows more options to adapt the tip to the tooth surfaces and access hard to reach areas.

Working in a community health center that has 5 dental clinics in addition to a mobile program, I thought I had used almost every ultrasonic unit on the market. But recently, I was able to test drive the new ACCLEAN™ Ultrasonic Scaler by Henry Schein which was just launched this year.

Many of us hygienists recognize the ACCLEAN trademark from Henry Schein’s private label products. Henry Schein recently updated their packaging and lineup of products, based on feedback from dental hygienists, to better meet the needs of hygienists. One of their newest products is the ACCLEAN™ Ultrasonic Scaler which was developed internally by Henry Schein's product development team.

Probably my favorite feature of this ultrasonic scaler is that it is compatible with both 25K and 30K inserts. With this feature, the ultrasonic scaler automatically identifies the frequency of the insert you’re using and works immediately. There are no special attachments or adjustments that need to be made. So many of us have ultrasonic inserts at our office that were for an older unit and no longer work in our current unit, but this is no longer an issue. No more running back to the sterilization area to get another set of tips because you accidentally grabbed the wrong one.

Another one of my favorite features was the auto purge. As the infection control coordinator in my office, I know how important waterline safety is. But, I also know how busy our days can be and the last thing we want to do is sit with our foot on the pedal to purge our lines. The ACCLEAN™ Ultrasonic Scaler has an auto purge feature. You can literally put the handle in the sink, press a button, and let the unit purge your lines for you while you set up your room and get ready for your day.

This unit comes with a removable and autoclavable sheath so that you can sterilize between patients, fully adjustable water settings, and fully adjustable power settings. Both the water settings and power settings are easy to use dials located directly on the unit itself. I found it very convenient to adjust the water and power when setting up the unit. The unit has a corded foot pedal that is round, so you can press from any side or angle, which helps with ergonomics.

There is a hands-free boost mode which gives you a temporary increase in power for removing tenacious calculus. The boost feature can be enabled directly from the foot pedal by pressing and holding the foot pedal down. This was very easy to activate and use without having to go back to the unit. There is a triangular light on the unit that lights up when it is in boost mode as well, so you can easily identify when you’re using that feature and ensure you aren’t increasing the power when you don’t need it.

The feature that I think I will really love, but haven’t quite gotten used to yet is the cruise control mode. Like many hygienists, I have become increasingly aware of my ergonomics at work lately, and I am really excited about the option for cruise control. This mode enables you to use the ultrasonic scaler without keeping your foot pressed on the pedal. As you move around your patient, this feature eliminates the need for you to manage another cord and move the pedal around with you. I do think that getting used to this feature has a little bit of a learning curve.

To activate the cruise control mode, you push the CRUISE button on the unit before you begin scaling. Once you are positioned in the patient’s mouth and ready to begin, you can hit the foot pedal once to turn it on and the cruise control is now activated. In order to turn the scaler off, you push the pedal once more. Not having used this feature before on any other ultrasonic scalers, it was hard to get used to having it as an option, but I do think it’s a great benefit and will be very helpful for ergonomics in the long run. The one thing that I wish was that I could resume the cruise control from the pedal as well, after turning it off,without going back to the unit to enable it again.

The ACCLEAN™ Ultrasonic Scaler by Henry Schein really is an excellent unit. It combines all my favorite features from other scalers I’ve tried and makes my day that much easier and more efficient. They’ve really given a lot of attention to detail and addressed every concern from infection control to ergonomics to ease of use. If you’re looking for a cost-effective option that doesn’t cut corners with its features, this is the unit for you. Pull out all those inserts that have been waiting to be used, but were the wrong frequency, and start scaling.

In this product test drive, Alyssa Aberle, RDH, shares her experiences using the newest ultrasonic scaler from Henry Schein's updated ACCLEAN product line.

Test Drive: Don’t Overlook This Feature-Packed Dental Ultrasonic Scaler

Over the last few months the dental industry has experienced shortages of supplies including masks, gloves, and other personal protective equipment (PPE). The PPE shortages have garnered national attention as hospitals and medical/dental facilities are competing for the short supply, as well as the public. But now…we have another problem–shortage of disinfectant wipes. While we want our supplies to last as long as possible, and look for creative alternatives, we need to make sure we’re doing so while ensuring patient safety and still remaining compliant with state laws.

The current supply chain issues regarding disinfectant wipes seem to be affecting several suppliers. The issues are not isolated to one company or one product. While many of the companies that supply infection control products have had increased demand over the past few months and are trying to ramp up to meet the demand, the problems seem to be a bit larger scale. Currently, there is a shortage of raw materials needed for disinfectant wipes including the plastic containers and the materials needed for the towelettes. For some companies, the materials needed for the towelettes are the same materials needed for masks, gowns, and other PPE. Combining a raw material shortage and increased public demand for disinfectants has created a huge problem in healthcare.

Are Wipes Acceptable for Use In The Dental Practice Setting?

First and foremost, it is always crucial to understand the manufacturer’s instructions for use and follow them. Many of the wipes on the market instruct the user to either spray with liquid disinfectant prior to using the wipe, or at lease clean the surface with one wipe first before using another wipe to disinfect. Similar to the “Spray-Wipe-Spray” method that we were taught in school, most products require a two-step process to clean first and then disinfect. It is important that we follow these instructions precisely when using the products to achieve the disinfection level shown by the clinical evidence.

The second factor we must consider is the amount of time for which the surface must stay wet. Each product has a specific amount of time required to kill both Mycobacterium Tuberculosis and SARS-COV-2. For the product to be effective for both of these, as well as the range of other pathogens in the dental practice, we must ensure that, again, we are following the instructions for use. The problem with some wipes on the market is that the saturation of the disinfectant is not high enough to keep the surface wet for the full amount of time required. In these cases, you would either need to supplement with a spray or liquid disinfectant or continue to wipe for the full amount of time required. Therefore, many practices over the years have continued to use liquid and spray disinfectants over wipes.

Find a liquid or spray disinfectant that meets CDC requirements

In the 2003 “Guidelines for Infection Control in Dental Healthcare Settings”1, CDC requires use of an “intermediate level disinfectant” for all dental practice settings. Intermediate level disinfectants must have an EPA registration number and have a tuberculocidal claim. A complete list of products that meet these criteria can be found on the EPA List B2. In addition, CDC has released “Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic”3 which states that a hospital grade disinfectant appropriate for SARS-CoV-2 in healthcare settings must be used for disinfection in the dental setting, which can be found on the EPA List N4. It is also important to look up the product by its EPA registration number, rather than its product name. Many products are sold under various names and may not show up under the brand name you are currently using in your practice.

Use plastic barriers to protect clinical surfaces.

Since the “Guidelines for Infection Control in Dental Healthcare Settings” was published in 2003, CDC has recommended to use plastic barriers on all surfaces that are difficult to clean or unable to be adequately cleaned. “Barriers include clear plastic wrap, bags, sheets, tubing, and plastic-backed paper or other materials impervious to moisture” (Centers for Disease Control, 2003). Surfaces which have a plastic barrier covering them do NOT need to be disinfected in between patients if the surface is fully protected by the barrier and does not inadvertently become contaminated. Per the 2003 report, “After removing the barrier, examine the surface to make sure it did not become soiled inadvertently. The surface needs to be cleaned and disinfected only if contamination is evident. Otherwise, after removing gloves and performing hand hygiene, DHCP should place clean barriers on these surfaces before the next patient”

Replace items with heat tolerant alternatives, when available.

Heat sterilization methods are the gold standard when preventing transmission of pathogens in the healthcare setting. Many items used for patient care in the dental setting can be heat sterilized. Whenever possible, use items that are heat tolerant and can be heat sterilized. Consider replacing items in your practice with heat tolerant alternatives to minimize transmission and simplify infection control procedures between patients.

Prioritize treatments to reduce patient load in your practice to conserve supplies.

If all other options have been exhausted and your practice is still unable to comply with CDC recommendations and/or state laws, the last option would be to prioritize treatments within your practice to reduce the overall volume of your practice and minimize the amount of infection control products required.

Pre-soaking gauze in disinfectant can inactivate ingredients in disinfectants compromising the efficacy of the disinfectant. Both CDC and the Organization for Asepsis and Prevention (OSAP) have stated that they do not support pre-soaking gauze in disinfectant prior to use. In a study cited by the CDC, pre-soaking gauze showed a decline in effectiveness of 40 to 50 percent after only one hour of soaking in a quaternary ammonium disinfectant.5 Another study cited by the CDC shows gram-negative bacteria can survive and even grow when other disinfectants (phenolics, iodophors) are pre-soaked in gauze5. OSAP says if you are going to use gauze with disinfectant, it should be saturated with the disinfecting agent at the time of use.6

Outdated recommendations from 1993 seem to be circulating which encourage dental healthcare providers (DHCP) to create solutions of sodium hypochlorite in office. The 1993 “CDC Guidelines on Infection Control in the Dental Setting” provided instructions on how to create a daily dilution of household bleach as an acceptable alternative to commercially available hospital disinfectants. However, the 2003 guidelines state that over-the-counter products cannot be used as disinfectants in healthcare facilities. All products used in the dental setting must be EPA registered and meet the criteria previously discussed.

Relaxing infection control protocols because of supply chain issues.

Many state practice acts and/or rules set forth by the boards of dentistry require DHCPs to comply with CDC recommendations. CDC recommendations from 2003 and 2016 both state that only intermediate level disinfectants should be used in the dental setting. Even when not explicitly required by state laws or rules, it is important that DHCPs continue to adhere to evidence based infection control practices for the safety of patients and employees. We all understand the pressures on our practices right now, but it is more important than ever that we remain diligent with our infection control practices. Both legally, and ethically, we are required to implement these practices.

1. Kohn, W.G., Collins, A.S., Cleveland, J.L., Harte, J.A., Eklunt, K.J., Malvitz, D.M. Center for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings – 2003. MMWR 2003; 52 (Report No. 17). Retrieved from 

https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm


2. List B: EPA’s Registered Tuberculocide Products Effective Against Mycobacterium tuberculosis. United States Environmental Protection Agency. 6 pp, 200 K, July 21, 2020. Retrieved from 

https://www.epa.gov/pesticide-registration/list-b-epas-registered-tuberculocide-products-effective-against-mycobacterium


3. “Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic”. Updated August 4, 2020. Retrieved from 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html


4. “List N: Disinfectants for Use Against SARS-CoV-2 (COVID-19)”. United States Environmental Protection Agency. Updated August 13, 2020. Retrieved from 

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19

.
5. Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities – 2008. Updated: September 18, 2016. Retrieved from: 

https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html


6. Organization for Asepsis and Prevention (OSAP). Frequently Asked Questions on Dental Infection Control. Retrieved from 

http://www.osap.org/?FAQ_Instrum_Disinf1#ireadrecently

Dental practices need to know what they can and cannot do when disinfecting surfaces when there’s a shortage of wipes.

What You Should Do If You Are Unable To Order Disinfectant Wipes

Are you having more trouble dealing with parents than you are your young patients? Check out these tips.

5 ways for hygienists to deal with parents of patients

	One of the best - and sometimes hardest - parts of our job as dental hygienists is working with individual patients and addressing their needs, concerns, fears and desired outcomes. When working with children, we also have to consider the parents of our patients and include them in the dental visit. There’s definitely a gentle balance (that can be learned over time) between the needs of the patient and the expectations of the parents.  

, I’ve spent my career in the community health setting. I currently work in a school-based sealant program within a federally qualified health center (FQHC). One of the best parts of my job is that I’m able to work directly with students in the schools, but I also get the opportunity to work with their families in our dental clinics. I’ve seen children and their parents interact in many different situations, and now, as a parent myself, I have new perspectives on dental care for pediatric patients.

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	While some of the same techniques may work for adult patients and child patients, there are certainly some different strategies worth pointing out.

	Click through the slides to find out five ways to deal with parents in the dental office.

	1. Acknowledge the fears and concerns of the parent

	I’ve been in many situations with patients where the fears of the parent and/or sibling have been projected onto the patient. Very young patients come in to their first dental appointment and have already been exposed to 

 from people they love very much. While I’d prefer these fears to not be pre-emptively shared with young children, the reality is that many people have had bad dental experiences and carry that fear with them daily.

Read more: 10 ways to simplify pediatric dentistry

	As a clinician, I think it’s necessary to discuss these past experiences with the parents and understand where they’re coming from. Ideally this conversation could take place separate from the child in a consultation setting. The parent’s experiences may be valid and may shape the treatment they want to consider for their child as well as the procedures they are (or aren’t) willing to consider. Brushing off these concerns won’t help us build a relationship with the patient and may hinder us from accomplishing the ideal outcomes for the patient. The most beneficial thing for everyone involved is to try to understand the fears and concerns of the parent, address them directly, and help the parent understand how to have appropriate conversations with his or her child without passing down his or her own fears.

	Understanding the concerns of parents can give us a starting point for a conversation about our dental office and how we treat patients. It’s important for any dental office to be clear with the patients (and parents) about treatment philosophies, scheduling guidelines and financial policies. While this seems pretty obvious, all of these things are very important in having an easy and successful appointment. Both the patient and the parent need to know that the office is a good fit for them in order for them to feel confident in the treatment we’re providing. Establishing this relationship early avoids stressful and emotional situations down the road.

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	Another expectation that should definitely be set from the beginning is the appointment flow,

, and role of the parent in the dental visit. Pediatric dentistry has come a long way over the past 40 years and likely isn’t going to be anything similar to what the parents remember from their childhood. If your office uses more “child-friendly” language like “sugar bugs,” “spaceship chair,” “sleepy juice,” etc., let the parents know that from your first meeting with them. Parents can play an active role in preparing the child for his or her appointments, especially if they can use the same language you’ll be using when you see the child for future visits.

	Explaining your office’s feelings on parents in the treatment rooms, siblings’ accompaniment and time line works best at an initial visit too. Waiting until the day of treatment, when emotions and stress are already running high, is an inopportune time to spring a new “rule” on a parent. Parents, like the patients, are probably anticipating the first treatment visit for weeks. The clearer we can be about what that appointment will look like, the more smoothly it will go for everyone. If your feelings on these issues are flexible, then have these conversations anyway so that you can create a plan together.

	Recently we found out that my 3-year-old son needed glasses. We had identified a “droopy” eyelid when he was only days old, and he has been seeing a pediatric ophthalmologist since he was about two weeks old. When we found out in February that he needed to wear glasses, we had SO MANY questions. We wanted to learn everything and do anything we could to help him see better. The thought that our child couldn’t see well, and that it may have been affecting him his whole life, was devastating. The most comforting part of the process was that there was nothing we could’ve done differently and no way we could’ve prevented him from needing glasses.

Related reading: How to ACTUALLY get kids to brush their teeth

	The need for dental care is different. For years we’ve preached that though early 

 is the No. 1 most chronic childhood disease, yet it’s nearly 100 percent preventable. As dental professionals, we see this as a great thing - preventable means that we can actually impact the prevalence of the disease. However, to parents, it sounds like you're telling them that they could’ve prevented this from happening ... but didn't. There’s so much personal guilt associated with the diagnosis of decay in our children. I’ve seen this fear in many of my dental professional/parent friends. We dread the day our child is diagnosed with decay because after all, we're dental professionals and should’ve been able to prevent this from happening.

	The reality is, as we all know, caries is multi-faceted. There are many things that can impact the occurrence and progression of decay. While diet and home care play a huge role in the caries process, so do pH of saliva, dry mouth from airway obstruction and sleep issues, and to some extent genetics (though we don't want to always acknowledge it). Regardless, it’s imperative that we, as clinicians, try to look at the big picture. Guilt is sometimes a great temporary motivator but rarely affects long-term change. The changes we want to see happen for our patients and their families are lifelong habits that need to be motivated by something bigger than temporary guilt. We need to keep pointing our patients toward optimal overall health and discussing the role of all systems in their oral health. Beginning the conversations about oral health and its impact on our whole health with expecting parents and evolving the conversation over the lifespan of our patients removes the “lecture and guilt” scenario that we (and our patients) are all too familiar with.

	Parents mean well. They really do. We have to remember that parents are trying to do the best for their children. Many of us, including myself, find it so much easier to be patient with our pediatric patients than to be patient with their parents. We’ll spend hours a day modeling “show, tell, do” for kids, but the second the parent tries to ask a question or step in to “help,” we get defensive and irritated. Don't forget that the parents are just as new to this situation as the kid is. Just because the parent has been a dental patient himself or herself doesn’t mean that he or she knows how to play the parent role in the dental office. I’ve even found myself stumbling to fit into this role when I take my kids in for their dental visits. I’m so used to being the clinician and walking them through it that I forget to take a step back and let their dental team carry them through the appointment.

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	Circle back to points No. 1 and No. 2 and realize that any misguided involvement (or lack thereof) on the part of the parents is most likely due to their own past experiences. If you haven't set the parents up for success by explaining what’s expected in this situation, then how can you expect them to succeed? Even though we see 30 or more children in a day, this is the one appointment this family has. We know what to expect and what it should look like in an ideal world - most of the time they don't.

	Whatever “type” of parent happens to be in your office today, give him or her the benefit of the doubt.

	It’s often easy for both parents and clinicians to get wrapped up in their own needs and forget that the focus of the visit is the child. It’s definitely okay to take a moment and point that out to both the parent or other team members. In cases where the parent is actually interfering with the visit, feel free to pull him or her aside and have a talk. Obviously you can do this in a professional manner, but it’s okay to remind him or her of the expectations that were already laid out and explain to him or her what needs to happen for you to have 

. We all know that it’s easier when the parent isn't in the room, but the reality is that it’s not always possible to remove parents from their child's visit (nor do we always need to). To parents, this seems so counterintuitive that the best thing for their child would be for them to be absent. However, when explained well, many parents will come to realize the benefits and will learn to feel comfortable with you and your office and be willing to empower their children to conquer their dental visits independently. After all, it's about the child and what’s best for him or her.

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	At the end of the day, the goal for everyone is that the child receives the best treatment possible and leaves having a positive experience. All the stress about schedules, problems with equipment, parent dynamics, etc. have to be put aside and the patient still has to receive your best. You’re setting the tone for this patient's dental future and potentially affecting his or her future parenting perspective on dental care. Keeping our focus on the child not only makes him or her feel cared for but also keeps us in the right mind to do our best at the job we've been trained to do. You're an EXPERT at your job and your patient should have the utmost confidence in your skill and desire to be that expert for him or her in that moment. Do whatever you need to do to remind yourself of this with every patient.
	 