Preventive Procedures - Outcome 8

Question 1

Parts of a Periodontal Instrument

Answer 1

1. Working End - refers to the part used to carry out the purpose and function of the instrument.
2. Shank - connects the working end with the handle.
3. Handle - is the part of the instrument that is grasped (held).

Question 2

Modified Pen Grasp

Answer 2

The modified pen grasp is utilized when performing coronal polishing with the slow speed handpiece and prophylaxis angle, when exploring and when dental probing. This grasp allows for the precise control of the working end of an instrument, allows the clinician to make a wide range of movements, and it facilitates good tactile conduction

The modified pen grasp is a three-finger grasp with specific target points for the thumb, index finger, and middle (second finger), which all contact the instrument.

Question 3

Fingers functions/placement in Modified Pen Grasp

Answer 3

index finger and thumb: placement - hold the instrument handle | function - hold the instrument

middle finger: placement - rests lightly on the shank | functions - helps guide the working end

ring finger: placement - on an oral structure, usually a tooth | function - used to stabilize the hand for control an strength

little finger: placement - held in a relaxed neutral fashion, near the ring finger | function - no function

Question 4

Palm Grasp

Answer 4

It is another grasp that is used when providing preventive procedures. The palm grasp is used to hold:

1. The air/water syringe
2. The rubber dam clamp holder

The handle of the instrument is held in the palm, cupped by the index, middle, ring, and little fingers.

Question 5

The Fulcrum (Finger Rest)

Answer 5

A fulcrum (or finger rest) is a stabilizing point for your hand while you are working in the mouth. A stabilizing point outside the patient’s mouth (for example, on the patient’s chin or cheek) is termed an extra-oral fulcrum. A stabilizing point inside the patient’s mouth on a tooth surface is termed an intra-oral fulcrum.

A fulcrum (or finger rest) serves the following functions:
-It stabilizes the hand.
-It supports the weight of the hand in the mouth.
-It enables the hand and instrument to move as a unit.

With the pad of the ring finger resting on (a) the occlusal or incisal surface, (b) the occluso-facial line angle, or (c) the occluso-lingual line angle of the tooth. It is not acceptable to rest entirely on a facial or lingual surface since in this position your finger would tend to slip on a saliva-covered tooth.

An extra-oral fulcrum is adequate for use with your mirror hand. The patient’s chin and cheek are mobile; therefore, an extra-oral fulcrum is less secure than an intraoral finger rest. Because the mouth mirror is not sharp, however, an extra-oral fulcrum provides sufficient stability. It is also perfectly acceptable to use an intra-oral fulcrum with your mirror hand.

Question 6

The Importance of an Occlusal Fulcrum

Answer 6

The pressure imposed on the occlusal surfaces/incisal edges during chewing is interpreted as a tension (pull tension). This pulling or tension causes the periodontal ligament (PDL) fibers to straighten and hold the tooth suspended in the socket. This prevents the apex of the root from jamming into the surrounding bone. When performing intraoral procedures, we fulcrum on an occlusal surface for two reasons:

To protect the fibers of the PDL because an occlusal fulcrum exerts pressure on the tooth the way in which it is used to receiving pressure, so it will not cause discomfort to the patient.

To maintain a sense of stability when exploring or performing a working action or stroke as in rubber cup polishing

Question 7

Fulcrum Rules

Answer 7

-Intraoral
-Same arch or
-Same quadrant or as close as possible to the working area
-Stable tooth (non mobile)
-Occlusal surface or incisal edge

Question 8

The Dental Mirror

Answer 8

The dental mirror is one of the most common instruments used in preventive procedures. The mouth mirror has 2 parts: the handle and head.

Question 9

Types of Mirror Surfaces

Answer 9

Plane (flat)
* The reflecting surface is on the back of the mirror lens.
* The mirror may produce a double (“ghost”) image.

Concave
* The reflecting surface is on the front surface of the mirror lens
* The mirror produces a magnified image.
* It may distort the image.

Front Surface
* The reflecting surface is on the front of the lens.
* It eliminates double images and provides a clearer image.
* Most common type used
* The mirror is easily scratched.

Question 10

Uses of the Dental Mirror

Answer 10

1. Indirect Illumination
   
   • the reflecting surface of the mirror is used to direct light onto the tooth surface for increased illumination of dark areas
2. Retraction
   
   • maintains a clear operating field by keeping the tongue or cheek out of the way during a procedure
3. Indirect Vision
   
   • is the use of the mouth mirror to view a tooth surface or intra-oral structure that cannot be viewed directly
4. Transillumination
   
   • is the technique of directing light of the mirror surface through the anterior teeth

Question 11

Hints to Maximize Patient Comfort (when using mirror)

Answer 11

Avoid making contact with tooth surfaces when inserting or removing the mirror from the mouth.

Avoid putting pressure on the angle of the lips when using the mirror for retraction. (retract lip with fingers in anterior sextants)

Avoid resting the mirror rim on the gingiva.

Avoid retracting using fingers in posterior areas.

Question 12

How to Prevent Mirror Head from Fogging

Answer 12

Prevent fogging of the mirror by performing one of the following procedures:

Warm the mirror by rubbing it across the patient’s buccal mucosa.

Request that the patient breathes through the nose rather than through the mouth.

Use special defogging solutions that are commercially available.

Question 13

Head Position (when using mirror)

Answer 13

The patient’s head position is very important and determines how well you can access and see into the patient’s mouth. The patient should be asked to adjust his or her head position so that you have the best access:

Headrest: The top of the patient’s head should be even with the end of the headrest

Mandibular Arch: Ask the patient to tilt their head downward

Maxillary Arch: Ask the patient to tilt their head up

Question 14

Operator Positioning while performing intra oral skills

Answer 14

Neutral Position is the ideal positioning of the body while performing intra oral skills. To establish ideal position following criteria should be met

Weight evenly balanced

Legs separated with your feet flat on the floor

Seat as far back as possible (backrest of the chair should support lower back)

Thighs parallel to the floor, or knees slightly lower than hips

Forearms parallel to the floor when bent at the elbow

Do not reach, lean, or bend for better access

Question 15

Operator Clock Positions

Answer 15

Right-handed operators = 8 o’clock to 12 o’clock

Left-handed operators = 12 o’clock to 4 o’clock

Question 16

Hints to Maximize Patient Comfort (for intra oral)

Answer 16

Always position the instrument or handpiece parallel to the long axis of the tooth

Don’t “cuddle” the patient. There is a tendency to move in very close to the patient, especially when positioned behind him or her

Have patient tilt head to the left and right to gain access to proximal tooth surfaces

Do not place the mirror head too near the maxillary anterior or you will find yourself leaning over to look in the mirror. Instead, position the mirror head near the incisal edge of the mandibular cuspid. Now, you should be able to see in the mirror easily.

The mirror will be angled differently to view the gingival third area versus the incisal third area. This is due to the presence of the cingulum on teeth 1.2, 1.1, 2.1, and 2.2. You may need to adapt the bottom third of the prophy cup to the tooth surface. This can be accomplished by rotating your working hand in the open position.

Do not retract patient lips with the mirror in the facial of sextant 2 and 5 as this will cause discomfort to the patient gingiva. Finger retraction is preferred in this situation

Question 17

Sextant 1- Buccal Aspect (1.8 – 1.4) Maxillary Right Posterior

Answer 17

Fulcrum the working hand on a maxillary occlusal/buccal surface, follow fulcrum rules
Position patient’s head slightly away from the operator
Sit at the 8-9 o’clock position
Intra oral mirror uses:
Establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
retract patient’s cheek
indirect vision of distal proximal surfaces
establish a fulcrum on the patient’s right cheek
TIP:

Ask your patient to close his or her mouth slightly after you have the mirror in place; this allows you to retract the cheek more fully.
Ask patient to shift mandibular arch toward you to increase access.

Question 18

Sextant 1- Lingual Aspect (1.8 – 1.4)

Answer 18

Sextant 1- Lingual Aspect (1.8 – 1.4) Maxillary Right Posterior
Fulcrum the working hand on an occlusal surface, follow fulcrum rules
Position patient’s head straight
Sit at 11-12 o’clock
Intra oral mirror uses:
indirect vision of all surfaces
illumination
establish a fulcrum on the patient’s left cheek and extend the mirror head across the right side of the mouth

Question 19

Sextant 2 -Facial /Labial Aspect (1.3 – 2.3) Maxillary Anterior

Answer 19

Fulcrum the working hand on an incisal edge, follow fulcrum rules
Position patient’s head straight, have patient tilt head to the left and right to gain access to proximal tooth surfaces
Sit at 11-12 o’clock position for surfaces towards and away
Intra oral mirror uses:
mirror is not used; direct vision is applied
keep the mirror cupped in your hand for quick access when you move to the next polishing area
retract patient lip with the index finger of your left hand

Question 20

Sextant 2 -Lingual Aspect- (1.3 – 2.3) Maxillary Anterior

Answer 20

Fulcrum the working hand on the incisal edge, follow fulcrum rules
Position patient’s head straight and have patient tilt head to the left and right to gain access to proximal tooth surfaces
Sit at 11-12 o’clock position for surfaces towards and away
Intra oral mirror uses:
establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
indirect vision of all surfaces
illumination
establish a fulcrum on the patient’s left cheek
retraction of patient lip with the index finger is not required

Question 21

Sextant 3- Buccal Aspect- (2.4– 2.8) Maxillary Left Posterior

Answer 21

Fulcrum the working hand on the incisal edge, follow fulcrum rules
Position patient’s head towards you
Sit at the 11-12 o’clock position
Intra oral mirror uses:
establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
cheek retraction
indirect vision of distal proximal surfaces
fulcrum on the patient’s left cheek
bring your arm over the patient’s head so that your line of vision is not blocked.
place the mirror head across from the second molar, and pull the cheek out and away from the teeth.
ask the patient to close his or her mouth slightly and retract the cheek more fully

Question 22

Sextant 3- Lingual Aspect- (2.4– 2.8) Maxillary Left Posterior

Answer 22

Fulcrum the working hand on an occlusal surface, follow fulcrum rules
Position patient’s head up and tilt away from you to increase direct vision
Sit at 8-9 o’clock
Intra oral mirror uses:
indirect vision of distal proximal surfaces
illumination
establish a fulcrum on the patient’s right cheek and extend the mirror head across the hard palate, over to the left side of the mouth

Question 23

Sextant 4- Buccal Aspect- (3.8 - 3.4) Mandibular Left Posterior

Answer 23

Fulcrum the working hand on an occlusal surface, follow fulcrum rules
Position patient’s head slightly towards you.
Sit at 11-12 o’clock
Intra oral mirror uses:
establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
retraction of the cheek or buccal mucosa
indirect vision of distal proximal surfaces
illumination
bring your arm over the patient’s head so that you do not block your view of the treatment area. Insert the mirror and slide it along the cheek until it is across from the posterior teeth
retract the cheek out and away from the teeth

Question 24

Sextant 4- Lingual Aspect- (3.8– 3.4) Mandibular Left Posterior

Answer 24

Fulcrum the working hand on an occlusal surface, follow fulcrum rules
Position patient’s head slightly away from you
Sit at 8-9 o’clock
Intra oral mirror uses:
establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
retraction of the tongue, (use back of the mirror to gently push away the tongue toward the midline of the mouth)
indirect vision of distal proximal surfaces
illumination

Question 25

Sextant 5- Facial Aspect- (3.3– 4.3) Mandibular Anterior

Answer 25

Fulcrum the working hand on an incisal edge, follow fulcrum rules
Position patient’s head slightly away and towards to view proximal line angles
Sit at 8-9 or 11-12 o’clock for position for surfaces towards and away
Intra oral mirror uses:
direct vision applied

Question 26

Sextant 5- Lingual Aspect- (3.3– 4.3) Mandibular Anterior

Answer 26

Fulcrum the working hand on an incisal edge, follow fulcrum rules
Position patient’s head slightly away and towards to view proximal line angles
Sit at 8-9 or 11-12 o’clock for position for surfaces towards and away
Intra oral mirror uses:
establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
provide indirect vision of all surfaces, including proximal line angles
gentle retraction of the tongue so that lingual surfaces can be viewed
illumination

Question 27

Sextant 6- Buccal Aspect- (4.3– 4.8) Mandibular Right Posterior

Answer 27

Fulcrum the working hand on an occlusal surface, follow fulcrum rules
Position patient’s head slightly away from you
Sit at 8-9 o’clock
Intra oral mirror uses:
establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
retraction of the buccal mucosa
the indirect vision of distal proximal surfaces
illumination

Question 28

Sextant 6- Lingual Aspect- (4.3– 4.8) Mandibular Right Posterior

Answer 28

Fulcrum the working hand on an occlusal surface, follow fulcrum rules
Position patient’s head to their right to increase the field of vision
Sit at 11 -12 o’clock
Intra oral mirror uses:
establish an extra-oral mirror fulcrum on the outside of the patient’s cheek in the vicinity of the cheekbone
retraction of the tongue
indirect vision of distal and mesial proximal surfaces
illumination

Question 29

SUMMARY OF POSITIONS FOR THE RIGHT HANDED OPERATOR

Answer 29

Sextant 1- Buccal Aspect (1.8 – 1.4) Maxillary Right Posterior - 8-9 o’clock - head slightly away

Sextant 1- Lingual Aspect (1.8 – 1.4) Maxillary Right Posterior - 11-12 o’clock - head straight

Sextant 2 -Facial /Lingual Aspect (1.3 – 2.3) Surfaces towards and away Maxillary Anterior - 11-12 o’clock - head slightly away and towards to view proximal line angles

Sextant 3- Buccal Aspect (2.4– 2.8) Maxillary Left Posterior - 11-12 o’clock - head slightly towards

Sextant 3- Lingual Aspect (2.4– 2.8) Maxillary Left Posterior - 8-9 o’clock - head up and tilt away

Sextant 4- Buccal Aspect (3.8 - 3.4) Mandibular Left Posterior - 11-12 o’clock - head slightly towards

Sextant 4- Lingual Aspect (3.8– 3.4) Mandibular Left Posterior - 8-9 o’clock - head slightly away

Sextant 5- Facial Aspect (3.3– 4.3) Surfaces towards and away Mandibular Anterior - 8-9 or 11-12 o’clock - head slightly away and towards to view proximal line angles

Sextant 6- Buccal Aspect (4.3– 4.8) Mandibular Right Posterior - 8-9 o’clock - head slightly away

Sextant 6- Lingual Aspect (4.3– 4.8) Mandibular Right Posterior - 11-12 o’clock - head towards

Question 30

Parts of an instrument

Answer 30

Working End - This is the active part of the instrument designed to perform the specific task it was created for. Whether it’s scaling, probing, or any other dental procedure, the working end is the part that makes direct contact with the teeth or gums to achieve the instrument’s intended function

Shank - the shank serves as the connector between the working end and the handle of the instrument. It provides the necessary angle and flexibility, allowing the clinician to maneuver the working end effectively within the oral cavity, ensuring precision and control during use.

Handle - The handle is the part of the instrument that is held by the clinician. It is ergonomically designed to provide a comfortable and secure grip, allowing the clinician to maintain steady control over the
instrument throughout the procedure

Question 31

Role of each finger in fulcrum

Answer 31

Little finger - The handle is the part of the instrument that is held by the clinician. It is ergonomically designed to provide a comfortable and secure grip, allowing the clinician to maintain steady control over the
instrument throughout the procedure

ring finger - Ring Finger:
Position your ring finger on a stable surface inside the patient’s mouth, such as a tooth or the gum line. This serves as a fulcrum or support to stabilize your hand and provide control over the instrument’s movement.

Middle finger - Rest the side of your middle finger lightly against the shank of the instrument. This finger helps to guide and control the working end of the instrument during movements.