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ultrasonic vs hand-scaling

I am a student and I prefer hand-scaling to an ultrasonic, even on patients that have moderate and heavy calculus, also for me ultrasonic is only slightly faster than hand scaling. I was told this would be looked down upon when I got into practice for wasting time. Is this true?



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Author Note:
wow everyone! thank you so much for your help. It really is a blessing to have experienced hygienists to go to for advice, versus having to ask the instructors for everything (we all know they can be scary.) I will definitely recommend my fellow classmates to come to this forum :)

26 Answers

If you are efficient and thorough with handscaling and prefer that I don’t think anyone would look down on you for it. But I also think the ultrasonic is good to use on most patients because the cavitation and lavage removes more calculus, plaque and bacteria than even skilled handscaling and I believe there is research to support that. In the end it is a personal preference but is quickly becoming the standard of care that you should consider working into your usual routine especially for SRP and perio maintenance patients.

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I fully agree with Hoosier Hygienist…I started out only handscaling, however quickly added the ultrasonic b/c of the thoroughness with lavage. I still go thru and handscale quickly afterwards.

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It’s easier in your body in the long run to use the ultrasonic. I use the blue boa high volume suction adapter with a hygoformic saliva ejector and it quickly removed all the water and you have a free hand for your mirror instead of holding the HVE.

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I would think that your hands would begin to hurt if you only hand scale. That’s just from my experience on hard patients that I can’t use the ultrasonic on. I love the ultrasonic!

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P.S…..its def NOT looked down upon…whats looked down upon is an incomplete job 🙂

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I have been practicing for 25 years and only used an ultrasonic scaler for RPS and areas of very heavy calculus or stain. (No hand pain, carpal tunnel as of now!)
I’ve had a ton of new patients complain of previous cleanings at their old office being unbearable due to the sole use of ultrasonics and are so happy when I don’t use it on them!

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I agree with all of the comments. The clinical benefits of the ultrasonic are numerous. That being said, I always like to also handscale to ensure smoothness.

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I enjoy hand scaling and after 30 years my hands are fine, back not so much. I have a lot of AID/HIV patients in our practice as well as Hepatitis patients my boss will not let me use the ultrasonic on them and many have not had cleanings in 10-20 years. The really dense calculus is very hard to break through but a good file will get too it. I like the combination of both when I have a choice.

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I’ve been practicing 28 years…I primarily hand scale…it does a much finer, complete job in my opinion…I do cavitron heavy calc but always fine scale after…some use it more…I think its preferences but I dont beieve cavitron alone is good enough…I’ve never had hand issues or soreness associated with hand scaling more…stick with whatever is the most efficient for you 🙂

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You won’t be looked down upon. Some patients may prefer handscaling rather than the cavitron esp patients who have sensitive teeth. Overall, I feel the cavitron is more efficient, and I always go back with handscaling after.

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I agree with DebbieG. I have been practicing for over 30 years. We were always discouraged from using ultrasonics in school except on perio patients. I do more hand scaling then ultrasonic. However, I use the ultrasonic more then before. I always use on SRP and PMT but with hand scaling as we’ll. in the end the important thing is being thorough, how you get there is less relevant. You do what feels right to you and comfortable.

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Do what you feel comfortable with!!! We were taught and stressed in school that if you use the cav you always fine tune with hand scaling! Cav is for moderate calculus and it’s good for lavage! I also feel that if the calculus is heavy sometimes it makes the prophy a smidge more comdortable, but it all depends on the patient!

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I use both hand and ultrasonic scaling! I don’t know if I could ever go back to just using one or the other! I also use the cavitation on almost all patients except young children under eight. I just put it on a lower power setting. I always seem to get the most tenacious calc off with my hand instruments though.

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I remember I hated the ultrasonic in school and preferred hand scaling. You learn in practice where it helps manage time but I still like a hand scale better especially with SRP cause I like to feel the calc this way and see it come out on the pocket if possible. You do things how you feel is best and don’t worry what others think;)

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At our office you would not be allowed to only hand scale. No longer is it is the patients best interest to provide glassy smooth surfaces the removal of biofilm is extremely important and the lavage is much more beneficial than just hand scaling. If it were our office you would be let go most likely

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I have been practicing about 15 years and utilize the ultrasonic about 80% of the time and hand scale 20% for debridement on every patient 12+. Two common comments that I have received over the years have been “that was the most thorough cleaning I have ever had” and “you are so gentle.” Personally, I’ve never practiced without having an ultrasonic and I am very thankful for that-I have a lot of respect for the hygienist’s from years ago without that option. I believe the sensitivity to it becomes an issue because the root cause (no pun intended) hasn’t been established and remedied. A thorough diet analysis needs to be done on these patients to figure out what type of acids are causing this sensitivity. Discontinue the agent and prescribe a fluoride regimen to combat this and there shouldn’t be any issues. Or don’t use the ultrasonic on buccal recession-where most sensitivity is-altogether because let’s face it, that area has been scrubbed so much by a toothbrush, there isn’t any bacteria there 🙂

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I agree with Hooster 100%. I would add that it is also ergonomic for you to use the titan first and then hand scale. In the working world you can see several patients a day and pure hand scaling alone can lead to fatigue and increase the likelihood of carpal tunnel syndrome:(

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I use the NSK pieso on almost all patients and I follow with hand scaling. It has extremely fine tips that help with even gingivitis pts with fine calculus. After many years of practice your body will thank you for this. All pts are different and so are hygienists. You are highly educated and should make this kind of decision based on your knowledge and skills and not worry about what other say unless it helps you to make a better decision yourself.

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I love my cavitron …even if I use it to break up most of the heavy calc it def saves on hand fatigue in the long run since I mostly see mod to severe perio…

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my dr would say you are doing a disservice to the patient by only scaling. I don’t use the cavitron on everyone, but I know he would prefer that I do

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I have been practicing 22 years and for the first 8 I mainly hand scaled with the exception on srp patients. Over time I began noticing my hands hurting or being over tired so I began by adjusting first my hand piece to a lighter weight one then followed by using the cavitron more. I still catch myself from time to time trying to “just hand scale” but end up regretting it. I believe you end up with better results combining both ultrasonics and hand scaling. Good luck in the profession, I still love my career choice.

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When I graduate from hygiene school 23 years ago, we only had 2 ultrasonics for the entire clinic (40 students) You could only use it on 2 quads and they had to have HEAVY calculus. I only use the ultrasonic for heavy stain and calculus, SRP or if the patient requests it. I have no hand or back pain, using loupes with a light has helped immensely.

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You will not be looked down upon. In school I hated the ultrasonic bc it decreased my tactile sensitivity. When I took my clinical boards I received a score of 100%. Not only was I the only clinician/hygienist to score a perfect score but I was the only one who chose to only hand scale.. However, now being in a busy General practice I’ve found hand scaling “only” to cause tremendous muscle and hand fatigue and it is more time consuming. Therefore, to maintain time efficiency, proper ergonomics, standard of care and reviewing patients med history, I typically begin with piezo(lavage is great for removing biofilm) and finish by handscaling to create that glassy surface…makes the calculus more difficult to bond to a smooth surface..most comments from my patients are that I am the most thorough, and informative hygienist they’ve seen yet. “Brightens both of our days.”

Don’t follow the leader… Do what feels right to you. Most hygienist get lazy and do a “quick prophy by basically only polishing!

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I don’t think it needs to be one or the other. It really needs to be a combo to be thorough. Remember that it’s not all about calculus removal, but about removing the biofilm. Not many patients floss, and I want them at least twice a year to have as much bacteria removed as possible. I almost always follow up with hand scaling. You miss stuff with the ultrasonic, as you don’t have the tactile sensitivity that you do with hand instruments. There is a skill to be learned though with ultrasonics. I have learned how to be gentle with sensitive patients, and I have to hand scale those patients longer because I am not as thorough with the ultrasonic on them. I love topical. I don’t feel you are really doing a good job without lavage, and when I educate my patients, they are much more compliant with the annoyances of using the ultrasonics.

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For me it depends on the patient. I love to handscale, especially to keep up the strength in my hands as well as the technical practice. If a patient has little calculus, no perio, no demineralization, I exclusively handscale. However, I did have one patient say that she prefers the ultrasonic to feel clean (I wrote a note of it in her chart). Patients with excessive biofilm I set the power on low to help remove the plaque and suction because polishing alone doesn’t cut it. For heavier calculus and perio I usually ultrasonic/irrigate and follow up with handscaling. There are a lot of patients who are wary of the ultrasonic (I let them know before the cleaning that I can control the power and lavage, just communicate with me), and others who hate handscaling (they can’t stand the “picking” at their teeth). I communicate with the patients and try to accommodate them if I can…But ultimately as a provider you have to do what’s best for their health. That’s when topical, oraqix,fluoride tx. comes in…Whatever you can use to make them more comfortable and explain the process and/or what to expect. Education/awareness is key.

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