Instrumentation Skills Flashcards
Carpel Tunnel aetiology
- Common stress injury occurring in the hand and upper arm.
- Repeated flexion and extension of the wrist.
- Simultaneous forceful finger pressure over a long period of time.
- Irritation of the flexor tendons.
- Results in mechanical injury to the median nerve.
Carpel Tunnel symptoms
- Tingling.
- Burning pain.
- Numbness in fingers.
- Weakened hand grip.
- Palm skin becomes dry and translucent.
- Radiates to forearm, elbow, upper arm, shoulder, neck, in later stages.
Carpel Tunnel risk factors
- Un-ergonomic instruments.
- Tight gloves.
- Cold vibration.
- Poor organisation of work.
- Inappropriate working conditions.
Carpel Tunnel prevention
- Use ergonomic instruments with large diameter.
- Slip free elastic handles.
- Light grip.
- Minimise extreme movements.
- Perform strengthening exercises.
- Rests.
- Appointment spacing.
Carpel Tunnel treatment
- Rest.
- Immobilisation of the wrist.
- Hydrocortisone injections.
- Low salt diet.
- Vitamin B.
- Surgery.
Ideal seating position
- Feet flat on floor.
- Thighs parallel to floor.
- Straight back.
- Head erect.
- Arms at waist level.
- Body weight evenly distributed.
Operator-Unit-Patient positioning
- Light at arms length but not near head of operator or patient.
- Too close gets in the way and generates heat.
- Low bracket table for visibility, and away from patient.
- Patients mouth level with operators waist.
Some sextants have 1 possible seating position. Some have 2. What are the reasons to learn both possible positions for some sextants?
- Surgery design may not allow for certain positioning.
- Patients arches and teeth vary in size and alignment.
- Some tooth surfaces difficult to reach from favourite position if they are rotated.
Seating positions
- Upright - Conversation and OHI.
- Semi upright - Medically compromised patients - Breathing difficulties, third trimester pregnancy, spinal or cardiovascual complaints.
- Supine - Scaling, RSD, treatment.
- Trendelenburg - First aid purposes.
Instrument grasps:
- Modified pen grasp.
- Palm grasp.
Instrument grasps provide…
- Maximum control of the instrument.
- Prevention of finger fatigue.
- Increase in tactile sensitivity.
Modified pen grasp used for
- Exploring.
- Probing.
- Scaling.
- Root planing.
- Holding the mirror.
Advantages of modified pen grasp
- Allows precise control of the instrument.
- Allows wide range of movement.
- Good tactile conduction.
No disadvantages.
Palm grasp used for
- Holding rubber dam forceps.
- Holding the triple syringe.
- Using the porte polisher.
Advantages of palm grasp
- Increases strength of grasp.
- Increases control of heavier instruments.
Disadvantages of palm grasp
- Limited range of movement.
- Limited tactile conduction.
Modified pen grasp finger placement
- Thumb and index finger hold the handle in a curved shape with light grip for easier rotation.
- Middle finger rests lightly on shank for tactile sensation and to guide the instrument. The side of the finger does not touch the shank.
- The ring finger is the fulcrum. It stabalises the hand. Keep straight in a locked position.
- Little finger serves no function or offers some support. Hold is a comfortable and relaxed manner.
Palm grasp finger placement
- All fingers hold the instrument.
- Thumb stabalises the hand in the patients mouth.
What is a fulcrum?
- The support or point of rest on which a lever turns in a moving body.
- The fulcrum is the tooth.
- The lever is the finger.
- The moving body is the instrument.
Indirect illumination
Using the mirror to illuminate an area.
Transillumination
- Reflection of light through teeth.
- Can reflect light from the overhead light through lower anterior teeth to see the translucency of enamel.
- Dental caries and calculus deposits appear opaque.
Instrument shank should be parallel to…
The long axis of the tooth.
Sickle scalers
- Sickle scaler H6/H7 - Supragingival calculus from interproximal surfaces 3-3.
- Posterior mini sickle S204 - posterior upper and lower teeth 4-8.
Chisel/push scaler
Supragingival calculus from interproximal surfaces of anterior teeth (mainly lower) 3-3.
Universal curette 13/14 (Coloumbia)
Removal of fine subgingival deposits from all surfaces.
Technique for scaling
- Adaptation.
- Angulation.
- Stabalisation.
- Stroke activation.
- Reposition.
Adaptation definition
The manner in which an instrument is brought into contact with a tooth surface and maintained during instrumentation.
Adaptation
- Cutting edge adapted to tooth for effective removal.
- Working end is rolled around the tooth to adapt to different areas.
Angulation definition
The angle formed when the working end of the instrument comes in contact with the tooth surface.
Angulation
- Rake angle - Scaling more efficient if the tip leans back from the direction of movement.
- Rake angle is positive if the instrument tip leans back.
- Rake angle is negative if the instrument tip leans forward.
- Clearance angle - The angle between the non-working lateral surface of the scaler and the tooth.
- Handles should be parallel to teeth.
Stabalisation
Fulcrum
Activation definition
Motion activation refers to the manner in which you move the instrument and your hand during instrumentation.
Activation
- Digital motion - Flexing fingers. Quickly fatigues fingers.
- Wrist rock.
- Rotating motion.
- Vertical.
- Oblique.
- Horizonal.
Reposition
Move to new area and repeat process.
