Starting out, students know very little (if any) about clinical dental hygiene. The skills taught in the classroom are by the book, and are taught the way they are because they’ve been proven effective. In the early stages, this classic dental hygiene should be reinforced by clinical instructors. Not only does it focus on effective ways to instrument, but also proper ergonomics. It is so important to use these to prolong a dental hygiene career, or the student will be headed for early retirement. However, clinical instructors have experience in the real world. They have learned little tricks to get that one stubborn piece of calculus or access a difficult area. One of my clinical instructors, after I had tried other instruments with her watching, told me to use the 204s on the lower anteriors. Now I just have another tool in my book to try to be sure I get every last bit. I think students need to practice the way they were taught in the classroom for the first year or so, and then they can learn modifications (different instruments, extra oral fulcrum, etc.). These would definitely be ‘modifications’, not changes. Students should be encouraged to keep the same form, technique, and ergonomics, while using a little trick. It is not wrong, just different. In the handbook, it talks about how part-time clincal instructors can provide a “real-life laboratory” experience for students because they are still in private practice.
To introduce these without negating what was taught in class, they could just explain what makes their modification work. Explain why they learned what they were taught, but also add why their modification was not taught. Going back to the 204s on the lower anteriors.. If there is a piece of calculus just under the contact on a patient with very healthy tissue, this may be the only way to access it. After asking what instruments the student tried, the clinical faculty could point out that the thickness of the 6/7 does not allow the clinician to get all the way there. They could explain that because the 204s has a thinner end, it is better for access. They would also need to point out that it is specifically designed for the posteriors, but this was a modification for certain circumstances that helps.
In my experience, the clinical faculty has offered great tricks. It is nothing I have changed permenantly, but always another tool up my sleeve when I’m having trouble. Each faculty member may do something different, and it just takes one of those to make a world of difference to the student.
I think you and Deb both made in effort to discuss proper ergonomics regardless of the instrumentation modification. I so agree. These modifications should be helpful to the patient but not harmful to the practitioner. I wish I had thought of ergonomics for my post.
This is a good example which many of you have used. It is important to know when modifications are appropriate and when they shouldn’t be introduced. This can be difficult to assess as a clinical instructor, especially if you don’t always work with the same students.
You brought in a great point not only is it important to stick with the textbook and classroom method in the early stages of dental hygiene clinical practice but also the need to teach proper ergonomics. This is one of the most important comptencies to focus on in the curriculum. It is the key to longevity in the dental hygiene career.