To assess the Knowledge about the principles in using the Ultrasonic Scalers among the Undergraduates: A Questionnaire Study.


Dr Kirtana Gopalasamy*, Dr G. Kaarthikeyan

Department of Periodontics, Saveetha Dental College, Saveetha University, Chennai ,India

*Corresponding Author E-mail:



To assess the Knowledge about the principles in using the ultrasonic scalers among the undergraduates: A questionnaire study.

Aim-The aim of the study is to assess the knowledge among various undergraduate students in assessing the usage of ultrasonic scalers during scaling.

Background-Ultrasonic scalers are being used widely now days for scaling. The correct usage of the ultra sonic scaler tip determines the efficient removal of plaque and calculus that is adherent to the tooth surface. An inefficient usage of the tip decreases the effectiveness of calculus removal; wear the teeth surface and the tip as well.

Material And Methods-A total of 100 undergraduate students are included in the study. They are divided into 30 students in each group named as third year, final year and the interns. A questionnaire containing 15 questions that assess the knowledge of using ultrasonic scalers is given to each student and the statistics were calculated.

Reason-The correct usage of ultrasonic scalers plays a pivotal role in removing the plaque and calculus but most of the undergraduate students are using the wrong side of the tip in removing it. This wrong way of learning enabling them to follow it in the practice and may cause destruction to the tooth and gums.


KEYWORDS: ultrasonic scalers, efficient use, knowledge, undergraduates, scaling.




Excipients A myriad of new products have been introduced that have revolutionised periodontal therapy in the past several years. Common in today’s hygiene and periodontal armamentarium is the sonic or ultrasonic hand piece. Whether used only occasionally or on a routine basis, most dental professionals are familiar with sonic or ultrasonic technology in some capacity. The use of ultrasonic devices has dramatically improved the practice of supra gingival scaling and periodontal debridement.[1]


The sonic scaler operates at a low frequency of about 3,000 to 8,000 cycles/second (which is how many times the tip comes in contact with the tooth). The sonic scaler is air-driven, and the tip moves in an elliptical motion.


The ultrasonic hand piece utilises either magnetostrictive or piezo-electric technology [7] Ultrasonic technology in general, whether magnetostrictive (long inserts with metal rods that flex) or piezo-electric (small tips that screw onto the hand piece), and sonic scalars to a lesser degree, offer several advantages over hand scaling.[6]


Ultrasonic instrument can remove calculus much faster and easier than the hand instruments also ultrasonic instruments may be better because they have a steady flow of water that comes out of them and that can help to dislodge tartar that may have accumulated below the gum line.

The sonic scaler operates at a low frequency of about 6000 to 8000 cycles per second. These scalers are air driven, in which the tip of the scaler moves in an orbital motion. But they are extremely noisy during use and low range of vibration hardly ever leading to cavitations.[5]


Ultrasonic scaling is a highly specialised power driven technique to remove calculus and plaque from the tooth surface [8] . Since this technique is highly specialised its efficient usage is needed for the proper removal of dirt from the tooth. Magnetostrictive scalers use linear or elliptical. Movement. And the lateral as well as the back surface of the scaler is best for the proper scaling .while in piezoelectric scalers. The insert/tip movement is linear and the lateral surface is the most efficient surface for removal of calculus so that must be used for scaling.[3]


Improper use of ultrasonic scalers may produce thermal damage to tissues (pulp and dentin) .Ultrasonic scaler is applied lightly to the tooth surface to remove plaque and calculus which may alter the topography of tooth surface.

It may roughen the surface of the tooth and may also lead to scraping of the enamel due to its improper usage .further leading to more deposition of debris causing the formation of calculus and plaque.[5]


Hence this questionnaire based study was done to assess the knowledge of mechanical principle of ultrasonic scaling among undergraduates and their efficient use. 



A  cross  sectional  questionnaire  survey was  carried  out to  assess  the knowledge  and  efficient use of ultrasonic scaling among the undergraduates..  Convenient  sample  size  of 100  dental students  was  decided  and  data was collected  by  questionnaire  . From them about 24 Third years, 30 Fourth years and 57 Interns filled the questionnaire. From them there were about 50 female students and 50 male students. This questionnaire was approved by the scientific research board of SAVEETHA dental college. A specially designed questionnaire  consisting  of 15 close  ended  questions was said to  assess  the  knowledge  and  efficient use of ultrasonic scalers among the under graduates .this questionnaire was distributed to the undergraduate dental students in Chennai . The name and Identity of the students was maintained anonymous. All the students were given a half an hour to one hour time to complete the questionnaire .the  completed  questionnaires  were  immediately  collected  and were  analysed.


Data Analysis:

The data entry was done by Microsoft Excel. The collected data was analysed using descriptive analysis.


FIGURE 1 – Graphical representation of the year of study of the students who answered the questionnaire


FIGURE 2- Graphical Representaion of the students gender.



What are the different types of ultrasonic sonic instruments available?

-Magnetostrictive, Piezoelectric Scalers


All the students who took part in the survey and those who answered the questionnaire have answered the question correctly. All the 100 students answered it correctly.


The following figures show us the graphical analysis of the students answer to the questionnaire.



FIGURE 3- QUESTION 2-  What is the mechanical principle behind the piezoelectric scaler?


FIGURE 4 - QUESTION 3- In which direction does the piezoelectric scaler work?



FIGURE 5 - QUESTION 4-What is the position of the scaler tip while scaling?



FIGURE 6 - QUESTION 5 – Which surface of the scaler tip is used for removing the plaque and calaculus?



FIGURE 7 - QUESTION 6- What surface is used to remove the stains for the teeth?



FIGURE 8- QUESTION 7- In what motion do you use the scaler tip?



FIGURE 9- QUESTION 8- Do you change the scaler tip according to the region being used?



FIGURE 10 - QUESTION 9- Which speed of the scaler is effective in removing the calculus?



FIGURE 11- QUESTION 10- In which regions do you use place the scaler tip during ultrasonic scaling?



The extent to which the proper knowledge on ultrasonic scalers and their efficient use on the patients  progressively increases from 4th year students towards interns then when compared to the third years This can be attributed to increased experience and attainment of knowledge about ultrasonic scaling and their efficient use on the patients over the years .



This cross sectional study was conducted to assess the knowledge about efficient use of ultrasonic scalers among undergraduate dental students, 100 dental students were interviewed with a structured questionnaire .This study discusses mainly about how efficiently ultrasonic scalers must be used by the dental students in order to give out the complete efficiency to the scaling done without causing any harm to the surrounding structure of tooth or the surface of the tooth itself .Among the study it has been found out that about the most basic of ultrasonic scaling that is two different types of ultrasonic scaling instruments available, were answered correctly by all the students who took part in this survey.

About 40% answered correctly that dimensional changes in crystal was the main mechanical principle behind piezoelectric scalers. About 70% answered correctly that the direction in which the piezoelectric scaler works is linear. About 33% answered correctly that position of scaler tip while scaling is up and down. About 76% answered correctly that the surface of scaler tip used to remove plaque and calculus was the lateral surface and also about 61% answered correctly that the surface used to remove stains on the tooth is the lateral surface of the scaler tip. About 30% answered correctly the motion of the scaler tip is up and down. About 70% answered correctly that yes, the tip of the scaler must be changed based on the region being used. About 50% answered correctly that the speed of the scaler must be medium while removing the calculus and about 91% answered correctly that the regions in which the scaler tip is placed during ultrasonic scaling is always apical to the deposit.


An analysis of the literature on the aggressiveness of magnetostrictive and piezoelectric ultrasonic scaling devices on tooth substances showed varying results. Flemmig et al. [3] suggested that a magnetostrictive unit was more aggressive than a piezoelectric device for root substance removal. On the other hand, Busslinger et al. [4] reported that a piezoelectric device left a rougher surface than a magnetostrictive device after instrumentation.[5]


From the result which  was obtained in evaluating the data we are also able to see that from practice over the years the inters are able to carry out better scaling due to their knowledge on the aspects and of ultrasonic scaling . We also see that since the 3rd years and the 4th years are apparently new to the technique of ultrasonic scaling they are not yet thorough with the knowledge required for the proper and efficient use of ultrasonic scalers for the patients. Hence due to this ultimately when used on the patients the quality of treatment is low. The correct usage of ultrasonic scalers plays a pivotal role in removing the plaque and calculus but most of the undergraduate students are using the wrong side of the tip in removing it. This wrong way of learning enabling them to follow it in the practice and may cause destruction to the tooth and gums.

Hence we see that how important and necessary the learning and knowledge on ultrasonic scalers is needed for its proper use on the patients.



From the present study we can conclude that dental students play an important role in the oral health of the patient and that the undergraduate dental student must have the knowledge and must know the basic principles behind ultrasonic scaling and this knowledge reflects on how efficiently the undergraduate is able to carry out a scaling. From this we also see the various side effects or harm any improper scaling can cause to the tooth surface and its surrounding structures. So from this we are able to conclude that proper knowledge level is required among the undergraduate dental students in order to perform a proper scaling.



1.     Arthur Gross,* Mary J. Devine and Duane E. Cutright

2.     Microbial Contamination of Dental Units and Ultrasonic Scalers

3.     Jotikasthira NE, Lie T, Leknes KN. Comparative in vitro studies of sonic, ultrasonic and reciprocating scaling instruments. J Clin Periodontol. 1992; 19:560–569. [PubMed]

4.     Flemmig TF, Petersilka GJ, Mehl A, Hickel R, Klaiber B. Working parameters of a magnetostrictive ultrasonic scaler influencing root substance removal in vitro. J Periodontol. 1998; 69:547–553. [PubMed]

5.     Busslinger A, Lampe K, Beuchat M, Lehmann B. A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument. J ClinPeriodontol. 2001; 28:642–649. [PubMed]

6.     Yousefimanesh H, Robati M, Kadkhodazadeh M, Molla R. A comparison of magnetostrictive and piezoelectric ultrasonic scaling devices: an in vitro study. Journal of Periodontal & Implant Science. 2012; 42 (6): 243-247. doi:10.5051/jpis.2012.42.6.243.

7.     Anirban Chatterjee, Baiju C. S,Somik Bose, Sonia .S .Shetty Hand vs Ultrasonic instrumentation :A review

8.     Drisko CL, Cochran DL, Blieden T, Bouwsma OJ, Cohen RE, Damoulis P, et al. Position paper: Sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology. J Periodontol. 2000; 71:1792–801. [PubMed]

9.     Nield-Gehrig JG. 4th ed. Baltimore: Lippincott Williams and Wilkins; 2009. Basic concepts of ultrasonic instrumentation. Fundamentals of Periodontal Instrumentation.







Received on 15.03.2016          Modified on 04.04.2016

Accepted on 04.06.2016        © RJPT All right reserved

Research J. Pharm. and Tech 2016; 9(9):1344-1348.

DOI: 10.5958/0974-360X.2016.00257.2