The Worn-Down Currette: Retip, Sharpen, or Replace?

When I started using Sharpen Free Technology Chairside, I didn't believe the company and I tried to sharpen them. Well, the first time I tried to sharpen them, I cut a big chunk out of my stone because they are so sharp. And because they're so sharp, you're getting the same instrument every single time. So they come to you and they're already kind of whittled down a little bit. They're thinner when they come to you and they last for about the same amount of time as you would spend whittling an instrument down. Welcome to the Phil Klein Dental Podcast. Our dental instruments, especially when it comes to our hygiene department, are the backbone of our practice. But when they start to lose their edge, the question arises, should you retip, sharpen, replace them, or even switch to sharpen-free instruments? Each option has its pros and cons, and making the right decision can significantly impact your practice's efficiency, budget, and patient care quality. In this episode, we'll demystify the process of instrument maintenance. To help us do that is our guest, Emily Boge. Emily blends her extensive experience in dental hygiene and dental assisting with a dual doctorate in education and organizational leadership. She is what I would call a true educator, advocating for accountability and empowerment among dental professionals. Emily shares her insights as a speaker and writer. always pushing the boundaries of dental practice standards and techniques. We'll be getting to our guest in a second, but first, for many years now, we've recognized that buffering local anesthetics can reduce injection pain, speed up onset, and decrease the overall volume of anesthesia needed. However, the process of buffering has always been complex, time-consuming, and expensive, until now. Introducing BufferPro. a single-use, sterile, self-contained capsule that delivers 0.1 mils of sodium bicarbonate into a dental anesthetic cartridge, raising the solution's pH to near physiologic levels. No measuring, no mixing, and no hassle. Join the growing number of dentists introducing BufferPro into their practices. To learn more, visit septodontusa.com. Emily, it's so nice to have you on our show. Thank you for having me. Pleasure to have you back on the show again. We've done other podcasts with you and we appreciate your insight and professional thoughts on hygiene, dental hygiene, and you certainly know a lot about it. And I think this is an important topic because listen, nothing lasts forever. And one of the major tools that hygienists use chairside, of course, are hand instruments. After many cycles of scaling, sharpening, and recontouring, eventually there's nothing left of the instrument tip, right? There's nothing left to sharpen. So yeah, I mean, hygienists face this all the time. So especially when they're really busy and working a lot. So the question is, should the dental practice re-tip their existing scalers and curettes or just by new ones? And I know there are folks out there that love to re-tip. They send them out to companies that take pride in re-tipping these handles. And others go right to buying new instruments. They don't think it's worth it. Or maybe there's a safety issue where they think the tips may break off or the handle may be jeopardized or compromised and the handle may crack. So what are your thoughts on this when you're down to that part of the instrument where you can't sharpen it any further? And so what we're really talking about here is stainless instruments, traditional 440 stainless. And I'm kind of a metal geek. Everyone who knows me in the industry knows I'm. I know way too much about metallurgy. And so we're talking about stainless specifically here. And so you whittle that stainless down, whether you're using an Arkansas stone, you're putting oil on it, whether you're using a ceramic, you've got your diamond sharpeners, all the plethora of sharpening options we have. So you're whittling that stainless down. And once it's whittled away, you obviously can't put it back on. And so what do you do? So in my opinion, retipping is not. a good option and i've written a couple articles on this i've done some research on it i know that's sometimes a not very popular opinion but when i was in private practice i i did a research study and it was independent it wasn't really sponsored by anyone the only i guess you could say sponsorship was an instrument company offered to give me free instruments to send back to the people so i asked 100 people to send me some instruments that had been sent in to re-tippers And then I studied them. I took them apart. I cut them in half. And there was some nasty stuff going on. There was some water trapped inside. Some of them had completely broken tips when the people sent them to me. So basically what happened were the practitioners sent me these re-tipped instruments, regardless of what the instrument looked like. I sent them a brand new one from a company who had told me that they would give me these instruments. So let me just ask you one question. You said there was some water inside. Now, obviously that breeds. spores and bacteria, microorganisms, the water was obviously in the handle, right? Right. From the ultrasonic unit or the, at that time it would have been an ultrasonic unit because there weren't a whole lot of mechanical instrument washers out there. We weren't using that kind of stuff yet. This was probably around 2012. So the handles are hollow, correct? It depends on the brand. But a lot of the times when the retippers retip the instrument, they forcibly take the tip out especially if it's a resin handle and then they have to force a new handle a new tip back in and so it becomes a forcible process sometimes you're using some kind of glue sometimes it's a heat treat process but what i found to be kind of gross about the whole thing was not only were it was there water trapped in there but there was some schmutz with that water and then it wasn't a balanced instrument so when you held it in your hand people sometimes don't realize that these dental instruments we're using, these hand instruments, are a class one medical device. So would you want to go to your doctor and have them be using some kind of instrument on some other part of your body that had been... remanufactured and so a couple things about re-tipping they have to stamp on the instrument after it's been re-tipped they have to they have to physically mark on the instrument most of them will melt it into the resin handle or print it onto the stainless that it was re-tipped and the new date because it is an FDA cleared device and so as I was doing this research I wrote a couple articles on it and my bottom line was as a patient I wouldn't want a remanufactured class one medical device to be used on me. And I understand, you know, there's a cost associated with getting a new instrument. But the bottom line here is, you know, the ergonomics and the time and engineering and science that goes into making these products. This isn't something that we should shake our heads at. We need to take it more seriously as health care professionals. And there's other. options out there. We don't need to be sending these instruments away and getting them retipped. Yeah. Now there's two thoughts to that. Now I totally get your side. The manufacturers or the retippers say that they're very, very meticulous about how they do their procedure. And they have clients that have been sending them instruments for many, many years. And there's two or three firms out there that have been around for a very long time and they retip, you know, they basically remove the old tip and they use this anaerobic adhesive of some kind with force and put it into the hollow part of the handle where the tip goes. And then they supposedly put it in where it's balanced and everything else. So, you know, some people are having success with this, but again, there's two sides. And I think what you're saying has a lot of merit considering it is a medical device. What's the formal classification? FDA medical one device. It's a medical one device. Yeah. Right. And that's why when, I mean, I have some instrument patents and And it's not the easiest thing in the world to get an instrument made. It has to go through a lot of things. And then on the back end, there's a lot of quality control things that it has to go through before it can even get to the dental office. There's so much that goes into that. And there's better options. I guess that's my big message I want to talk about is that if there's something better out there and it's not that much more expensive, why wouldn't you do that for your patients? Right. So what's the option other than just buying a new instrument? when you're at that stage you know there's there's a couple different options here one of the great options is um quick tips and so one of the manufacturer companies actually makes these threaded tips that go into a handle much like a mirror right when your mirror gets scratched up and dinged up or heaven forbid it breaks You just unscrew the mirror and screw in a new one, right? And so there's instruments that are designed like that. I believe the only company that's making those is American Eagle that's owned by Young. And they're making these quick tips that thread in. So you twist them in. And then when you get them just a little bit tight, you quarter turn them with this little tiny wrench. And so once your instrument wears out, you're only replacing the tip of the instrument rather than the entire handle. It's more sustainable, more eco-friendly. Um, that's, that's one option you have. Your other option is to, to go completely sharpened free where you have a whole different level of metal with the instrument and you, you can take that route. How much more expensive are those? And you can answer for both companies, the one that's designed to replace the tips. Cause you actually have to buy the instrument from the company that sells the quick tips, right? Cause they're, they're designed those handles to receive the replacement. It's almost like a razor, you know, using a Gillette razor, you have to get, you have to get the blades. So what's the cost comparison between buying a typical hand instrument from Premier or Euphrates is just your traditional Q-Rad and Scaler versus the quick tip version. So the quick tips, to my knowledge, I, I believe they're only sold in the sharpen free variety. So they're designed in the material that you're going to want to replace anyway, rather than sharpen. And so they're, Don't beat me up if this is an exact quote. I believe they're about 20% more expensive. Okay. So when you say sharpen free, that means they're kind of disposable once they get dull. That means you can't sharpen them and you don't want to sharpen them. So I'm such a cynic. Oh my gosh, I'm horrible. You can't tell me anything until I find it out for myself. So when I started using sharpen free technology chair side, I didn't believe the company and I tried to sharpen them. Well, the first time I tried to sharpen them, I cut a big chunk out of my stone because they are so sharp. And because they're so sharp, you're getting the same instrument every single time. So they come to you and they're already kind of whittled down a little bit. They're thinner when they come to you and they last for about the same amount of time as you would spend whittling an instrument down. Right. So when I was in private practice, I had what, eight kits. I would see about eight, nine patients a day. And they would last me about a year and a half. And I really like to sharpen my instruments. I have to have sharpened instruments. It drives me crazy if they're not sharp. And so I would get about a year and a half out of those, whereas most people get about a year and a half, two years out of stainless before they either get them retipped or dispose of them. But with this sharpened free, you know, there's a couple different companies that are making them now, but both companies are making, they have a stainless steel core and then they're surface engineered. technique, it changes the metal. So they're taking, one company takes titanium nitride and embeds it into stainless steel. The other company, I'm not sure it's a proprietary metal coating, but it's that same oxidized reaction. And their company, it turns into a black instrument is the end product, whereas American Eagles turns gold, LM's turns black. So the LM instruments, they're called Diamond Sharp. Whereas the American Eagle ones are called XP. 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Explore VOCO's full range of composite materials and request a sample at voco.dental. So these instruments that are basically sharpen free obviate the need for all the labor. So you're saving on all the labor of sharpening the instrument. But you're saying that the duration of time that you use these instruments are similar to the instruments where you do sharpen them. Right. They're comparable. Right. They're comparable. But the ones that you need to sharpen, you have to spend time sharpening them. So that's that's a lot of how much time does it take you to sharpen unless it's just takes you seconds? I might not be the best hygienist to ask that question. But I mean, I was really good at sharpening, but I sharpened often because to have a dull instrument drove me ballistic. So how long did it typically take you to grab a Gracie Curette and make it like new again by sharpening it? Mine wouldn't get to that point where they had to be made like new. So I mean, three or four sharpened strokes and I would be fine. But if I would help one of my fellow colleagues who might not have sharpened in a long time, it could take me, you know, maybe five or 10 minutes to restore the blade on a Columbia 1314. Okay. So for those that are not consummate sharpeners, to me, it doesn't make any sense to go that route, right? At that point, it would make more sense to use a sharpen-free instrument. Right. And the other thing with the sharp and free is patients notice the difference. And that's the one thing that really surprised me because I was, you know, oh, I don't need those sharp and free instruments. My patients are fine. I keep my instruments sharp. Patients notice that you don't have to have as many working strokes to remove that plaque retentive factor, whether it's stain calculus, whatever it is. You know, at the school level, we started using sharpen free back in 2017 at the dental hygiene school where I was chair for nine years. We started integrating both because students were going into private practice and they were coming back to me and saying, well, Bogey, I went out on private practice and there's all these sharpen free instruments and I don't know how to use them or take care of them or I never had experience. So our seniors get a specialty kit. The only thing that's different about caring for sharpen free is you need to use a pH neutral solution in your ultrasonic bath or in your instrument disinfector washer. But you really should be using a neutral pH one anyway, because that's going to decrease on your corrosion. Right. And the cost of those are about 20 percent. You said higher than a traditional instrument. They are more expensive because there's more labor intense. manufacturing and their production. But I guess it's important today with the staffing crisis for every dental hygienist to know how to sharpen instruments because a lot of hygienists are now working or at least looking into working flex time where they... don't have a full-time position at a particular practice. And they're kind of at the mercy of the office they go to, to what instruments are being used. So that practice might have a sharpen-free instrument system, but they may have the traditional one where they're going to have to know how to sharpen instruments. So I guess it's important for every hygienist to be maybe not as good as you the first day, but at least work towards that goal, Emily, as being a pretty good sharpener. Absolutely. Today's episode is sponsored by Sunstar, makers of gum products. Gum's premium line of interdental cleaners, soft picks, and toothbrushes offers innovative, easy-to-use solutions for better oral care. Introduce your patients to gum, the tools they need to maintain healthier smiles. Learn more today by visiting sunstargum.com. And so what we did at the school several years ago, I don't know how familiar you are or the listeners would be with PDT. It's a company out of Missoula, Montana. Yeah, I think she climbs mountains, the owner, doesn't she? The CEO, Linda. Yeah, she's fantastic. Her and I went on a mission trip together. Great person. I know her. She's a great person. Phenomenal human. But she worked with a gentleman. His last name was Gleason. And so they make this Gleason guide. And it's a two-sided stainless steel block. It's probably maybe, I don't know, four and a half inches by three inches big. And it fits over a sharpening stone. And on one side, it guides your ability to sharpen a curette to the correct angle. And on the other side, it guides your ability to sharpen a scaler. And I'm amazed at how much faster the students catch on when they don't have to think about the angle. Yeah, it sounds like the Gleason guide is a jig, which is very clever. And it's almost foolproof once you put the sharpening stone on the right side. Was Mr. Gleason a dentist? I believe he was an instrument worker, like a metal worker. Yeah, it was probably an instrument. He probably sharpened a whole lot of curettes before he figured that one out. When I thought it was funny, when Linda first introduced it to me, she's like... yeah people buy one of these and they use them for their whole life you never have to replace them which is so true because it's this big durable hunk of stainless that you just rest your instrument against and i mean there's a lot of professional um professionally manufactured sharpening guides out there i mean there's the sidekick there's the um jave perio star i mean lots of companies have one i know um oh premier has one i can't remember what theirs is called but there's lots of different guides i really think the gleason guide though is the one that is the most user friendly i feel like students pick it up and they understand it right away whereas when we were teaching sharpening and we were using a video and a traditional stone with oil They just weren't, it took a long time for them to connect. The math wasn't mathing with the angulation. So let me ask you this. So when you look at all the dental practices out there, how many in ballpark percentages, how many are using traditional instruments where they sharpen it themselves? And then they either retip or buy a new instrument once it gets down to nothing. And how many are you actually using sharpen free instrumentation? I don't know the exact percentage in the US. I think it's... If I had to ballpark it, I would say maybe 40, 60, 40% people who are using the sharp and free and using them effectively and maybe 60% stainless. And that might be a little bit generous on the sharp and free side of things. Europe is a whole different ballgame. Over there, they've really grasped the concept of sharp and free. The sharp and free companies have really gotten into the European system of dentistry. And I also just feel personal opinion. Europeans are so much more accepting to change specifically in dentistry, in my opinion. I mean, you look at the number of practices in Germany that don't have an instrument washer, thermal disinfector, like barely any. People here are like, ah, just get a dishwasher. No, don't do it. It's just interesting to me. And then you have like that whole option out there of professional sharpeners. So people that you can send instruments to. to sharpen them and send them back to you, which I think is a great option. I know a lot of people who end up sending their instruments to a professional sharpener wait until they're really, really dull. And then you have to think about the problem of, okay, there's got to be some kind of turnaround time, two, three weeks turnaround time in the mail. And what are you going to use while all your instruments are gone? Yeah, well, obviously you have to cycle them through to the professional. But what you said was very interesting because that's the first thing that came into my mind when you said to send it out. Just human nature, people are going to wait for that instrument to be really, really dull. And what does that mean? It means that their efficiency during that period of time, when it becomes in that stage of questionable to really, really dull, they're not cutting efficiently. So they're spending more time. scraping calculus uh you know off the teeth because the blades are not sharp because they're waiting for them to get dull so they get their money's worth with sending it out to the professional sharpener so there's there's an issue there with just human nature which is and if they're not sharp you're putting your patient at risk you're putting yourself at risk from an ergonomic perspective and a percutaneous injury perspective i mean there's so many i you know i often thought about maybe i should start a professional instrument sharpening company but then I also get to thinking you're going to see the worst of the worst. And how many people are you going to have to tell in good faith and ethics that you can't sharpen their instrument and send it back because it's gone. Yeah. So you mentioned safety. It seems to me the sharper the instrument is, the safer the operator is. Absolutely. But the bottom line is the sharper it is, the more efficient you are, the less likely the instrument's going to kind of skid off the tooth and go somewhere. You don't want it to go where either damage the patient's tissue or yourself. Right. Right. And it's not rocket science. I mean, think about the last time you cut a tomato or you cut a loaf of bread or something you were cutting with a kitchen knife. If it's sharp, it's going to glide through. You're going to have to have less. There's going to be less tension involved. I think about my husband on the farm with his pocket knife. He pulls his pocket knife and it's dull and he's seesaw and seesaw. And it's like, just give me the dang thing. I'll go sharpen it for you. Of course, you've got to be his wife, the ultimate instrument sharpener. Yeah, great, great to be married. Yeah, right. Great to be married to you. So yeah, he needs to get a couple of pocket knives that are sharp before he goes out on the farm with you. Let me ask you this about hand instrumentation as we wrap up this episode. With all the ultrasonic instrumentation out there, are we still using hand instruments like we used to back in the day? Like when I was in dental school, when I graduated in the mid 80s? I am a firm believer that hand instrumentation will never go away. Why is that? There's a certain sect of hygienists that will argue that with me until they pass out from not being able to breathe from talking so much. But you can't use air polishers and ultrasonic units on every single human. people with COPD, people with certain health conditions, people who have limited nasal breathing, people. I mean, there's a lot of people with underdeveloped enamel, people with incredibly active curious lesions. I mean, there's a laundry list and I speak a lot on ultrasonics and biofilm control. And I am the biggest advocate for getting an ultrasonic unit in every mouth where it can be used because there's a lot of research also that the ultrasonic does produce that lavage and that that tornadoe action of cavitation and bubbles and clouds and all that fun stuff it just does a better job with biofilm removal but you also have to look at the finite details sometimes there's just that little tiny piece of calculus that your ultrasonic is going to slip slide around on and you're going to need that hand instrument. And so in my opinion, hand instruments will never be obsolete because there's always going to be a subsection of your patients, different percentages within different practices that just aren't going to be able to tolerate air polishing and ultrasonics, whether you're using Piezo or Magneto, it doesn't matter. And so it's my opinion that, yeah, I value all of that biofilm. guided biofilm therapy, assisted biofilm therapy, whatever company you want to ask to get their terminology. But at the end of the day, you're always going to need a sharp hand instrument. So other than the contraindications of those patients that you mentioned, would you use ultrasonic instrumentation first and then fine tune with hand instruments? That's what I do as a clinician. Yeah, that makes sense. Get the bulk buildup off first and then go in there and see what you missed and just kind of really... add the precision by using the sharp hand instruments afterwards. And if you're a student listening to this podcast, you still need to do what your instructor tells you to. That's really the way that the market is trending. What do they say in school? You ask five different schools, you're going to give five different answers. Is that right? Wow. Gosh, yeah. Because the standards just say the school needs to teach you all the options that are current. They don't. You don't have to go by a certain order. And so the research and the current trends are indicating that hygienists are going in, they're using the air polishers or the slow speed polishers and the ultrasonics and then going back in and fine scaling with their scalers. But I always have to put that caveat in there for education because I know a lot of students are listening to podcasts and then they want to go back to their teachers and say, but Emily said, and then, you know, I get. I get all sorts of emails, right? All sorts of emails. All right. Well, Emily, thank you very much. Send your husband my regards regarding his pocket knife. That's not sharp because that is something that would certainly be on my mind if I had a pocket knife and a wife like you. Yeah. So he'll figure it out after a certain number of years of marriage. He'll get he'll figure it out. So we appreciate your time and we look forward to having you on another program soon. Thank you so much. Yeah, you bet. Take care.