Instruments for periodontal treatment

Question 1

what are the parts of a handheld periodontal instrument?

4

Answer 1

• handle
• shank
• lower shank
• blade

Question 2

how should you hold instruments?

Answer 2

modified pen grasp
* instrument held between thumb and index finger
* middle finger held further up the shank for stability and strength
* middle finger can be used as a finger rest

Question 3

what should the ideal finger rest be?

Answer 3

• as close as possible to the tooth being treated
• on a stable tooth rather than soft tissues
• may need to use a finger rest further away in difficult to access areas

Question 4

how should the wrist be positioned when using periodontal instruments?

Answer 4

neutral wrist
* wrist should be straight
* hand and forearm should be in same horizontal plane

Question 5

how should you use the instruments when carrying out PMPR?

Answer 5

• ensure the final third of the blade is always closely adapted to the tooth structure
• use lateral upward strokes from base of pocket
• rotate the instrument as you work around the tooth
• lower shank should be parallel to the long axis of tooth
• use overlapping multidirectional strokes upwards from the base of pocket

Question 6

what position would left and right handed operators sit when working on the labial and lingual surface of 43-33?

Answer 6

• right: 7 o’clock
• left: 5 o’clock

Question 7

what position would left and right handed operators sit when working on the buccal surface of 44-48?

Answer 7

• right: 9 o’clock
• left: 3 o’clock

Question 8

what position would left and right handed operators sit when working on the lingual surface of 34-38?

Answer 8

• right: 9 o’clock
• left: 3 o’clock

Question 9

what position would left and right handed operators sit when working on the buccal surface of 14-18?

Answer 9

• right: 9 o’clock
• left: 3 o’clock

Question 10

what position would left and right handed operators sit when working on the lingual surface of 44-48?

Answer 10

• right: 11 o’clock
• left: 1 o’clock

Question 11

what position would left and right handed operators sit when working on the buccal surface of 34-38?

Answer 11

• right: 11 o’clock
• left: 1 o’clock

Question 12

what position would left and right handed operators sit when working on the labial and palatal surface of 13-23?

Answer 12

• right: 11 o’clock
• left: 1 o’clock

Question 13

what position would left and right handed operators sit when working on the palatal surface of 14-18?

Answer 13

• right: 11 o’clock
• left: 1 o’clock

Question 14

what position would left and right handed operators sit when working on the buccal and palatal surface of 24-28?

Answer 14

• right: 11 o’clock
• left: 1 o’clock

Question 15

what surfaces of which teeth should the operator be scaling at 7 o’clock/5 o’clock?

Answer 15

43-33 lingual and labial

Question 16

what surfaces of which teeth should the operator be scaling at 9 o’clock/3 o’clock?

Answer 16

• 34-38 lingual
• 44-48 buccal
• 14-18 buccal

Question 17

what surfaces of which teeth should the operator be scalling at 11 o’clock/1 o’clock?

Answer 17

• 44-48 lingual
• 34-38 buccal
• 13-23 labial and palatal
• 14-18 palatal
• 24-28 buccal and palatal

Question 18

what are the systemic health condition indications for hand instrumentation?

4

Answer 18

• communicable diseases where aerosols may increase risk of infection e.g. TB or COVID
• difficulty swallowing lots of water e.g. parkinsons, MS, severe gag reflex
• cardiac pacemaker (check make and model)
• access to certain areas of the mouth may be difficult with ultrasonic

Question 19

what are the oral condition indicators for hand instruments?

5

Answer 19

• demineralised areas can be removed with ultrasonic
• sensitivity e.g. exposed tubules, recession
• children may be less tolerable to ultrasonic scalers due to anxiety
• porcelain or composite restorations can be marked by ultrasonic scalers
• titanium implants need a rubber tip that may not be available

Question 20

what are the 8 hand instruments used for PMPR?

Answer 20

• mini sickle / point scaler
• universal columbia curette
• hoe scaler red 156-157
• hoe scaler yellow 134-135
• gracey curette grey 1-2
• gracey curette green 7-8
• gracey curette orange 11-12
• gracey curette blue 13-14

Question 21

describe the mini sickle / point scaler

Answer 21

• double ended with two cutting edges