Ultrasonic Scalers and patient refusal

Would you use a rotary phone when you can connect instantly with a cell phone? Who gets up to change the tv channel when we have remote controls available to us? Since the invention of the wheel, inventions and advancements have allowed us to move forward and never look back.

     The world of dentistry should be no exception yet many dental hygienistsFullSizeRender (1) are not taking advantage of the tools available to them. I understand there is a financial obligation to staying current in this high-tech world and it is challenging for dental practices to purchase the latest greatest tools but I don’t know of any dental offices that do NOT have an ultrasonic scaler on hand. With this (not so new) technology available to us, why do we not use it as often as we should?

Our patients complain. That’s why.

     We are letting our patients talk us out of it. They tell us they don’t like it so we back down and don’t use it. The dentist does not get questioned on the tools he needs to use so why do we allow our patients to talk us out of the tools we feel necessary? The Patient complains and we don’t like when they complain so we back down and follow their wishes.

Patients typically reject the use of the ultrasonic scaler due to:


>Water pooling in the mouth

>Water spraying the face

>Vibration and sensation

>Pain and sensitivity due to the vibration

>Pain or sensitivity from the water temperature

>And simply unwillingness to try something new to them

     In addition to the typical complaints some patients’ claim it doesn’t do as good of a job as the ‘old way’. This excuse holds no water (pun intended!) since we are still using hand instruments during their treatment so they are getting their ‘normal cleaning’ in addition to a new and improved way.

     To use or not to use. As professional, educated, licensed health clinicians we are choosing the ultrasonic scaler for patients who show signs of inflammation, heavy plaque, moderate/heavy calculus or disease. These patients are not the picture of oral health, therefore they should not be directing their treatment. We hold the degree and the state licensure-that should be what the directs the treatment plan. It is up to us to provide our patients with the education that backs our professional decision.

     Many tests have been performed comparing manual and power scalers which has concluded they are both equally effective in removing subgingival plaque and reducing bacterial counts. They both had similar amounts of remaining calculus deposits post-treatment also.

So does this mean our patients win and we don’t need to use power tools?


There are many benefits to the patients and to the clinician from using power scalers over hand instruments.

*Reduction in treatment time (on average 33% faster)

*Improved ergonomic benefits to the clinician

*Reduction in clinician fatigue and repetitive strain concerns

*Decreased cementum removal

*Improved access to class II and III furcations

     It should be a no-brainer, win-win for all. If the use of the ultrasonic scaler is there for us to provide better overall treatment in less time while maintaining a healthier tooth structure for the patient all while suffering from less strain on ourselves which will prolong our career and ergonomic health than we shall not be talked out of it.

     As licensed professionals, we need to be firm with our patients in directing their treatment and not allow their ‘dislike’ lead us to provide lesser care.


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Chatterjee, A., Baiju, C., Bose, S., Shetty, S., Wilson, R. (2012). Hand Vs. Ultrasonic Instrumentation: A Review. Journal of Dental Sciences & Oral Rehabilitation, Oct-Dec 2012.

Copulos, T. A., Low, S. B., Walker, C. B., Trebilcock, Y. Y., & Hefti, A. F. (1993). Comparative Analysis Between a Modified Ultrasonic Tip and Hand Instruments on Clinical Parameters of Periodontal Disease. Journal of Periodontology, 64(8), 694-700. doi:10.1902/jop.1993.64.8.694

Tomasi, C., Bertelle, A., Dellasega, E., & Wennström, J. L. (2006). Full-mouth ultrasonic debridement and risk of disease recurrence: A 1-year follow-up. Journal of Clinical Periodontology, 33(9), 626-631. doi:10.1111/j.1600-051x.2006.00962.x


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