In a recent article in Dentaltown titled 5 Reasons You Should Purchase Quality Hygiene Instruments, I articulated my thoughts on why you should not skimp when it comes to hygiene instruments or any other instruments for that matter.

First, let me say that I did not receive any compensation from anybody to write that article nor was I solicited to write the article.  It is simply my opinion that our number one responsibility is to perform quality work for our patients and frankly that should go without saying.  In my experience, quality tools and instruments help you to perform your job with consistent quality.

In my opinion, there are 5 reasons that you should purchase quality instruments for your hygienists and yourself: durability, reliability, feel, long-term use, and productivity.

Durability

In the 1950’s, W. Edwards Deming helped revitalize the Japanese economy with his enduring economic principles.   Deming’s teaching became the impetus for pulling Japan out of the ashes and making them the second largest economic power in a span of only ten years.  One of Deming’s primary beliefs was that:

higher quality, more durable products allow you to provide better service. 

Durability of instruments is important for the rigors of dentistry.  When we purchase cheap instruments, they have a tendency to break, dent, or bend.  How frustrating is it when your forceps tips no longer meet together or when a suture needle spins in the needle holder? What about when a 1/2 Gracey becomes an 11/12 because it now has a bend at the end or has lost its edge altogether? Durability is a very important asset that we should look at when buying quality instruments.

When I was tasked with finding the best deals for hundreds of dental practices, I searched the globe for the products that provided the best value.  About a year ago, I had the privilege of attending the AEEDC Dental show in Dubai.  While walking the exhibit hall, I was astonished at the number of dentists purchasing cheap instruments. When I asked dentists why they purchased cheaper generic instruments, I heard responses like, “it’s cheap so when it loses its edge I will just throw it away and get another one”, or, “I know they are not as good but I only use it to scrape calculus off the teeth”.  This reasoning appalled me.  I know first-hand that quality instruments cost more, but, the value of an instrument that breaks adds inefficiencies to the practice that cost time and money and may even cause harm to our patients.  Think about what a instrument goes through in its life-cycle, overuse, cleaning, handling, sharpening, sterilizing, etc. and when you pick-up that instrument, you want it to perform the same way it did the last time you used it. Durable instruments last longer and perform consistently throughout their life-cycle, especially if they are housed in a cassette.

Reliability

A well known telecommunications company created a digital test board that they installed millions of in the 1990’s.  Only 50% of the boards proved to be reliable and the company spent millions of dollars on diagnostics, service calls, repairs, and replacements. By the early 2000’s, the company was bankrupt.  Reliable products are crucial to the success of a business and it is an essential quality in the instruments we use to perform our trade.  Reliability with instruments is important because when you pick it up, you want to be sure it works for its intended purpose.  For example, If the instrument is a specialty instrument like a scaler, you must know that it will maintain its edge and remain sharp.  However, so often, hygienists spend their time sharpening an instrument with something like an Arkansas stone.  Do you pay your hygienist to treat patients or to sharpen instruments? What if your hygienist was elevated from the tedious and important task of sharpening instruments? I want my hygienist to be treating my patients and spending time with them building rapport.  In my ideal practice, my hygienist would never be taking time from our patients to sharpen instruments.

According to the research study, “The Effect of Multilayer Filtered Arc Coatings on Mechanical Properties, Corrosion Resistance and Performance of Periodontal Dental Instruments”, the authors wisely articulate, even if the sharpening procedure takes a few minutes per instrument tip, the labor cost will outweigh the replacement cost of the instrument after only a few sharpening sequences. This does not take into account the loss of productivity by the dentist or hygienist. The constant re-sharpening of instruments has another, possibly more sinister, side effect. Every stroke of the sharpening stone removes a small amount of metal from the instrument. With repeated sharpening, the thinner parts of the instrument can become sufficiently weak to cause breakage during function creating a danger of the piece of metal becoming imbedded in the surrounding tissue. Many instruments (especially scalers and curettes) are designed to be bulky in the beginning to minimize future fractures. In fact, I was curious about the effectiveness of sharpening and found a recent study by Lory Laughter, RDH, BS who found that only 6.5% of hygienist were able to maintain original angles on instruments after sharpening (RDH, April 14, 2015). I have become more concerned about providing the highest quality dentistry that I can.  In doing so, I also utilize the highest quality instruments.  In our practice we have embraced XP technology for our instruments.  This technology uses stratified cermet layers that are embedded in the metal substrate in different dental instruments using a metal-gas plasma arc known as  Large Area Filtered Arc Deposition making the instruments harder yet less brittle.  At the end of the day, our instruments are more reliable delivering a sharp edge every time we pick them up.  Persistent inflammation is not good for our patients and we need to do all that we can to remove it.  Research has proven that If 17-64% of calculus remains after scaling and root planing, persistent inflammation will remain next to the calculus².  A reliable instrument will help us to effectively treat our patients.

Feel

I have a friend that spends his weekends in a meadow scratching, scrawling and stroking canvas with water colors to create beautiful interpretations of landscape and wildlife.  He is very particular about his paint brushes and swears that a brush remembers your stroke.  His explanation is that a good brush is all about feel and his brush of choice is a Kolinsky sable brush; the most expensive brush money can buy with a price per ounce higher than gold.  When I asked him if it was really necessary he said without hesitation yes.  His brushes are an extension of his fingers and his mind and when he is in his element, the brush just seems to know where to go. The tactile feedback of a good instrument provides a sensation that is difficult to explain so, we often simply say that it just “feels” right. When a surgeon holds in her hands an instrument with good feel, less force is required and the tactile sensation afforded the surgeon is that of a paintbrush in the hands of a painter.

For me, it is my composite instruments which must be reliable when I use feather strokes to smooth the composite.  I am very particular about what I use and strongly prefer lightweight instruments with thicker, ergonomic handles, and non-stick, treated tips. In our practice, we have given our hygienists the freedom to test multiple products and they most frequently choose higher quality instruments that maintain their sharpness.  When I find a quality instrument that has a great feel, I know that I will provide a great outcome for my patients.

Long-term

Our family has the funniest sayings and idioms.  For example, I had an uncle Bob that, “smoked like he was on fire and drank like he was trying to put it out” and he had a “cast iron stomach” because he could eat “everything but the kitchen sink”.  Several sayings frequented the top ten list and one was, “The bitterness of buying poor quality remains long after the sweetness of low price is forgotten”. This was one that has stuck with me and every time I buy something cheap, it echoes in my head.  Recently while reading a well known dental blog, a colleague shared that they had found curing lights for $79 on a website.  So, I of course purchased one as well.  It cured composite if you held it directly on a very thin layer and continuously cured the composite for a minute.  When our local dealer representative visited the office, I asked him to check the wavelength on the lights.  The verdict was that these lights were more like green lights coming in at about 500nm.  So, they ended-up in the lab for curing block-out resin and for oddball projects, but mostly, they rest in a drawer with other mistakes that we have made. If you purchase something that functions properly for a long time it provides greater long-term profitability.  When it comes to dental instruments we need to be purchasing instruments that will maintain their function for the long-term. When evaluating this concept, we performed a retroactive evaluation on instruments across 10 practices. We identified instruments using Easy ID Rings.  One color designated the month it was purchased one represented the year and one was used for the usual purpose of procedure type.  In our informal study, we found that instruments purchased through cheaper no-name sources, had a 63% shorter life span than the premium brand name instruments.  Coincidentally, we found that the instruments with XP technology (American Eagle Instruments) lasted the longest.  One obvious conclusion is that we need more formalized research around this subject. Having said that, If an instrument is half the cost and lasts a third as long, your business assumes a greater on-going expense with a lower ROI.

Productivity

Do you pay your hygienist to sharpen instruments?  In the United States, a Hygienist’s average hourly rate is about $42 an hour.  As a business owner, I breakdown each person’s role by determining their objectives, goals, strategies and tactics.  As far as a dental hygienist is concerned, I would not include sharpening instruments in any of those categories.  Some people have offered anemic arguments that sharpening is a tactic that allows a hygienist to provide periodontal care.  This is faulty logic since the instruments that they utilize should be adequate prior to performing their primary task.  Imagine if a carpenter had to sharpen all of his nails before building a house.  Therefore, a hygienist should be using tools that are either already sharp or maintain sharpness.  Let’s take it a step further.  If your hygienist spends 10 minutes a day or an hour a week sharpening instruments, they will have spent 48 hours over the course of a year sharpening instruments.  If your hygienist is paid $42 an hour then you will have spent an unnecessary $2,016 to sharpen instruments in your practice.  However, you also lost on potential earnings, at average $200/hour and you had a loss of earning potential of about $10,000 over the course of a year.  Now, these are only the hard numbers because you also have an anticipated ongoing ROI from diagnosed work that comes from hygiene as well as elective services, etc.  Bottom line is that you do not pay your hygienist to sharpen instruments and having her do so is a poor business decision because they have less time to perform tasks that align with their objectives, goals, strategies and measures.  Provide your hygienists with the proper tools so they can have greater efficiency with instruments that function properly.  Cheap instrumentation causes unnecessary workload. Focus on increased efficiency, quality dentistry and everybody wins.

If you do the right thing, the money will follow.  Which is why I believe that there are 5 reasons that you should purchase quality instruments for your hygienists and yourself: durability, reliability, feel, long-term use, and productivity.  Do quality dentistry and use the best instruments to perform your job and the money will follow.