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Overcoming Patient Objections

The Ask the Expert column features answers to your most pressing clinical questions.

QUESTION: Many of the patients I treat are sensitive to the high-pitched noise produced by the ultrasonic scaler. They ask me to use hand instrumentation only vs the blended approach. It is very frustrating because, in some cases, I cannot finish scaling without utilizing ultrasonic instrumentation. How can I get patients to overcome their dislike of this important modality?

ANSWER: First, I would explain the benefits of ultrasonic technology, as using it along with hand instrumentation constitutes a “best practices” approach.1–3 Reinforce the value of treatment, beginning with the periodontal-systemic health connection and the challenges inherent in eradicating every trace of pathogenic biofilm. Let the patient know it is our duty as licensed practitioners to provide evidence- based treatment protocols that ensure he or she is receiving the maximum benefit provided by professional debridement.

There are significant advantages to incorporating power scaling in your therapeutic approach, just as there is equal benefit to including hand instrumentation in nonsurgical periodontal therapy. The benefit of implementing a blended approach in periodontal instrumentation is well established in the literature.4–7Given the challenges of root morphology, the likelihood of achieving comprehensive coverage is greater when both power scaling and hand scaling are used together.8

After data collection and review of the findings, your treatment presentation may include the reasoning behind your debridement plans. Patients who understand the rationale supporting your treatment approach are more likely to accept it without complaint. If they voice objection, listen with empathy and acknowledge that, while technology can bring less-than-desirable stimuli (sound, vibration, water), the beneficial effects of ultrasonic therapy on periodontal and overall health more than make up for the temporary inconvenience.

When you are ready to begin ultrasonic therapy (after administering a preprocedural antimicrobial mouthrinse), tuck a soft cotton towel around the patient’s cheeks and chin to protect the neck from condensing aerosol droplets. This simple step can go a long way in making the experience more palatable. A large surgical towel can be placed over the disposable bib, and 2×2 or 3×3 gauze can be unfolded and positioned over the opening to the nostrils. Providing patients with noisecancelling headphones featuring music of their choice or earplugs to reduce the sound of power scaling may help patients feel more comfortable during nonsurgical periodontal therapy.

I hope these suggestions provide the solution you’re looking for, and I commend you on your dedication to clinical practice!


  1. Graetz C, Plaumann A, Wittich R, et al. Removal of simulated biofilm: an evaluation of the effect on root surfaces roughness after scaling. Clin Oral Investig. May 27, 2016. Epub ahead of print.
  2. Apatzidou DA. Modern approaches to non-surgical biofilm management. Front Oral Biol.2012;15:99116.
  3. Voller RJ. Ultrasonic scalers: clinical use and benefits. Dent Today. 2006;25:82–84.
  4. Ioannou I, Dimitriadis N, Papadimitriou K, et al. Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: A randomized clinical and microbiological trial. J Clin Periodontol. 2009;36:132–141.
  5. Mann N. The blended approach to instrumentation. Dimensions of Dental Hygiene.2016;14(11):45–50.
  6. Shaklee R. A modern approach to periodontal debridement. Dimensions of Dental Hygiene. 2006;4(10):24–27.
  7. Shaklee R. A blended approach. Dimensions of Dental Hygiene. 2006;4(4):26–27.
  8. Gher ME, Vernino AR. Root morphology—clinical significance in pathogenesis and treatment of periodontal disease. J Am Dent Assoc. 1980;101:627–633.
The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, and Rachel Kearney, RDH, MS, on ethics and risk management; Durinda Mattana, RDH, MS, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpening; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Bryan J. Frantz, DMD, MS, and Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to to submit your question.

From Dimensions of Dental HygieneFebruary 2017;15(2):60. 

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