Ultrasonic Scaling

When using the ultrasonic scaler on fairly heavy calculus I find it useful to clear the interproximal calculus first. In cases where there is a heavy bridge of calculus joining the lower incisors, it is often beneficial to break large chunks of calculus off in one go. This saves the effort of running the scaler over every square mm of the root surface that can be very sensitive. Removing the interproximal calculus first starting at the contact point and working towards the gingiva removes the areas of calculus that are locked in between the teeth and makes the bulk of it less retentive.

Always be sure to prewarn the patient that after cleaning the teeth may be more mobile. This is because the extra support from the bridge of calculus has been removed and the actual mobility of the teeth is revealed. In cases of moderate to severe mobility where function is uncomfortable you can prewarn the patient that you may wish to splint the teeth with resin post debridement. Consider taking intraoral photographs or xrays as medicolegal protection against the patient saying you made their teeth mobile with your clean. Many patients actually believe this. However informed consent as always is important.