Patients are scared of the handpiece by and large. That’s just the way it is whether they admit it or not. In an effort to put their minds at ease I try to explain exactly what I’m doing at the debond appointment. I also proceed in a very specific order that I’ve found to make the process easier for patients. My hope is that this or some variation of this will be useful to you and your patients by improving patient comfort and your speed.
After the brackets are off I explain that I’m going to use the handpiece to remove the glue (I am the only person who runs a handpiece in my office and it will always be that way but that’s another discussion).
“So I’m going to use this thing (I show them the handpiece) to get the rough glue off of your teeth and make them smooth and shiny. It will be a little cold and smell like fireworks but it won’t hurt and it only takes a couple minutes. It’s important that you don’t move. If you’re uncomfortable raise your hand or make a noise but don’t move!” I always begin.
As I start removing glue, they almost always move their tongue towards the bur and so I tell them, “Keep your tongue back. Don’t touch the bur because it will hurt! I would rather you take my word for it than find out the hard way.” I used to try to tell them beforehand about their tongue but found it more effective to do it after we start glue removal. If a patient is particularly nervous or fidgety then I’ll touch the first tooth just a little with the bur (handpiece running) and then stop and ask them if it’s ok and if they smelled the fireworks. This allows them to be in control and almost always makes them settle down.
Usually patients are most sensitive on their lower incisors. Especially adults. For this reason I always start on the lower right canine and work across to the lower left canine. The bur is at its sharpest and I want to finish the lower incisors as quickly as possible. Next I go to the upper right canine and work across to the upper left 3. I do this because these are the social 6, the teeth everyone looks at, and they are flat with relatively huge surface area so I want the bur to be very sharp when I remove glue from them. After removing glue on the max anterior, I continue around from the upper left 4-7. Then I move to the lower left 7-4 and then on to the lower right 4-7 then I finish with the upper right 7-4. The posteriors are round and the action of the bur tends to fracture the adhesive and knock it off quickly so that only minimal polishing is needed.
It takes me about 3 minutes and one bur to remove glue at debond. I haven’t always been able to do that but with lots of practice and the intention to improve I’ve gotten better and faster. My patients sure appreciate the speed – patient comfort is always paramount!
As an aside and a nod to orthodontic culture I feel I should mention: I know many of you will balk at one bur and 3 minutes and will believe that it’s not possible to do that and get a good result (because you cannot do it, yet). If you need to see to believe then check out the video I posted on the Ortho101 Facebook page. It’s not fancy but you can see how it works.