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CA Ultrasonic Scaling Course

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The objective of this course if to develop competency in ultrasonic scaling use and techniques.

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CA Ultrasonic Scaling Course

  1. 1. Ultrasonic Scaling Course SOUTHERN CALIFORNIA ORTHODONTIC ASSISTING SCHOOL
  2. 2. Introduction to Ultrasonic Scaling  An ultrasonic scaling unit legally can only be used by an RDA or OA that has successfully completed a board certified 4 hour Ultrasonic Scaling course  The ultrasonic scaler is primarily used during cleaning treatment sby the dentist or Registered Hygienists  To remove deposits of tartar by force of vibration the ultrasonic tip sends high frequency sound waves to the tooth, dislodging unwanted build-up or cement
  3. 3. Introduction to Ultrasonic Scaling  Electricity is converted into mechanical energy that can generate 50,000 vibrations per second from the scalers tip, making techniques pressure sensitive  These vibrations will make the tip hot, never keep in one place to avoid patient discomfort or damage to root/tissue  Water is constantly sprayed from the scaler tip to prevent overheating  It is best to have direct vision of the area being worked on. If this is not possible, indirect vision can be achieved with the use of a mouth mirror  All operators of the ultrasonic scaler must wear full PPE: Gloves, facemask, lab coat or disposable gown and glasses.
  4. 4. Advantages of Ultrasonic Scaling Reduces operator fatigue 01 Fast, effective scaling when proper technique is demonstrated 02 Fewer instruments required 03 No instrument sharpening required 04
  5. 5. Disadvantages of Ultrasonic Scaling Produces potentially infectious aeresols 01 Requires a power source 02 Possible heat damage to tooth if used incorrectly 03 Magneto- restrictive risk to patients with health issues Potential damage to restorations 04 05
  6. 6. Types of Ultrasonic Scalers  Magnetostrictive: This type of device uses rods of magnetic metal that when magnetized creates a 360° motion. More heat is generated with this type of ultrasonic scaler, so a cooling agent is important (water). Since the tip is moving in an elliptical motion, when you leave the teeth it takes a moment to slow down, thus creating a slight banging motion against the teeth.  Piezoelectric: This type of device utilizes electrical currents, resulting in two sides working together instead of the 360° motion. This method requires less water because less heat is generated from it. A pro for this type of device is that it is much softer of the tooth’s crown because it works in a linear motion, stopping immediately. This prevents surface roughness.
  7. 7. Parts of Ultrasonic Scaler Unit Ultrasonic Tip Insert Hand Piece Rheostat
  8. 8. Types of Tips/Parts of Tip As the tips wear over time & use, the efficiency of the scaler will decrease. Replace periodically. Universal Universal Thin Triple Bend Beaver Tail Concave side Convex backside Tip Lateral surface
  9. 9. Goals of Ultrasonic Scaling  The goal of ultrasonic scaling in Orthodontics is to remove cured band cement from the tooth surface  Indications of using ultrasonic scaler:  Easy accessibility to teeth receiving treatment  Using ultrasonic scaling method would be more time efficient
  10. 10. Contraindications of Ultrasonic Scaling  Always check health history before performing ultrasonic scaling. Do not proceed if the patient has any of the following health issues:  Tooth sensitivity  Cardiac issues (pace makers or defibulaters)  Heart issues  Communicable disease (disease that can be spread through aerosol transmission  Prosthetic joints  Diabetes  If patient wears a hearing aid  Dysphagia
  11. 11. Contraindications of Ultrasonic Scaling  Do not perform ultrasonic scaling of a tooth that has exposed dentin present, apparent cavities or demineralized areas
  12. 12. Assistant Responsibilities  To use sterile equipment and that is operating correctly  To protect themselves, the patient and third parties from danger  To avoid contamination and minimize aerosols  It is mandatory that operators wear proper PPE during procedure at all times to prevent to possibility of infection  Obtain informed consent from patient or responsible party
  13. 13. Assistants with an Ultrasonic Scaling Certification May Not… Use the ultrasonic as a prophylaxis Remove calculus and build-up from subgingival or supragingival tissues Remove cement related to restorations ect. fillings or crowns
  14. 14. Armamentarium for Ultrasonic Scaling  Bib for patient  Cotton Rolls  2x2 Gauze  Scaling Tip Insert  Goggles for patients eyes  Saliva Ejector/HVE  Mouth Mirror  Scaler  Band Removing Plier  Prophy angle and paste  Mouth rinse  Floss
  15. 15. Proper Method for Use of Ultrasonic Scaler  Hand Placement:  It is important that your chosen hand placement allows for steady and swift movements, prevents fatigue of the hand and maximum flexibility. Always establish a fulcrum in the same quadrant you are working in.  Pen grasp: Main area of support is from the inside area of the thumb and index finger. The scaler tip rests on the side of the middle finger.  Modified Pen grasp: Resembles the pen grasp, but instead of the scaler tip resting on the side of the middle finger, the middle finger slides forward and is closer to the working end of the scaler tip  With opposite hand, use mouth mirror for cheek/tongue retraction
  16. 16. Operator Positioning  Correct chair position helps with visibility and accessibility  Illumination and retraction are utilized to allow comfortable positioning  Proper positioning eliminates operator fatigue and strain  Position the patients head so it is supported by the headrest  Position patient in the supine position
  17. 17. Operator Positioning  Right Handed: The operators zone is between 7 o’clock and 12 o’clock  Left Handed: The operators zone is between 5 o’clock and 12 o’clock
  18. 18. Proper Method for Use of Ultrasonic Scaler  Settings  Adjust the hand piece so that the water and power are performing at maximum efficiency with as little discomfort to patient as possible  Ideal comfort for patient is with power adjusted as low as efficiently possible and the water to where droplets are occurring and a fine mist as necessary  Do not create a heavy mist. Avoid aerosols outside of the mouth that can spread germs and bacteria “In Phase” for light to heavy cement removal “Out of Phase” for sensitive patients
  19. 19. Maneuvering Around Orthodontic Bands  When performing ultrasonic scaling on a bracketed and banded patient, it is important not to break or loosen anything that would inconvenience the orthodontist  When scaling around cemented bands, use a wider tip such as a beavertail at a 10°- 30° angle  Along with proper technique, use a lower power setting around bands  Always check for loose bands or appliances with a weingardt after using ultrasonic scaler to confirm it did not come loose.
  20. 20. Tips for Cement Removal  You can often find band cement at the most inner crevasses between the buccal and lingual cusps  Use gentle tapping motion to remove large deposits of cement  Keep insert moving at all times  Work starting from the crown and moving in a back and forth stroke motion toward the gum line  Use light pressure  Control aerosols by using saliva ejector frequently  The tip and concave surface of scaler are most effective Mesiobuccal cusp Distobuccal cusp Distolingual cusp Lingual groove Mesiolingual cusp DISTAL MESIAL
  21. 21. How to operate Ultrasonic Scaler  Turn power on  Check water supply  Select desired insert tip and seat into the hand piece until it is locked  Set power knob to suitable level  Hold the hand piece with the tip pointing into a cup or drain. Step on rheostat for a few seconds and allow water to flow out  Adjust water appropriately for proper technique to reach the “In Phase” or “Out of Phase” setting
  22. 22. How to operate Ultrasonic Scaler  Always flush the waterline for 2 minutes before first use of ultrasonic for the day & for 30 seconds between each patient  Try and keep the angle between the patients tooth surface and the hand piece as close to 30° as possible
  23. 23. After Cement Removal with Ultrasonic Scaler  Use a hand scaler or band remover to confirm all cement is removed  Use ultrasonic scaler again if necessary and repeat this step  Polish the area that was scaled  Floss to confirm all contacts are open  Have patient gargle antimicrobial mouth rinse
  24. 24. Equipment Sterilization  Remove insert from hand piece and allow hand piece to run for a couple of seconds to drain any possible contamination left inside  Outer surface of hand piece should be wiped with a chemical disinfectant  Cable connecting to hand piece should be scrubbed with solution at the end of each day  Insert must sit in ultrasonic cleaner with cleaning solution, rinsed and dried thoroughly, packed in sterilization pouch and placed in an autoclave  The main unit should be swabbed with alcohol or a disinfectant and kept away from dust
  25. 25. Infection Control Between Each Patient Includes  Always disinfect the following  Loose instruments (packaged or not) laying around operatory  Walls, floors, countertops and dental chair surrounding where scaling was performed  Overhead light handle/operatory switches  Dental chair controls  Any object the assistant touches after scaling begins

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