Positioning And Basic Instrumentation Flashcards
What are some other advantages of correct positioning?
Reduces muscle strain and fatigue for the dental team and patient, basic manipulation of instrument is much easier
What are the advantages to using correct positioning?
Most efficient and comfortable to 1) see work area (good vision) 2) maintain finger rest (fulcrum placement), 3) adapt the instrument (access)
Where should the patients mouth be?
At elbows, heart level
What is the patient position for maxillary instrumentation?
Supine position, back of chair parallel to the floor, feet at same height as the head (nose)
Patient position for the mandibular instrumentation?
Raise back of dental chair 20 degrees
What is carpal tunnel syndrome?
Compression of the median nerve and the carpel tunnel of the wrist. Affects thumb, index and middle fingers
What is ulnar nerve entrapment
Compression of the ulnar as it passes through the wrist, affects lower arm and wrist
What is pronator syndrome?
Compression of the median between the two heads of the pronator teres muscle, affects thumb, index and middle fingers
What is tendinitis?
Inflammation of the tendons of the wrist, affects outer edges of the hand
What is tenosynovitis?
Inflammation of the tendons on side of wrist and base of thumb
What is extensor wad strain?
Injury of the extensor muscle of the thumb and fingers
What is thoracic outlet syndrome?
Compression of the brachial nerve plexus and vessels between neck and shoulder, affects fingers hand and wrist
What is rotator cuff tendinitis?
Inflammation of the tendons in the shoulder region, affects shoulder joint
What do you use to maximize visibility?
Dental light, mouth mirror, and the triplex syringe and magnification
How is the dental light positioned when viewing the mandible?
Nearly perpendicular to the floor, directly above mouth
How is the dental light positioned to view the maxila?
Nearly parallel to the floor (above patients lab)
How far should the light be from the patients mouth?
Three feet
What is the dental mirror used for?
1) retraction
2) direct vision
3) indirect vision
4) illumination
5) transillumination (reflects light through tooth to view caries, sub gingival calculus, supra gingival calculus and stain)
Diameter of mirror surfaces
5/8”, 1 1/2”, 1 1/4” and 2”
Types of mirror surfaces
Plane surface, concave surface, front surface, two sided
What is a plane mirror surface?
Flat- doubled image
What is a concave mirror image?
Magnifying
What is a front surface mirror?
Normal reflecting surface
What is a two sided mirror surface?
Double mirror
How do you retract the cheek?
Pull cheek directly out, not out and back at commissure. Have patient close slightly (relaxes muscles) gives greater latitude when retracting
What is the purpose of the air syringe?
Deflects free gingival margin, detect sub gingival calculus, clear salvia from work area
What grasp do you use with the air water syringe?
Palm grasp
How do you prevent patient discomfort with the air water syringe?
Do not bump teeth, use short bursts of air, if sensitive to air use gauze to dry with saliva ejector in place
What is the water used for in the air water syringe?
Flush loose calculus, bacterial plaque, food debris, blood, suppurations and polishing agents
How is eye loupes used
Magnification through the lens, flip up magnification only, or loupes with head light
What is the goal of dental hygiene instrumentation?
The complete removal of hard and soft deposits from teeth with no damage to the hard or soft tissues
What is the oral prophylaxis?
A preventive periodontal treatment whose first objective is to create an environment in which the tissues can return to health.
How does the tissues return to good health?
Removing the calculus and smoothing the rough bed cementum helps the tooth surface resist the formation of dental deposits. Additionally the removal of endotoxins may occur
Identify dental hygiene instruments by there uses
1) examination 2) gross debridement 3) root planing, gingival curettage, 4) polishing
Types of scaling instruments
Curets (supra gingival, sub gingival)
Scalers (supra gingival- sickle, hoes, chisel)
What are the three parts of the dental instruments?
Handle, working(terminal) end, shank
The handle is…
Part grasped by the operator. Wide or medium- more comfort less fatigue and cramping.
Hollow- conducts vibrations, lighter, better than solid.
Textured- smooth, ribbed, easier to grasp, good control
Hexagonal/octagonal- smallest diameter
The working end…
Determines purpose of instrument
Head of mouth mirror, tip of explorer, blade of curet, design of working end determines class, type, use. Double or single end
Advantages of a double ended instrument
Decrease number of instruments, less motion needed, decrease cost, ergonomic- less injury and faster work
Shank…
Connects working end and handle.
Made with varying thickness and rigidity, this relates to specific uses. Thinner than the handle, length varies to accommodate crown lengths, pocket depths, area of the mouth.
Variety of shank designs
Anterior teeth: fewer angles, often short and straight
Posterior teeth: longer and angles on one or more plane, particularly for interproximal surfaces
Varying weights for shanks…
Rigidity for heavy deposits, springiness for light deposits and root planning
Graceys “after fives” have…
Thin long shanks
Terminal shank…
Part the shank nearest to the working end (blade)
Instrument grasp and fulcrum…
Enables stability and control, essential for effective and safe instrumentation
Appropriate grasp of the instrument …
Increase tactile sensitivity, positive control with balance and flexibility motion, decreases tissue trauma which means decreased post op discomfort, prevents fatigue to fingers, hand, arm
Modified pen grasp…
Is sensitive, stable and strong.
Place middle finger on the instrument where the shank and handle meet, bend the index finger at the second joint and position it well above the middle finger on the same side of handle, place the thumb midway between the middle and index fingers on opposite sides of handles… Rest upper 1/3 of instrument just above the upper index finger joint
Advantages of the modified pen grasp
Control
Prevention of finger fatigue
Increases facile sensitivity
Define the palm grasp
Instrument held in the palm and fingers are wrapped around the handle
The own grasp is used for…
Air/water syringe
Rubber dam clamp holders
Porte polisher
Hand piece for instrument sharpening (whittler)
When performing palm grasp and modified pen grasp…
Keep elbows at your side not in the air, shoulders relaxed
Fulcrum
Support or point of rest on which a lever turns in moving a body
Finger rest
Support or point of finger rest on the tooth surface on which the hand turns in moving an instrument
Intraoral fulcrum is used for…
Stability, unit control, prevention of injury, comfort for the patient, control the length of stroke
Intractable finger rest for the maxillary arch
Palm up … Expect with right buccal and left palatal
Extra oral fulcrum only-
Only maxillary arch, facial of near side and palate of far side
Alternate fulcrums
Extra oral, cross arch, opposite arch, finger on finger, reinforced
Disadvantages to alternative fulcrums
Decreased stability and control. Increase operator and patient injury
Adaptation
Is the relationship between the instrument and surface of the tooth or soft tissues
Insertion
Placing an assessment or treatment instrument into the sub gingival area
Stroke
Employed to activate the working end of the instrument
Activation
Enables instrumentation
A stroke is…
Short, controlled desire and concise to protect tissues from trauma
Vertical storke
Move parallel to the long axis of the tooth
Imaginable oblique stroke
Move diagonally to the long axis of the tooth
Exploring stroke
Feel tooth anatomy and find calculus
Probing or walking stroke
Measuring the depth of a sulcus or pocket
Scaling stroke
Calculus removal ( supra gingival and sub gingival)
Root planning stroke
Light callus removal from and smoothing root surfaces
