Very Dental: The 80/20 Rule of Dental Hygiene with Beth Parkes

[00:00:00] Did you know Net32 was actually started by a dentist? Someone who is just fed up with how broken and expensive the supply process had become. This isn't some generic medical site. It was built specifically for dental practices. Thousands of dentists use it every day to save time and money. You'll find all the big brands you already know and trust just at better prices. Instead of calling reps or chasing down quotes, you can compare products and pricing in seconds. It's completely transparent and you're in control of what you spend. Same products, same vendors, less hassle and lower prices.

[00:00:30] The next time you need supplies, check Net32. Built by a dentist for dentists like you. Check them out at Net32.com. This is a production of the The The Very Dental Podcast Network. This is the The Very Dental Podcast.

[00:00:56] Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians and your friends in the dental space. Now here's your host, Dr. Alan Mead. Very Dental people, welcome to another episode of the Very Dental Podcast. I'm your host, Dr. Alan Mead. Today, I have a new friend on the podcast. Her name is Beth Parkes. She's a hygienist and an educator. She's coming to me from Canada. This is kind of cool. Beth, welcome to the show.

[00:01:25] Thank you so much. It's such an honor to be here. So, Beth, you have a history in both clinical hygiene and education. Is that right? That's true. Yes. Clinical for about 20 years. Okay. And then I entered into the continuing education space about seven years ago.

[00:01:43] Okay. Okay. If I were to walk into one of your continuing education classes as you've been in it, what am I going to see? What do you talk about? And what are the hot topics that you're mostly talking to your students to?

[00:01:57] That's a great question. I try my best to stay on the pulse of what's kind of a trending topic, what's hot. But I think I always default back to what's genuine to me, which would be hand instrumentation and then the oral microbiome. Oh, interesting. Okay. There's lots to talk about there for sure. For sure, right?

[00:02:20] I think I want to start with the hand instrumentation because it is funny. I will say that even when I was in dental school, but even more so recently, I hear a lot of people doing hygiene, whether it's hygienists or even, you know, as around in the United States, there's more dentists doing hygiene probably now than ever before for a lot of reasons.

[00:02:41] But the reality is, particularly with the dentists, I'll hear about, oh yeah, I can, I can, you know, all I basically do is take an ultrasonic around and it really does the trick. And there, so there, so there's, I feel like it's gotten a little bit away from hand instrumentation because in a way when I hear it, I hate to say this, I'm not pointing fingers, but it's a little bit of laziness. Like, ah, you know, I'll just do the power washer and with the ultrasonic, it'll be all done.

[00:03:06] And clearly Beth is someone who talks, who might have some opinions on that. So let me have it. Let me hear it. Might have opinions. That's a, that's kind of a funny statement. I actually have probably too many opinions. However, I try to be polite in how I remember them.

[00:03:22] Yeah. So this is a great question. And so one of my really good friends is actually the ultrasonic queen and her and I will lecture together, which is always kind of funny because she's very much into that ultrasonics to completion. And I'm over here like, but what about the hand instrumentation? And so we can have these great conversations and it's never something that we have to fight over.

[00:03:49] I think when you're looking for efficiency, ultrasonics are, they're going to be faster. There's less hand fatigue involved. So I think for me, it's the marriage of the two that I have found to be the most effective. So 80% ultrasonics is kind of my, I guess that's my thought process. And then 20% is where I'm finishing with my hand instrumentation.

[00:04:15] But that doesn't mean 80% of the time I'm using ultrasonics and 20% of the time I'm using my hand instruments because that last 20% is intricate. It's into those deep concavities. It's time consuming. It's more time consuming probably. Exactly. Right. So it's, it's those fine details that I think can sometimes take a little bit more time, but I want optimal tactile feedback when I'm into that last little section.

[00:04:44] Mm-hmm. And I would say that, okay, so using the ultrasonics, the reality is, is what, if you, this is how I'm going to take this. Ultrasonics can get a lot of the, a lot of the heavy lifting done. And every patient's a little bit different. You know, if you've got a patient that has a lot of, a lot of harder deposits and stuff like that, yeah, it's pretty satisfying to, to let it fly with the ultrasonics. But the reality is, is that once you go back, even after the ultrasonics, there's always still, every patient's got those little intricacies where you got to kind of get in there.

[00:05:14] Is what I, what I'm assuming you're saying. Is that, is that where the hand instrumentation becomes a big deal? That's what I believe. Yeah. I mean, when I'm speaking to people who will say ultrasonics to completion too, like the following question is, okay, well, how many ultrasonic inserts are you using? And if the answer is, well, I love my green slimline or maybe it's one piezo tip. I don't think that's even the, even the instructors, the people who are very educated in this space.

[00:05:44] I don't think that's what they mean when they say ultrasonics to completion. They would be under the impression that you have this array of tips or inserts that you're using for those little intricacies. But how are you going to take a slimline and use that? It's, it's a relatively straight curve.

[00:06:03] How are you going to hug that around and get into the depression of the distal of your final molars or the mesial aspect of your first molars? Like those are detailed areas with intricate anatomy. I don't think that was ever the design, but if that's the assumption, I don't know. Well, and I mean, every patient probably has individual factors that make that interesting, but I get your point.

[00:06:31] And the other thing is, is like when you're talking ultrasonics, no one's thinking about, well, I'm going to use three or four different inserts. You know, that's like the reality is, is like ultrasonics are meant for efficiency and switching, switching to a bunch of different. And I mean, they do have inserts with, with really great, great contours and stuff to get into those places, but they're kind of specialized, sort of like a lot of the instrumentation. And, and my understanding is, is Beth has, is into kind of having a lean presentation of your kit and that sort of thing. I want to get to that.

[00:06:59] But so the reality is, is you, you feel like the best, the best way to approach this is, is a combination of both ultrasonic and hand instruments and using the right, right things in the right place. Is that what you're telling me? I think that's where I'm at right now. Um, and I, and I think that our education and the, the way we use ultrasonics is changing from always open to watching that evolve and changing with it.

[00:07:24] But I think where we're at right now, the way it's being utilized, the marriage is kind of what I stand for. Okay. Okay. And which is, which I feel like that's, that's a pretty good place to be. This is, this is not something I threw at you, but I'm, I'm curious what your thoughts are on, on like the, the guided biofilm and the kind of thing where you've got the airflow. Cause that's, that's a whole other instrumentation challenge or, or, you know, add on.

[00:07:50] And I'm wondering where, how you feel about that and where does that fall in with these, the combination of these two, two modalities? I love it. I'll say that first and foremost. I mean, I'm a system person. So the fact that you're starting with the disclosing solution, the level of education we get to with our patients when they can actually see that. I'm all for it. Yeah. And then again, starting with your ultrasonics, getting as much as you can off with that.

[00:08:20] I'm completely on board with that. I get a little offended when it's like hand instrumentation is not allowed in the conversation, but I think that when we bring hand instruments as the finishing tool, I think it's great. Yeah. This is, this is all good stuff. I mean, the reality is like the conversation we're having now. I mean, I graduated from dental school in 1997 and it's, it's a very different conversation now than it was.

[00:08:47] The, the, I think a lot of people like to think of hygiene as being sort of this monolithic. It doesn't change much. It's just, you know, just scrape the teeth and get them clean. And I'm like, nah, it's, there's a lot of stuff going on there. And there's a lot of, there's a lot of changes happening. Not the least of which is like you said, there's different ways of handling ultrasonics. The, the disclosing, which is so funny because disclosing is OG. I mean, I, I remember when I was a kid, my dad's hygienist always had us. We would chew in a little pink tablet and swishing it around and stuff like that. That was, that was typical.

[00:09:16] And then honestly, it, it kind of went away. I mean, maybe it didn't for some folks, but it was not what I thought of as the standard in hygiene. And now it's really become, it's come on strong. And I mean, like, is it, what do you, am I, am I, am I right about that? Is that, is that sort of a, have you noticed that as well? You are so right. In fact, I think that there's some speakers who are almost offended because they used to be preaching that message. Like just disclosing solutions. And we were all like, we don't have time for that. Yeah. Yeah. And then we marketed the right way.

[00:09:44] It was educated to us in the right way where we're like, okay, we see how that's actually something that could save us time in the long run. And now we got all on board. It's funny because the end points are in dentistry. Um, okay. So one of the reasons that a lot of dentists like me kind of love extractions, not, I mean, I don't love that people are losing their teeth, but extractions are awesome because we know when we're done, you know what I'm saying? Like we're, we know it's like, yep, all the two structures out of there. We've cleaned it up. We are done. And they're ready.

[00:10:10] And, and in some cases you're just like, ah, removing decay. It's you're like, well, am I there? Am I not? Or whatever. Well, like hygiene is a funny thing because when you disclose, you, you get a lot more information than when you don't like, like, and I feel like hygienists know what they're doing. They know what they're seeing, but this is, this is something that it's like using Carrie's, Carrie's staining dye. You think you got, you think, you know what you're seeing until you don't. And it's, so I, I feel, I feel strongly. It's a good, it's a good thing to be getting back into the habit.

[00:10:40] And I have to say that disclosing solutions are much better now than they were when I was a little kid. I'm pretty sure about that. They different, different types of things you're seeing. It's kind of interesting. You're, you're, so you're pro that, huh? Yes. And I love the parallel you just drew because I think the visual stimulation of removing the disclosing solution, it's almost like, there's not a lot for us. That's gratifying. Yeah. Yeah. Super gingival calculus. We're like, Oh, let's blast that. Oh yeah. The best, the best. Yeah. Right.

[00:11:06] But then when we're going subgingively, it can sometimes be a bit thankless because Brad was disclosing solution. You have it all purple and blue. And then at the end, the patients are like, Oh, look what you did. Yeah. And then we feel good. Yeah. Yeah. Yeah. I feel strongly that, that disclosing and taking a picture and letting the patient see it is that's, that's a, an educational moment that you don't get that often. I'll say if your patient is used to being disclosed like that and you show them the picture probably

[00:11:35] after the fifth time, like, yeah, okay, whatever, you know, but the reality is a lot of times, I think a lot of patients come in thinking they're doing a pretty good job and maybe, and maybe they are, but if they're not, this is a really good way to show them that they're, that they might need to be doing a little bit of different work or better work or more work or something like that. And so, yeah, I'm glad that, I'm glad that disclosing has kind of made it back. I'm kind of, kind of about that. Me too. I'll say that the visualization is really funny and I'm going to, I'm going to drag you right

[00:12:04] into this because I, there's a ton of dentists now that are using retractors, disposable retractors or different kinds of retractors. And, and I see that like a lot of people are thinking opt-in gate or that sort of thing. And I have to say, I like the opt-in gate. I, I oftentimes, I have a hard time placing the opt-in gate, like, and people like, well, you just got to do it more often. A lot of times I literally will get to a point where this is so funny. I will sometimes show the patient how the opt-in gate goes in on myself.

[00:12:32] I literally put one on myself and say this, and they're able to do it better than I am. And probably just cause I don't do it that often, but you, I have to say, I'm going to ask you about this. Because you, the other thing about the opt-in gate is disposable. It's expensive. It's disposable. And it's in, it's single use, which is great. But I literally, as I'm researching Beth, I see this thing that I've never seen before. That seems brilliant. It's called the vision butler. Tell me about the vision butler. I love that you did your homework. Yeah.

[00:12:59] Like, I mean, when I saw, well, not only homework, I'm like, okay, I want this. I like this, but, but just tell the, tell listeners what the heck of vision butler is in comparison to something like an opt-in gate or something like that. Okay. So I think the one pain point for me was the waist. So I really liked having some kind of, like, retraction, but also something that kind of had the patient, even if it wasn't open all the way, just had them comfortably resting open. Yes. Yes.

[00:13:29] But I would feel guilty about the cost involved because I would have to throw that out after every use. Mm-hmm. Also, the opt-in gate has a frame that has, on some patients, can be a little pokey. That's the story. And pulls on the freedom just a little bit. Yep. So this came across us. It's called the vision butler. Okay. Vision butler in Canada. Uh-huh. But it's called Spandex Advanced in the U.S. Is that right? Yeah. Okay. That's so funny. It kind of makes me laugh a little bit.

[00:14:00] But it's available. Okay. So in Canada, it's the Kirion that distributes that. And then in the U.S., it's Hager Worldwide. Hager. Okay. But I believe you can get that through your main distributors like Henry Schein, Patterson. So it's the same elements that it's giving you this retraction. Mm-hmm. But it's this medical-grade silicone that you can sterilize and keep reusing. Mm-hmm.

[00:14:25] The visualization aspect that we were talking about, you can get it in pink or you can get it in black. I actually really like the black. Yeah. Yeah, yeah. The photos. Yep. It's like a contractor. Yep. Oh, I just found it on the – I'm sorry. There it is right there. Spandex advanced lip and cheek retractor. They really do call it spandex. They really do. Which is hilarious because, I mean, okay, I'm a kid. I grew up in the 80s. I have a certain picture of spandex.

[00:14:52] And I would not have – I'm not sure I would have named it that for the U.S. market. But here we are. Here we are. Okay. So the Vision Butler in Canada, the spandex advanced in the United States, it is an Optragate-esque – it's similar to an Optragate or that sort of retractor. But it is medical-grade silicone and it's autoclavable. Exactly. But it's soft. It's soft and it does a lot. Like I would say – I'm looking there is pink and black.

[00:15:22] There's zero chance I'm going to get pink. Everything – every material made in pink in dentistry is made to frustrate. Honestly. Just it's like, why would you do that? We need – I mean, we need contrast. I don't want it to blend in. That's crazy. That's like – that's why Carrie's removal dye that's pink looks exactly like a blushing pulp. It's the worst – I can't – it doesn't make any sense at all. So this is very cool. Okay. So I'm super glad that you pointed me to this because I – I was convinced before I talked to you. I'm like, they only have this in Canada.

[00:15:51] Because I couldn't find it anywhere. So this is awesome. Okay, cool. So listeners, go check this thing out. It looks really good. I'm going to get one. So I'm sorry. I just interrupted you. No, it's good. I like this kind of train of thought. It's like we're talking systems efficiency and it kind of goes inside with what we're talking about. So this is something that you might be different from me. I think you might be. So as a hygienist, I'm working solo. I don't have an assistant.

[00:16:17] So when I'm talking or asking a question, it's on the patient to answer and my hands are in their mouth. On your side, you typically have an assistant. So it's a two-way conversation if the patient can't respond. Yeah. So sometimes I like that there's this subtle thing in their mouth that is letting them know, I know you can't necessarily talk back to me right now. Don't answer. Yeah. So I'm just going to talk or I'm not going to talk. Yeah. It's all good. And you have this little excuse now.

[00:16:46] That is real. That is what you just said might be one of the more valuable things. First off, okay, so just like the social contract is that when people talk that you're inviting them into a conversation. The reality is I don't really want you to talk if I'm working on you. I mean, I want you to tell me if what I'm doing is uncomfortable. But I don't – I mean, I'm happy to talk to you about your vacation before we get started.

[00:17:09] But the reality is the time to talk about it's not while I'm trying to instrument the distal of 14. It's like – or remove decay on it. So I will say that the rubber dam for dentists is glory. You can't talk with a rubber dam on it. I mean, there are people try, but you can't talk. So this is sort of something like that for hygiene where they can – okay, I'm just not going to try and talk because this is just too much. So I love that. That's really good. And any patients that might listen to this, don't take offense to this.

[00:17:38] It's a matter of – this is just like – it isn't that we don't want to talk to you. It's just like there are times. There are times, and that is not the time. So I love that. That's fantastic. Like it's a bit passive-aggressive now that I'm listening to what I'm saying. A little bit, yeah. I have those days. I mean, dentistry in general, it's like after – if I've worked three solid days and it's Thursday afternoon, passive-aggressive is – that's my love language at that point. I'm there. I'm totally there. It's a really like on profession, right? Yeah.

[00:18:05] Like you can't go and kind of have a moment behind your desk for the most part. There's a human being in front of you. And I just think any little thing like that that can help alleviate some of that stress, I'm on board. It's actually super brilliant. It's a good point. And I think a lot of times we don't take that point. Honestly, what I'm saying is even if you don't need the retraction, just do it. Just do it. I mean, it lets you get to work. I mean, I don't know.

[00:18:34] Maybe there's some people who really love the back and forth talking. But during clinical stuff, I have TVs in the operatories running and like we'll do commentary. We'll say this. I used to think that HGTV was maybe the best dental thing because you can dip in and out of your attention. You don't need to – I'm telling you. I've got a channel that plays in the afternoon reruns of The Love Boat. And that is my childhood. That is red hot dental content. It is so good because you don't have to be involved at all.

[00:19:04] And it's still – first off, I relive my childhood. I'm not watching it. I'm mostly listening to it. But it is – and if you have patients of a certain age, it is such a goodwill. I swear people love it. It's just the best thing ever. I forget the name of the channel, but it just basically runs – it's got Bonanza. It's got Perry Mason. And it's got The Love Boat. I'm like, I'm here for this. This is just a couple weeks that I've been doing this. For the longest time, it was, you know, the Food Network and HGTV.

[00:19:32] Crazy Dental already has some of the lowest prices on dental supplies anywhere. But you know what's even crazier? Free shipping. Head over to crazydentalprices.com, load up your cart, and use coupon code VERYSHIP. That's VERYSHIP for free shipping on every single order. Plus, every time you use that code, Crazy Dental kicks back support to the Very Dental podcast network. Save money, get free shipping, and support the show. Use code VERYSHIP today. Because it's not politics. You're not hearing people worry about, you know.

[00:19:59] But I'm telling you, The Love Boat is the – this is the new go-to. If I could just run reruns of The Love Boat at all times, I probably would do that. It's fantastic. Ah, little kids. You got bluey for the little kids. But what are you going to do? You know, so it's been kind of funny. And they're less likely to talk if they're kind of involved in the show or whatever. So I like that. That's true, too. But like you said, it's not. We don't want to talk. It's just it is very difficult to get everything you need done. And, you know, have those conversations. A hundred percent. A hundred percent.

[00:20:27] So I want to go back to hand instrumentation because this is one of the reasons that you and I are together. I want to know what your thoughts are on the sharpen-free kind of hand instruments. Now, in the story, my understanding is this is a – it's not that you just don't sharpen your instruments. These instruments are designed to not be sharpened. That's the – you know, like I'm like, hey, that's like in dental school. I never sharpened my instruments. And it's like, wow, that was an error at that point.

[00:20:56] I mean, so – but there are literally instruments designed to not be sharpened. And actually, the folks at Garrison have sent me over some of these. They also sent me some of the nonstick – well, there's the black – what? The hygiene instruments are black – no, sharp – I can't remember. One of them is black diamond. Black diamond is the restorative, I think. Sharp diamond. Yeah, and sharp diamond. Sharp diamond and black diamond. That's what it is.

[00:21:20] So the sharp diamond are the LM-branded instruments, and Garrison distributes them in the United States for hygiene. And then the black diamond are the restorative instruments. And I'm actually going to be talking to someone about those later, too, because Garrison sent me some of these to try, and I love all of them. But I'm just curious. Tell me about sharpened-free hygiene instruments, and is that a real thing or not? It is a real thing.

[00:21:44] And I'm really glad that we're talking about this, because it's the perfect opportunity to just talk about these instruments very candidly. So one of the things that I'm finding is there's some confusion around sharpen-free and sharpen-less. Interesting. Interesting. Different situations. Maybe let's start with sharpen-less. Yeah, yeah. So, I mean, I can talk about metallurgy for days.

[00:22:13] I understand I'm in my own club there. Yeah. So I won't go too deep. Okay. But essentially, there is a stainless steel that has now come to be that is a higher grain structure. It's a powder metal alloy. Compared to what we used to use, or used predominantly, which is called the 440A stainless steel. Okay. That stainless steel has been around for about a century.

[00:22:42] Great proven track record. It holds its edge relatively well. But then we received this powder metal alloy that there were two major companies, to my knowledge, that have ever sourced from this. And that would be the original, I don't know if I'm allowed to say name brands. Absolutely. Okay. The original Huefretti Everedge. Yep. And then the LM Duragrade Max stainless steel. Okay.

[00:23:09] So what that means is because it's a finer grain structure, you can get this edge that retains its edge longer. So you're going to sharpen them, but you're going to sharpen them less. Less often. Yeah. Right? Okay. So if you're looking for an instrument that's going to last a long time, that you sharpened, maybe sharpened less frequently, go for that type of metal. If that's the pain point.

[00:23:33] But if your pain point is you can't sharpen, you don't have time to sharpen, then there's this other metal, and it is sharpened free. You never sharpen them for the duration of that instrument's life. When they're done, they're done. And in fact, if you do sharpen them, you'll wreck them. That's what I understand. Exactly. So that's where I think some of this misconception comes from. If someone's heard sharpened less and they get a sharpened free in their hand, they're like, okay, I'll just use it until it's dull.

[00:24:03] And then I'm just going to take my stone and go to town. But it's not going to work. The coating on these sharpened less is the key. And so once you've worn through that coating, that's when you get rid of them and you get new ones. Because they aren't meant to be sharpened. Where the other ones are meant to just be sharpened but less often. Is that what I'm getting? Exactly.

[00:24:25] And if we were almost to draw the lifeline of these instruments, if you think about drawing the lifeline of stainless steel, you would use them and then they would be dull. And then we would try to sharpen them back as close to the factory edge as we can. And then dull again. Sharpen them. Dull. And that line gradually starts to decrease until, I don't know, they're like a whisper in the wind. Yeah, you're thinning them to the point where, yeah, you're not. Yeah, exactly. Right?

[00:24:51] But sharpened free, that lifeline is just a very, very slow progression until you reach the point where they're dull. And it falls off. Yeah. Yeah. Yeah. And that's, so in your experience, I mean, I've used them and they're pretty, they are impressively. What I like is the fact that they kind of hold the edge that they were created with for a really long time. I mean, I haven't used them all that long, so I haven't run into that.

[00:25:17] But I'm just like, for someone who's using on the regular, how long would you expect, how long is a typical lifespan of one of these things? It's such a good question. I think there's a little bit of subjectivity to the answer to that. For sure. So, manufacturer's standpoint, they're designed, I'll stick to what I know best, the LM is designed to last as long as a conventional stainless steel. Wow. Okay. Okay.

[00:25:45] Now, the trouble with that, so most manufacturers will say anything from six months to 18 months for a stainless steel instrument. That's a pretty wide, yeah, that's a pretty long. It's wide. Yeah. Right? But then there's also the point that stainless steel doesn't tell you, hey, I'm done, replace me. So, if we can pick up a stone and get a sharp cutting edge, we just keep using them. Yep. They may not be functionally safe anymore, but we keep using them. Yeah, exactly, yeah.

[00:26:13] So, if you're using them every day, I'll speak to my experience. Yeah, sure. So, in my experience, it was about nine months to a year. Mm-hmm. I've told you kind of the 80% ultrasonic, 20% hand scaling. Yep, yep. Or hand scaling. Yep. If you have a different ratio, your outcome's going to be different. Mm-hmm. If you're dealing with different calculus deposit than I was, it's going to be different. Mm-hmm. How you're scaling is different. Some will use a shaving technique.

[00:26:41] Some will get under the calculus and fracture it. That's going to affect it. Does that help answer that question, or is it still? It does. No, the story is, too, is I think that, okay, so when you're using something that you can sharpen, I think you're looking for effectiveness, and then, okay, I'll sharpen it. If you're seeing these sharpen-free ones, the effectiveness fall off, you're done with them. It's time for a new instrument. That's the difference.

[00:27:10] And it's the same signs you're looking for with stainless steel. Mm-hmm. Like, when you're using a stainless steel instrument, and you're thinking, okay, I still have some life in this, but I'm probably going to have to sharpen in the next couple of days. It's the same signs with sharpen-free, but those signs are going to come, like, far into the future, and then you start to know, okay, I'm getting towards the end of this lifespan. And then when you feel compelled to pick up your stone, you just, you can't. You replace them. Yep. Exactly. Exactly.

[00:27:38] So one other thing that I really want to get to, because this is something that I've struggled with over the years as a dentist, and I think, and as an employer of hygienists, too, there is a certain, oh, my kit, my regular trays seem to, over years, add instruments to them, and they get more complicated. And we, in a lot of cases, we're sterilizing instruments that aren't used in every appointment and stuff like that.

[00:28:07] It's getting, it gets a little bit dumb. I feel like your background is in kind of lean, you know, okay, I think your concept was called making every tray count. And it's making sure you have the right instruments when you need them, but also, you know, makes your sterilization process a little bit more efficient as well. I want you to dig into that for me. Sure. So one thing that I do is work with clinics, work with offices to create kits. Okay.

[00:28:35] The other thing that I'm doing, and this is where I would love to get your insight on this as a practice owner, is I'm helping to equip them with the conversation. Like, here's what you need, and here's how to ask for it in a way that respects the financial resources available and the practice owner, putting it in a way that kind of makes sense. So you let me know. No, I'm here. I'm here for it. This is a great conversation, actually. Okay.

[00:29:00] So my belief is if we can start with like a basic tray. So this tray is going to be relatively lean, but efficient. It's going to have your mirror, your probe and explorer in a couple of very carefully selected sickles and curettes. That's what you pull out every patient, every single person who's in your chair, you bring that out. Mm-hmm. Let's be honest. As the day progresses, we're going to have a perio patient.

[00:29:29] We're going to have a patient who has really thin, delicate tissue. We're going to have a patient who has this really tenacious calculus that, and maybe they refuse ultrasonics. Maybe there's somebody who has location involvement. But what I've just described doesn't describe everybody. Yeah, yeah, yeah. So we can't fit all of those things into that base tray. Mm-hmm. So I start with this base, and then gradually I help them build these accessory kits that they'll just pull in as they need them. Mm-hmm.

[00:30:00] Right? So if you have seven patients a day, just hypothetically, and you want to have one tray per patient, okay, those base trays, maybe you're getting seven of those. Mm-hmm. But maybe you're only getting three or four of these specific accessory kits. Mm-hmm. And your accessory kits aren't going to have a mirror probe explorer because that's already in the case. It's already there. Sure, sure, yeah. Right? So that's what I try to build. And then it's this plan. It's this system.

[00:30:25] So you're going and asking for what you need, and now you have this explanation and dialogue with the practice owner why you need them. Mm-hmm. What do you think about that? I'm here for that. I think that's great. And tell me this. The advantage of having – the advantage is you're sterilizing probably less instruments in general. Is that right? You're sterilizing less instruments. You're sterilizing the base kit regularly, but a lot of times these accessory kits are

[00:30:53] not running through sterilization as often. And frankly, if you can sterilize instruments less, it beats them up less, right? Like they – I mean, sterilization is really hard on instruments. So the reality is if you've got some instruments you're not using very often, why sterilize them all the time? Is that kind of the point of it? Yeah. I think it's kind of like twofold, right? It's the lack of – like why do we need to be reprocessing them? Yep. Now, I will say with the advancement of metallurgy, there's less – I mean, there's still some. There's always going to be a degree of that.

[00:31:23] But like back in the day, you would sharpen your instruments, put them through sterilization, and dull again. And they dull – exactly, yeah. It was so frustrating. Yeah, yeah. That has changed. Yeah. But even still, why do we need to have either massive sterilization bags or cassettes all the time if that's not necessarily needed? If you're – I will say this. As a hygienist, like you said, typically you're not working with an assistant.

[00:31:49] So you kind of need to know what kits you need if possible early on. And I guess it depends on where the kits are being stored as well. Like the story is like – the question I have is are you walking down the hall because you realize you've got a thin biotype patient and you need that accessory? Or is that something that you can grab pretty easily? I'm very curious about that from your end of things. And that's a great question too because every office is set up so differently. Yeah, exactly. It's exactly right. So I have to try to be so careful not to always just like speak from my own lens of what I've experienced. Yep.

[00:32:18] What I like to encourage if possible is that those accessory kits are in your cabinets. So maybe there's three hygienists. Maybe each one has a set of these accessory kits and there might need to be some sharing back and forth. But I would love to have that stocked in my cupboard behind me so that I assess my patient. So I see my patient. Hopefully my chart notes are really great. Yeah, yeah, yeah. So you'll know in advance. That's exactly right. Yeah. Failing that, ideally it's kind of in my cabinet where I can pull it out.

[00:32:47] I assess them first. Oh, I'm going to need some mini Gracies. I have them in my accessory kit. I love that. I love that. I will say this. I've been very lazy about keeping my kits lean. And I strongly believe it, but I'm kind of terrible about it. And it's one of those things where then when you sit down to do it, everyone's got to be on the same page. And then someone will say, yeah, but you always want this or whatever. It's more controversial than you would think.

[00:33:17] But probably I would say every listener needs to probably just make sure they're taking a look at their kits every once in a while to make sure they're not good. I got kits where I got three explorers, four explorers. I'm like, I don't really need three explorers. Somehow explorers got into this kit or, you know, like, I don't know. And it depends on this is where someone who's really gone through a process of thinking about this stuff for efficiency, it makes a big difference. And some offices like myself where I get a little lazy about that, I'll get some kits with a lot of instruments in them.

[00:33:47] And a lot of instruments that are getting processed a lot that I don't use very often, which is a little weird. But there's reasons not to do that. So it's reasons to look at this. It makes a lot of sense. I like the idea of lean. That's very good. And I should be honest. I love instruments. So I wouldn't have like 50 at a time if I could. You know, I just, I have to be able to be realistic about it. 100%.

[00:34:11] And I think now too, like as instruments become advanced, there's one instrument, for example, that is a combination. It's a dual gracie. So this one's cool. It's probably one of my favorites. It's the syntet. So it combines a set of gracies. And then to be honest with you, it even brings in the benefits of a universal. Okay. So in theory, you could be going from three instruments down to one. Yeah. Out sacrificing your efficiency. Yeah. That kind of stuff is cool to talk about. Yeah, it is.

[00:34:41] Right? What's your wish list? And then we kind of go from there. How do we streamline that? How do we kind of narrow it down to a few without making you feel like you're sacrificing? Yeah. That's like the, I'll be talking about the LM restorative instruments and the kit has a lot of instruments. And it's a cool little cassette. And I'm like, yeah, except there's some of these instruments I'm only going to use every once in a while. Like this is, you know, you really need a simple posterior kit versus a simple anterior kit versus a complex anterior kit.

[00:35:09] But there's like the reality is you don't, there's, I hate the idea of processing instruments that you're not using regularly. So the leaning, having the idea that you could take an instrument. And that's, that is something that I love the concept of and I'm not great at executing on is like, what instruments can I, are there instruments that I can use for, for things still efficiently and well where I don't have to, where I can take two instruments and just use one? And that's, that's a, that's a good question for not only for hygiene, but for restorative dentistry, particularly direct restorative dentistry.

[00:35:39] Cause it's like, man, there's a, there's a million composite instruments out there and I've tried all of them and I love, but I'm like, I don't really probably, I need to look a little harder at that to tell you the truth. You know, that's, that's, and that's something probably everyone, everyone can evaluate their kit on somewhat. Well, I'm excited for you to have someone on talking about those dark diamonds, like especially into the Arte instruments. Yeah. Cause I've just been sort of fly on the wall watching these restorative courses and just looking at the aesthetic dentistry.

[00:36:07] I would be with you. I would want all of them. Yeah. It's exactly right. First off, you know, and the other thing is, this is all social media stuff. So you're seeing these really wild, cool instruments. I've been, I remember back when they first came out, the, the, the LM Arte instruments and, and you couldn't get them anywhere in the United States. Like, like at some point, like Patterson and one other like place, like, and they can only get a few of them and stuff like that. It was wild. Like you really couldn't get them. And of course I really want them.

[00:36:36] And now when Garrison sort of taking all of a sudden you're like, okay, so I can access these from, from one place now. And they have a huge variety of them. So it's worth, it's worth looking at them there. They're in, in, it goes the same with the, with the, uh, the sharp and free instruments. They have a lot of them. Don't get all of them though. I mean, like the reality, it's great, but get the ones that, that work instead of, I don't know. And, and if you're an, your point's well taken that you love instruments and you'd love to have all of them. But the reality is we should find the ones that are working for us best.

[00:37:05] Probably, probably stay as lean as we can. I think that's the takeaway, right? I agree. I agree. And also try different things. So try it, try one in sharp and free, but then like try their DuraGRED Max steel. See which one you like better. Okay. And I'll have links to all this stuff in the show notes too. Cause they, their website actually is quite good about this stuff. The Garrison website kind of covers all of it and everything. And, and I will definitely find the spandex. That's a, I'll find this.

[00:37:33] I'll also put the Canadian link for, but, but the spandex I'm here for the spandex, the vision, vision, Butler in Canada spandex here. So we'll, I'll put all that stuff up there. Beth, I can't wait to try. This was really good. I have to say, you know, as the very dental podcast, I don't do a ton of hygiene pod. This was excellent though. I really, and I think that hygienists are maybe more likely to listen to podcasts now than dentists at this point. I really, I really kind of believe that. So I'm kind of glad to have, have you on. This was really good stuff.

[00:38:02] Oh, it was a big honor. Like one thing I've just loved the open candid conversations you have. So I normally I get quite nervous about anything speaking. Right. But I think just being a listener of your podcast, I just thought, Oh, you know what? It's really open and candid. So I'm not saying I'm going to get everything perfectly, but I just love that. It's like, we can just talk about these things together and learn from each other. And you've really created something pretty cool here. That's what, that's what it should be.

[00:38:28] And when we started doing it, I mean, I was just crazy back in 2014, 12 years ago, that was the goal. The goal was to emulate the kind of conversations you have at lunch or after or dinner after a continuing education thing, sitting around talking with other dentists, you know, or that was the concept because you didn't, that was what I wanted to listen to. I was a podcast listener. I wanted to listen to it. I'm like, there isn't really that out there. So that's kind of what, what I was trying to create. And I think, I think we've done okay with it. There's moments, but, and the other thing is, yes, Garrison, Garrison put us together.

[00:38:57] But this isn't a Garrison ad. This is, this is, I love their products. I use their products like crazy and I love to talk about them, but you're the one who, you know, you really are the, are the pro. And I think conceptually, this is all good stuff. So I don't, this isn't a Garrison ad. This is the Garrison's products featured on a podcast. And I think it makes a big difference than a lot of podcasts out there are selling a specific product. And I'm not, although I could get into selling spandex just for the name, to be honest. I might, I might be okay with that.

[00:39:24] I might, I might be having a big spandex sponsorship push just for the name. I'm not mad at the name. Yeah, no, I'm not at all. I feel like, I feel like, I mean, Vision Butler is great, but spandex, you guys are missing out up in Canada. This is, this is good stuff. Oh, I'll convey the message. Very good. You know, see what I can do. Beth, thank you so much for being on. This was fantastic. And if you guys have questions or comments, I will make sure that all of her links and social media and all that stuff so you can get in touch with her.

[00:39:52] Or I'll just get, or I'll just ask her the question myself and bring it into the Very Dental Facebook group. So thanks very much, Beth. Thank you so much. This is honestly true honor. I was so happy to be here. Thank you so much. Thanks.