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

Instrument Grasps:

Answer 2

Stability is essential for effective, controlled action of an instrument. This depends on maintaining control of the instrument through the use of an effective grasp and the establishment and maintenance of an appropriate and firm fulcrum finger rest.

Question 3

Modified Pen Grasp:

Answer 3

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 4

Modified Pen Grasp - Finger Functions

Answer 4

Index Finger & Thumb - hold the instrument

Middle finger - rest lightly on the shank, helps guide the working end

Ring finger - on an oral structure, usually a tooth - used to stabilize the hand for control and strength

Little figer - held in a relaxed neutral fashion, near the ring finger - no fuction

Question 5

Palm Grasp

Answer 5

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

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

Question 6

The Fulcrum (Finger Rest)

Answer 6

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.

Question 7

A fulcrum (or finger rest) serves the following functions:

Answer 7

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.

Question 8

Where to rest the ring finger for fulcrum?

Answer 8

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.

Question 9

Fulcruming with the Mirror

Answer 9

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 10

The Importance of an Occlusal Fulcrum

Answer 10

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.

Question 11

When performing intraoral procedures, we fulcrum on an occlusal surface for two reasons:

Answer 11

1. 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.
2. To maintain a sense of stability when exploring or performing a working action or stroke as in rubber cup polishing.

Question 12

Fulcrum Rules

Answer 12

1. Intraoral
2. Same arch or
3. Same quadrant or as close as possible to the working area
4. Stable tooth (non mobile)
5. Occlusal surface or incisal edge

Question 13

The Dental Mirror

Answer 13

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 14

Types of Mirror Surfaces

Answer 14

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, the most common type used, the mirror is easily scratched

Question 15

Uses of the Dental Mirror

Answer 15

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 16

Hints to Maximize Patient Comfort

Answer 16

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 17

How to Prevent Mirror Head from Fogging

Answer 17

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

-warm the mirror by rubbing it accros 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 18

Patient Positioning

Answer 18

The patient lying in supine position on his or her back in a horizontal position and the chair back parallel to the floor (the chair back may be raised slightly for mandibular treatment)

Question 19

Patient Head Position

Answer 19

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 20

Equipment Position - Dental Light

Answer 20

• to view the mandibular teeth, position light directly above the patient’s head
• to view maxillary teeth, position light above the patient’s chest, tilt the light so the beam shines in the patient’s mouth

Question 21

Equipment Position - Bracket Table

Answer 21

-instruments should be within easy reach

Question 22

Equipment Position - Patient Chair

Answer 22

Lower the chair so that your forearms are parallel to the floor when your fingers rest on the maxillary teeth

Question 23

Operator Positioning - Neutral Positioning

Answer 23

Neutral Position is the ideal positioning of the body while performing intra oral skills. To establish ideal position following critera 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 slighty lower than hips
-Forearms parallel to the floor when bent at the elbow
-Do not reach, lean, or bend for better access

Question 24

What is exploring?

Answer 24

Exploring is the process of looking closely at examining or investigating. This is exactly the purpose of a dental explorer. It is an instrument you can use to investigate, examine or explore portions of the oral cavity through the sense of touch.

Question 25

Use of explorers:

Answer 25

1. for tactile examination of teeth and other surfaces
2. to remove soft material from teeth or other surfaces

Question 26

There are three dental procedures that routinely use explorers for tactile examination:

Answer 26

• detection of rough tooth surfaces and calculus
• examination of dental restoration
• detection of dental decay/caries

Question 27

Shepherd’s Hook Explorer Use

Answer 27

Supragingival examination for dental caries and irregular margins of dental restorations
NOT recommended for subgingival use as the point could damage the tissue

Question 28

Straight Explorer Use

Answer 28

Supragingival examination for dental caries and irregular margins of dental restorations
NOT recommended for subgingival use as the point could damage the tissue

Question 29

Curved Explorer Use

Answer 29

Calculus detection supragingivally (can also be used in shallow sulci)

Question 30

Pigtail and Cowhorn Explorer Use

Answer 30

Resmble a pig’s tail or cowhorn

Calculus detection supragingivally (can also be used in shallow sulci

Question 31

Orban Explorer Use

Answer 31

The tip is bent at 90 degrees

Calculus detection supragingivally on anterior teeth all surfaces and posterior teeth facial and lingual aspects only

Question 32

Plaque Control Record

Answer 32

A plaque control record provides a method of recording the plaque biofilm on the mesial, distal, facial and lingual tooth surfaces along the gingival margin.

Question 33

Indications for Plaque Control Record

Answer 33

• to evaluate for the presence of plaque biofilm
• to calculate a Plaque Control Record (O’Leary Plaque Index), or
• to determine the location of deposits before and after rubber cup polishing
• patient oral hygiene education

Question 34

Coronal Polishing Proximal Surfaces

Answer 34

Use dental floss, dental tape, and finishing strips to polish the interproximal tooth surface, and to remove any abrasive agent or debris that may lodge into the contact area.

Question 35

The Bristle Brush: When and How To Use It

Answer 35

The bristle brush is not advocated for routine use. In view of the spatter that is created, it contributes to the contamination of other surfaces. Additionally, aerosols are specially created with the use of the bristle brush, the polishing paste, and the spinning prophylaxis handpiece.

Sometimes the occlusal surfaces are more effectively and efficiently cleaned with a soft bristle brush rather than with a prophy cup

The bristle brush should be soft and flexible. To prepare for use, soften the bristles by soaking them in warm water.

The brush bristles should NEVER come in contact with the soft tissue since they could severely abrade or lacerate it. For this reason, the brush is never used on the gingival third of any tooth surface. It may be used on orthodontic appliances away from soft tissues.

The tips of the bristles are placed on the occlusal surface, and enough pressure is applied to “splay” (flex and spread) the bristles over the surface.

The stroke is started in the central fossa. The tips of the bristles are then worked along the grooves and up and over the ridges. Light, intermittent, overlapping strokes are used.

Question 36

Polishing Sequence

Answer 36

A systematic sequence of polishing each tooth surface assures that all areas will be covered.

A vertical stroke toward the occlusal surface is used, especially on buccal and lingual surfaces. The edge of the cup is positioned in a more horizontal stroke when polishing interproximally to adapt around the line-angles.

It is also important to develop a specific sequence for polishing the entire dentition. You may want to devise your own routine or sequence, or you may adopt the sequence that has been presented below:

1. Buccal of mandibular right quadrant; lingual of mandibular right quadrant; buccal of mandibular left quadrant; lingual of mandibular right quadrant; lingual and labial surfaces of mandibular anterior.
2. Repeat in the maxillary arch.

Question 37

A systematic procedure ensures..

Answer 37

1. ensures thoroughness in the removal of deposits and stains
2. increases efficiency and decreases operating time
3. increases patient comfort
4. demonstrates the ease and smoothness of operation
5. increases the patient’s confidence in the operator

Question 38

Coronal Polish Tips - To minimize loss of tooth structure:

Answer 38

1. Use the least abrasive prophylaxis paste (smallest particle size or grit)
2. The rubber cup should be applied with just enough pressure to make the cup flare slightly
3. The rubber cup should rotate at the slowest speed possible to remove the stain
4. The rubber cup, according to your MDA, should be applied to the tooth for only 3-5 seconds before moving to another area of the tooth or mouth

Question 39

Before polishing

Answer 39

-Explain the procedure and the rationale for selective polish
-Review the medical history - check for any contraindications
-Have the patient rinse with a pre-procedural rinse
-Provide the patient with protective eye wear
-Discuss the importance of daily biofilm removal and proper self-care
-Teach the patient plaque control techniques and provide the patient the opportunity to practice these techniques
-Identify stains that require scaling to remove
-Ensure all calculus has been removed prior to polishing
-Use all appropriate PPE
-Ensure you use a latex free cup on patients who are sensitive to latex

Question 40

After polishing

Answer 40

-Thoroughly rinse the mouth with water using the air/water syringe and saliva ejector
-Floss the entire mouth to remove any remaining abrasive particles
-Thoroughly rinse the mouth again.

Question 41

Reducing Aerosol Production

Answer 41

Dentists and dental staff have an increased risk of airborne infections with airborne pathogens and droplets as dental handpieces, ultrasonic scalers and air-water syringes can produce aerosols that contain bacteria, fungi and or viruses. The reduction of aerosols during dental procedures can be accomplished using suction devices and systems. Studies have shown that with the use of high-volume evacuators (HVE), aerosol production can be reduced by 90% during aerosol-generating procedures such as coronal polishing

The Purevac HVE is one example of an HVE evaluation system that is a one-handed approach that assists in the reduction of aerosols, retraction, visibility and illumination during dental procedures.

Question 42

Reason for Pre-Operative Instructions

Answer 42

Prior to any type of patient care, including preventive procedures, it is important to explain the rationale for the treatment, discuss the sequence of procedures, and address any concerns the patient may have.

Patients who have been well informed regarding the reason for the preventive procedure. and who have had questions answered, are more likely to be compliant with treatment recommendations

Question 43

Plaque Control Record - Pre-Op Instructions

Answer 43

It is important to explain to the patient what a plaque control record is, how it is used and calculated.

Question 44

Coronal Polish - Pre-Operative Instructions

Answer 44

Prior to patient care, it is important to explain the rationale for polishing, the meaning of selective polishing, and why it is not necessary to polish all the teeth at every appointment.

Question 45

Fluoride Application - Pre-Op Instructions

Answer 45

It is important to advise the patient on the reason that a fluoride application has been recommended, based on the patient’s specific caries risk, the benefits of the procedure, what the patient can expect throughout the procedure, and any possible side effects.

Question 46

Desensitization: Pre-Operative Instructions:

Answer 46

t is important to discuss with the patient what may be causing the gingival recession and their activities and habits that may be contributing to exposure of the dentinal tubules, which can trigger a pain response.
You should also explain how the professional desensitizing product you are using works, and to explain the possible need for repeated application(s).
It is also possible that the patient may experience some discomfort or pain with the application. This should be explained to the patient ahead of the procedure.

Question 47

Operative Instructions

Answer 47

Throughout the course of a preventive procedure appointment, it is vital to keep the patient informed of the process and what to expect next.

Question 48

Post-Operative Instructions

Answer 48

Always remember that professionally delivered procedures should support and/or make possible home/self-care procedures. Without effective personal dental plaque biofilm removal measures, preventive procedures may have limited, and frequently, temporary effects.

Question 49

Plaque Control Record: Post-Operative Instructions:

Answer 49

You should be able to correlate the patient’s score with specific home care practices that will help improve the patient’s oral health

Question 50

Coronal Polish: Post-Operative Instructions:

Answer 50

Stains and plaque biofilm removed by polishing can return if daily home care procedures are not followed.

Question 51

Fluoride Application: Post-Operative Instructions:

Answer 51

Specific fluoride post-operative instructions depend on the product used.

It is also important to review with patients that professional fluoride applications are only one part of a caries prevention program, and the importance of the control of cariogenic food, daily home care, and regular professional dental care in reducing their caries risk.

Question 52

Desensitization: Post-Operative Instructions:

Answer 52

Specific post-operative instructions depend on the product used. The following are general post-operative instructions that should apply to most products.

1. Avoid brushing the area for the time indicated by the Manufacturer’s Instructions.
2. The importance of thorough dental plaque biofilm removal using a sulcular toothbrushing method with an ultra-soft bristled toothbrush to prevent further recession, and the importance of dental flossing to help maintain oral health.
3. Selecting a dentifrice that is low in abrasives, contains a desensitizing agent, and has approval for its fluoride compound

4.. To contact the office if the pain persists or worsens

Question 53

Conflicts of Interest - Referral Relationships

Answer 53

Dentists may have agreements or incentives to refer patients to specific specialists, laboratories, or suppliers. While referrals can be appropriate, if the recommendation is based more on financial gain than the patient’s best interest, it can lead to conflicts

Question 54

Conflicts of Interest -Ownership of Ancillary Services

Answer 54

Some dentists may own or have financial interests in dental laboratories, imaging centers, or other ancillary services. This can create a conflict if the dentist stands to benefit financially from ordering additional services or procedures that may not be necessary.

Question 55

Conflicts of Interest -Sales of Dental Products

Answer 55

Dentists may sell dental products directly to patients, such as toothbrushes, mouthwashes, or whitening kits. While this can be convenient for patients, it can also lead to conflicts if the dentist promotes products based on profit rather than efficacy.

Question 56

Conflicts of Interest -Participation in Research or Clinical Trials:

Answer 56

Dentists involved in research or clinical trials may have conflicts if they receive funding or other incentives from companies whose products they are testing or evaluating.

Question 57

Conflicts of Interest -Financial Relationships with Dental Product Manufacturers:

Answer 57

Dentists may receive payments, gifts, or other benefits from dental product manufacturers for using or promoting their products. While these relationships can sometimes be legitimate, they can also create conflicts if they unduly influence treatment decision

Question 58

Conflicts of Interest -Dual Relationships

Answer 58

Dentists may have personal or professional relationships with patients outside of the dental setting, such as being friends or relatives. While this doesn’t necessarily create a conflict of interest, it can blur boundaries and potentially influence treatment decisions.

Question 59

Ergonomics - Prevention of Musculoskeletal Disorders (MSDs):

Answer 59

Dental professionals often work in awkward postures for extended periods, which can lead to musculoskeletal disorders, including back, neck, and shoulder pain. Ergonomic practices, such as proper chair height, adjustable stools, and positioning of dental equipment, help reduce the risk of these injuries.

Question 60

Ergonomics - Improved Comfort and Efficiency:

Answer 60

An ergonomic setup can enhance comfort for dental professionals by reducing strain and fatigue. This leads to increased productivity and efficiency, as practitioners can work more effectively without being hindered by discomfort or pain.

Question 61

Ergonomics - Enhanced Precision and Quality of Work:

Answer 61

Proper ergonomics allow for better posture and positioning, which can improve the precision of dental procedures. When professionals are comfortable and well-aligned, they can perform tasks with greater accuracy and less strain.

Question 62

Ergonomics - Patient Safety and Comfort:

Answer 62

Ergonomically designed dental chairs and workspaces can also contribute to a more comfortable experience for patients. Proper positioning can make it easier for professionals to reach and treat patients, reducing the risk of accidental discomfort or injury.

Question 63

Ergonomics - Long-Term Health Benefits:

Answer 63

Adopting ergonomic practices helps prevent long-term health issues, such as chronic back pain or repetitive strain injuries. This not only benefits the individual practitioner but also reduces absenteeism and associated costs for the dental practice.

Question 64

Ergonomics - Optimized Workflow:

Answer 64

Ergonomics can streamline the workflow by ensuring that tools and materials are easily accessible and well-organized. This reduces unnecessary movements and interruptions, making the overall process more efficient.