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20 Dental Tribune Middle East & Africa Edition | July- August 2014hygiene tribune Prevention: Take regular hand breaks to stretch and exercises the muscles, tendons and liga- ments. See Figure 2 for some possible exercises. Breaks don’t only include time away from scaling, but also time away from the computer and writing notes. Typing can also compress the nerves in the Carpal Tunnel. Treatment: If it is not possible to take long term time out from the activity causing the repeti- tive strain on the small muscle groups, then it is necessary to take regular short breaks and stretch (Figure 2, 3). A hand splint, the hand is held in a relaxed position to take pres- sure of the Median nerve run- ning through the Carpal Tunnel and as a final resort surgery. A brief history of Hygiene The earliest recorded text asso- ciated with teeth cleaning dated 3000 BCE where tooth picks were used in Mesopotamia (ear- ly Iraq) according to the M den- tistry Time line of Dental Hy- giene, but it was not until 1915 in USA, Conneticut that Alfred C. Fones trained 97 Dental Hy- gienists and the Dental Act set regulations stating their duties. Then in UK 1943 saw the 1st Dental Hygienists trained in the Women’s Auxiliary Army WAAF. Instruments: The 1st Dental hand instruments were very thin and heavy with smooth metal handles requiring a very tight grip. Later a cross hatch was scored into the metal han- dles for easier grip but were still very thin, wider lighter steel gripped handles were intro- duced and in the last 10 years a wider ergonomic soft silicone was used around a metal inner part then came into production, a very light completely resin handle with a grip for less wear on the muscles and tendons. Ultra Sonic Scalers have dra- matically improved the Dental Hygienists ability to remove hard deposits from the tooth surface by either working in a Magnitoconstictive or Piezo electric capacity. This reduces the need for excessive forces applied by the hand over an ex- tended period of time increasing the risk of strain and inflamma- tion of the wrist muscles and tendons resulting in RSI or CTS (Figure 4). Sharpening: Numerous articles state the different methods of sharpening instruments: Arkenstone different shapes round, flat, long, short. Differ- ent sizes, angles, grades course, medium, fine Machines: The Hu-Freidy in- strument sharpener, the LM Rondo- plus electrical disc sharpener The Neivert Whittler to name a few. The consistency of the preci- sion of angulation is unpredicta- ble and operator error possible. It is possible to affect the cutting edge, causing more strain on the fingers hand and wrist. It is human nature to not sharpen immediately when required. Figure 5 shows the different types of next generation hard- ened steel. Results: LM handles present to be ergonomically superior with awidersiliconegriptohelpkeep the Carpal Tunnel open, howev- er they do still contain an inner part of steel. This runs the entire length of the handle increasing the overall weight compared to the completely resin handle of the American Eagle. The XP Technology instru- ments requires no sharpening at all, and will allow more repet- itive strokes with minimal pres- sure on the tendons and wrist. The LM DuraGradeMax states a hardened steel alloy more dura- ble than the XP Technology. It is advised to send the instruments back to the LM company for fac- tory sharpening, requiring dou- ble the amount of instruments in order to continue a full working schedule, resulting in LM being less cost effective . Once the XP technology tips becomes dulled it is feasible to use their Quick tip® to replace the tip at less cost than the full instrument. The statistics in Figure 7 do not clearly state how the results were determined for LM in- struments, it is not clear what numbers 9, 7, 5 and 3 represent, minutes, hours, Days, Strokes? It is possible however to see in photographic evidence 15000 strokes to 1,500 from American Eagle instruments. Regarding the hardness of the Steel alloy of the LM instru- ments there is no evidence to support this but the American Eagle XP instruments have the Rockwell hardness test to prove their claim. Conclusion: In conclusion the Ultra Sonic Scaler should be used as much as possible to avoid excessive strain on the transverse carpal ligament and median nerve. It is clear that some calculus deposits remain interdentally after Ultra Sonic Scaling alone. Ultra Sonic Scal- ing alone is not sufficient and hand instrumentation is neces- sary in conjunction with Ultra Sonic Scaling. The correct choice of hand in- strument is essential for a Den- tal hygienists to help avoid RSI. It seems the American Eagle lightweight resin handle with the XP Technology blade will be of most benefit long term. Due to its superior stokes carried out 15000 to 1,500 before starting to dull. For this reason it seems the American Eagle XP technol- ogy would be in the instrument of choice compared to the LM DuraGradeMax. The American Eagle XP will ensure less pres- sure is exerted on the median nerve, the transverse ligaments and the carpal tendons reducing the risk of RSI or CTS. References: 1. NHS UK choices website May 2014 2. May 2012, RDH Feature, No more dull instruments, Dianne Glasscoe Watterman RDH, BS, MBA 3. http://school/sindecuse-mu- seum/timeline-dental-hygiene Figure 1: http://en.wikipedia. org/wiki/File:Carpal_Tunnel_ Syndrome.png Figure 2/3/4: Google images Figure 5: DG Double Graceys XP technology next generation/ http://www.lm-dental.com/ sites/lminstruments.com/files/ materials/duragrademax_en_ flat.pdf Figure 6: DG Double Graceys XP technology next generation. Figure 7: http://www.lm-dental. com/sites/lminstruments.com/ files/materials/duragrademax_ en_flat.pdf < Page 17 “...Ultra Sonic Scaler should be used as much as possible to avoid excessive strain on the transverse carpal ligament and median nerve.” FOR: • PFM • ZIRCONIA • LITHIUM DISILICATE