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Dental elevators: One size does not fit all

The equipment and instrumentation available to veterinarians has evolved and progressed

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The better suited your shoes are to the task at hand, the more likely you can achieve your greatest potential in your chosen activity. Obviously, there’s a reason why basketball players don’t wear flip flops on the court. This is simple common sense. Similarly, choosing an appropriate dental instrument for the task at hand can have a significant impact on the success and efficiency of the procedure you’re performing.

When it comes to elevators and luxating-type elevators, the size and fit of the handles and shanks of the instruments matter. If you’re using an elevator that is meant for someone with a size “8” surgical glove, and you wear a size “6,” you probably won’t like dental extractions very much. What’s more, there’s a greater chance you will injure yourself and/or cause harm to your patient. Unfortunately, many veterinary professionals are unaware they have options when it comes to the handles and shanks of their elevators and are using instruments that don’t fit them properly. The following factors should be taken into consideration when using or purchasing dental instruments.

Yes, size matters

On the left is an elevator that is held correctly, fits the user’s hand properly, and allows them the most comfort and control.  If an elevator is too big, it can’t be held properly (as shown in the photos in the middle and the right) and can result in harm to the user and/or patient.
On the left is an elevator that is held correctly, fits the user’s hand properly, and allows them the most comfort and control. If an elevator is too big, it can’t be held properly (as shown in the photos in the middle and the right) and can result in harm to the user and/or patient.

Historically, elevators and luxating-type elevators used in veterinary dentistry were made for the use of dentists working on human patients. The techniques used to extract teeth in human patients are somewhat different from those used in veterinary dentistry, and dentists generally favor longer instruments for leverage. The handles and shanks of these “standard” size instruments are therefore long. In more recent times, manufacturers supplying instruments to the veterinary community began paying attention to requests to make smaller instruments that fit veterinarians’ hands properly and were also better suited to veterinary extraction techniques. As a result, there is a greater variety of handle and shank options on the market.

Elevators and luxating-type elevators are available in a variety of sizes, and finding the right one can make a noticeable difference in your comfort, the efficiency of your procedures, and ultimately, your health. Properly fitted instruments also increase your patients’ safety during dental extractions. If your current dental elevators are too big or you find you need a second set and you don’t have the budget to replace them all at once, don’t let that deter you. Start by identifying the instruments you use most often and commit to replacing even one or two a month.

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It’s all in the fit

Elevator handles are available in a variety of sizes, shapes, and weights. The second and fifth handles from the left are the most popular and are often referred to as “stubby” handles.
Elevator handles are available in a variety of sizes, shapes, and weights. The second and fifth handles from the left are the most popular and are often referred to as “stubby” handles.

When fitted properly, an elevator’s heel should be seated in the mid to lower-mid portion of the palm, while the instrument tip should be at or close to the end of the index finger. Ideally, you shouldn’t have to strain to extend your index finger to reach the tip of the instrument. When the instrument is correctly positioned, your index finger is perfectly placed to prevent the tip from slipping during use and causing harm to the patient. Being held in this position also ensures the instrument is in straight alignment with your arm, allowing it to be used as effectively and ergonomically as possible.

Comfort is key

In addition to ensuring the overall elevator length is a good fit, the shape and circumference of the handle also affects the comfort of the instrument and should be a consideration. Different manufacturers make a variety of handle shapes. Which one you choose is largely a personal preference. If your palm is narrow, an instrument with a less bulbous handle is often more comfortable. Some examples of the variety of handles able via various manufacturers are pictured below.

The importance of ergonomics

This luxating-type elevator features a “standard” handle and shank. With an overall length of approximately 6 in., this handle and shank length combination is too large to properly fit the hands of most veterinarians.
This luxating-type elevator features a “standard” handle and shank. With an overall length of approximately 6 in., this handle and shank length combination is too large to properly fit the hands of most veterinarians.

Utilizing ill-fitting instruments leaves the user with two choices, both of which have consequences. One is to hold the instrument with the index finger near the tip to protect the patient during use. In this instance, the instrument is usually held offset to the side, and/or the user needs to bend their wrist to prevent the instrument from slipping out of their hand during use. Alternatively, the user can hold the instrument in proper straight alignment with their arm, with the heel of the handle seated in their palm. The drawback, however, is the tip extends well past the index finger. This can obviously result in serious injury to the patient and is usually the least popular choice.

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Both scenarios are far from ideal and result in the user being unable to properly control the instrument. Further, he or she will likely cause strain to their hand, wrist, arm, neck, and/or shoulder. The chance of developing carpal tunnel syndrome, cervical radicular pain, thoracic outlet syndrome, or another musculoskeletal disorder is greatly increased with repetitive, sustained grips and prolonged awkward positioning. Utilizing instruments that fit correctly not only increases comfort during dental extractions, it significantly reduces the chances of users developing these types of injuries. You may even find you like doing dental extractions!

Single-doctor versus multi-doctor practice

As the sole veterinarian in your practice, you are generally able to pick the instruments that offer the best fit and comfort for you. Multi-doctor practices, however, may require more than one set due to varying hand sizes. In this author’s experience, the most common surgical glove size range in the veterinary industry is “7” to “7.5.” If multi-doctor practices have veterinarians with hands in this size range, they are usually able to share elevators. If, however, the practice has one doctor with size “6” hands and another with size “8,” for example, different sets of elevators are needed. If you require some guidance on how to pick the correct size, look for sizing guides for handle and shank options on the websites of dental equipment vendors.

Moving forward

The field of veterinary dentistry has evolved and progressed, and so has the equipment and instrumentation available to veterinarians. Increased attention to the importance of ergonomics in veterinary dentistry, long-recognized amongst dentists, has had a significant impact on the development and availability of instruments that are better suited for veterinary use. Being aware of the options now available, and subsequently selecting and utilizing instruments that fit appropriately, will not only help the user to improve their efficiency, but will do so while reducing potential harm to both the user and the patient. Veterinary dentistry can be challenging enough as it is, why make it harder? In other words, stop wearing flip flops on the basketball court and set yourself up for success instead!

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Tara Evans has worked in numerous capacities in the veterinary industry over the past 30 years, focusing almost exclusively on dentistry for the last 14. Presently, she works as the product and continuing education manager at Serona Animal Health, a veterinary distribution company, where she is responsible for organizing seminars and teaching various aspects of dentistry to veterinary professionals. Evans can be contacted at info@serona.vet.

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