Welcome to the sharpening revolution! This series is a simple, enlightening re-evaluation of all things sharpening. It is intended to give dental staff everything needed to construct a plan for hygiene instruments that is safe, effective, financially sustainable, easy, and of course—quick. Throughout this series, you will find easy-to-understand practice resources which can be used in team meetings as your practice considers implementing new sharpening systems.

The first subject covered will be the end results of a lacking or ineffective instrument maintenance routine. There are numerous ways in which poor instrument care causes harm to patients, staff, and the bottom line. Unfortunately, these logical consequences of dull or misshapen instruments are easily and often overlooked in the rush of daily dentistry. In fact, even when dental teams do want to address these issues, it can be difficult to pin down the exact causes of revenue loss or patient dissatisfaction without analyzing each individual patient interaction. However, it is critical that providers assess patient and staff retention factors critically, including the factors discussed here. Ultimately, no practice can thrive without taking timely and appropriate measures to prevent patient and staff-retention challenges.

Below is the first of several free resources available for teams reconsidering their current scaler care routines (or lack thereof). Note the ten unintended consequences of dull or misshapen handscalers listed in the second column, which each create a distinct path towards loss of practice revenue. Be sure to discuss with staff the consequences below that are already apparent in your operations. This will garner support and create team consensus on the benefits of change.

Now that you and your team have established the necessity and value of proper instrument maintenance, let’s go over some of the major obstacles practices face in execution. You will likely find that your practice faces these same issues in your own attempts to care for your scalers. These challenges are both valid and significant, and research shows that many hygiene departments are in similar situations. Be sure to discuss honestly with your team how these issues each need to be adequately avoided before implementing any new systems, as failure to do so may ultimately lead to wasted time, financial investments, and instrument damage. (The rest of our series will address and resolve each of these obstacles in a way that reduces the workload for you and other team members).

1. Financial concerns or budgetary restrictions—Overhead in dental practices is notoriously high, so purchasing alone can present challenges for practice staff and owners. Also, the delicate nature of subgingival scaling requires clinicians to have a variety of instrument designs even for simple prophylactic services, so the initial investment into scalers is considerable. Additionally, because instrument toes and tips are small for interproximal and subgingival use, they cannot be sharpened indefinitely. This means that there is already a significant revolving replacement cost for scalers. Often, when clinicians request sharpening solutions, new financial concerns emerge. In-house sharpening requires time and equipment, leading to increased payroll and supply costs and missed opportunities for production while sharpening. Professional sharpening services usually involve monthly fees or per-instrument fees, along with recommended replacement costs as instruments wear beyond safe sharpening points. Even “no-sharpen” instruments are costly due to their inflated purchase prices (and of course, they still get dull and need replacing regularly). It can seem there are no practical financial answers to this dilemma. (Spoiler alert: there actually are great solutions for these challenges coming up in the series).

2. Inadequate time—Every practice strives to maximize patient care and schedule as fully as they can during working hours. Those practices which are the most successful in these efforts experience very low no-show and cancelation rates. Naturally, in order to allow adequate time for sharpening they would have to either expand weekly employee hours or block off productive time-slots for this task. Neither of these is typically desirable or ideal. Those practices that do have cancelations and no-shows freeing up staff time would be well-served to use that time for scheduling efforts. Furthermore, there are already expansive lists of administrative, OSHA, infection control, or other duties that should and could be addressed during those hours. Sharpening usually does not end up first on the priority list during downtime. In reality, cutting edges begin to dull after about 15 calculus-removal strokes, and typically become quite rounded after about 45 strokes.¹ This means that proper sharpening in-house would need to be completed on every instrument after nearly every use! Unfortunately, this is far from the case. In one recent nationwide hygiene survey, respondents reported that they are told there isn’t time to sharpen instruments, or even that their corporate policy forbids routine sharpening.²

3. Inadequately trained staff—Proper sharpening requires virtually-perfect angulation so that cutting edges do not become ineffective or overly thin. Proper free-handed sharpening at these perfect angles is not practical and arguably, not even possible. We will touch more on this later in our series. Because dental hygienists usually receive about a half-day or a day of sharpening instruction in school, they are not trained to execute this task to the quality needed. Furthermore, even if they were expertly trained, it is virtually impossible to visually judge and manually maintain precise angulation for the duration of sharpening to avoid improper shaping. In fact, one study shows that sharpening scalers using the moving stone, stationary instrument technique actually created a high incidence of beveled, or third, edges on scalers.³ This is the most popular and oldest method around, and yet it seems highly ineffective. Our bodies simply can’t maintain a perfect handle angle while sliding a stone against a metal scaler.

So, what is to be done, then? Together, all of these obstacles may seem insurmountable. It’s no wonder hygienists are sharpening much less frequently than they should—it seems there is no workable solution in place for most of them. In one recent large sharpening survey, 73% of hygienists cited lack of time as the primary reason they don’t sharpen frequently enough. Interestingly, 15% of respondents reported a lack of proficiency in sharpening, and only 34% described themselves as “very confident” in their sharpening skills. Many of them also stated other reasons for not sharpening routinely, such as superiors that actually discouraged sharpening, stating the instruments would be “worn down” too quickly.² It seems clear that if manual in-house sharpening with stones was quick, effective, and easy, nearly every practice would be in compliance with sharpening standards. It’s time for more practical options.

Not to worry—Part 2 of this series will cover all of the major in-house sharpening techniques and methods, from manual stones to automated devices. It will thoroughly review the differences between them and identify those which are the quickest, more safe, and which create the least noise or mess in the office. It will also take into consideration the longevity of each product, and even its versatility to sharpen unique instruments. It will include a simplified table of these features and more for use by your practice to make sure any system your team implements will clear all the obstacles you face as a practice. This will help eliminate sharpening woes and help you move closer to an effortless system that keeps the patient, the practice, and the clinician happy and thriving.

References

1. Daniel SJ, Harfst SA, Wilder RS. Mosby’s Dental Hygiene Concepts, Cases and Competencies. 2nd ed. Philadelphia: Mosby Elsevier; 2008.

2. Amelia Williamson Destefano. “Sharpening in the Trenches; Results from the RDH Magazine State of Sharpening Survey.” RDH Magazine, July 2018, pg. 32-35.

3. Andrade Acevedo RA, Cézar Sampaio JE, Shibli JA. Scanning electron microscope assessment of several resharpening techniques on the cutting edges of Gracey curettes. J Contemp Dent Pract. Nov. 2007; 8(7):70-.