Lisa Mayo, RDH, BSDH Staci Janous, RDH, BS DH 101: PRECLINICAL SCIENCES Mouth Mirror, Explorers, grasp Wilkins ch 38 Nield ch 2,3,4,5,6,7,12 Lisa Mayo, RDH, BSDH Staci Janous, RDH, BS NEED TYPODONT & CASSETTE IN CLASS!

Objectives Modified Pen Grasp, Palm Grasp, Fulcrum Introduction To Instrument Anatomy Mouth Mirror Dental Explorers: Shepherd’s Hook & Explorer ODU 11/12 Using Clock Positions for Instrumentation

OBJECTIVE #1 Modified Pen Grasp Palm Grasp Fulcrum

Modified Pen Grasp Nield p.71

Modified Pen Grasp Nield p.77

Modified Pen Grasp Nield p.77

Modified Pen Grasp: Finger Function Nield p.72 Digits Placement Function Index/Thumb On instrument handle Hold the instrument Middle Rests lightly on shank Guide the working-end Feels vibrations transmitted from working-end to shank Ring On oral structure, often a tooth surface Advances ahead of the other fingers in the grasp Stabilizes & supports the hand for control and strength Little Near ring finger Natural, relaxed No function in grasp

Correct Finger Placement Rests on Ring Finger Contacts Shank Contacts Shank Rests on Ring Finger Rests on Tooth Rests on Tooth Contact Handle Contact Handle Handle rests Handle rests Contact Handle Contact Handle

Nield p.75

Modified Pen Grasp: LF Nield p.73

Modified Pen Grasp: RT Nield p.73

Modified Pen Grasp Palm Grasp

Palm Grasp Description Handle of the instrument is held in the palm by cupped index, middle, ring, and little fingers Thumb is free to serve as the fulcrum Limitations of use Instruments for calculus removal, root planing, and maintenance root debridement are not used with a palm grasp Examples of uses A/W syringe Non-dominant hand for instruments stabilization while sharpening

Neutral Positions Nield p.92 Wrist Elbow Shoulder Straight, and the forearm and the hand are in the same horizontal plane when in the neutral position Elbow 90 degrees or greater, with the forearm positioned horizontally or slightly oblique Hand is in straight alignment with the forearm Shoulder Neutral, both shoulders are level and relaxed to their lowest position From a lateral position, each is vertically in line with, and beneath, each ear The upper arms are straight down to the elbow

Nield p.91

WHICH ONE IS CORRECT?

Nield p.92

Nield p.92

Fulcrum Nield p.89 Definition: The support, or point of rest, on which a lever turns in moving a body Finger rest: The support, or point of finger rest on the tooth surface, on which the hand turns in moving an instrument

Fulcrum: Finger Rest Nield p.90 Objectives Stability: controlled action of the instrument Unit control: provides a focal point from which the whole hand can move as a unit Injury prevention: to the patient’s oral tissues can result from irregular pressure and uncontrolled movement Patient comfort: Confidence in the clinician’s ability ↑ Control of stroke length: limits the instrumentation to where it is needed

Nield p.90

Nield p.89

“Princess Wave” or Wrist-Rock When instrumenting, wrist/hand/forearm should never break neutral position Instruments are moved using the “Princess Wave” or “Wrist-rock” motion

OBJECTIVE #2 Introduction to Instrument Anatomy

Instrument Anatomy Each instrument is designed for different purposes Clinicians know the names & numbers Classification by purpose and use Examination/Assessment Instruments ex: probe, explorer, mirror Treatment/Working Instruments ex: curets, scalers, file, hoe, chisel

DENTAL MIRROR

DENTAL EXPLORERS

DENTAL PROBES

DENTAL SCALERS

Instrument Anatomy Wilkins p.580-581 Nield p187-199 Handle Shank Working End

1. HANDLE Overall design Single-ended instrument 1 working end Double-ended instrument Paired (mirror image) or complementary working ends Paired working ends are used for access to proximal surfaces from the facial or lingual aspects Cone socket handles Separable from the shank and working end They permit instrument exchanges / replacements

1. HANDLE Shape: Round or Hexagonal Solid or Hollow Metal or Silicone Weight Handles w/lighter weight: enhance tactile sensitivity, ↓ fatigue Diameter 4 available: 3/8, 5/16, 1/4, and 3/16 inch Ideal instrument: lightweight, serrated (next slide), hollow handle with a 3/8- or 5/16-inch diameter

1. HANDLE Surface Texture/Serrations Smooth, Ribbed, Knurled Texturing increases static friction between fingers & handle Results in reduced pinch force in the grasp No texturing Decrease control of instrument in wet environment Increase muscle fatigue Raised texturing Easier to hold in wet environment Maximize control of instrument and reduce muscle fatigue

2. SHANK Connects working end with handle Shape, length, rigidity govern the access of the working end to accomplish goals of clinician Lower / Terminal Shank Section adjacent to the working end (cont’d next slide) Blade Shank Lower Shank Handle

2. SHANK Lower Shank cont’d Provides important visual clue’s for the clinician in selecting the correct working-end for the particular tooth you are working on General rule of thumb: TERMINAL SHANK PARALLEL TO THE TOOTH for correct adaptation Lengths Standard Extended: 3mm longer

2. SHANK Shape Simple/Straight Flat Bent in one plane (front-to-back) Anterior teeth Ex: Anterior sickle scaler H 6/7, Gracey ½ (your instruments in clinic) Complex/Angled/Curved Shank bent in 2 planes (front-back and side-to-side) Posterior teeth Ex: Posterior sickle scaler 204S, Universal scaler 13/14, Gracey 11/12 or 13/14 (your instruments in clinic)

Nield p.194

2. SHANK Flexibility Length Varying degrees of thickness and rigidity that relate to the instruments purpose Rigid/Thick Shank: stronger, able to withstand greater pressures w/out breaking. Needed for removal heavy calculus Less Rigid/More Flexible Shank: More tactile sensitivity. Used for finer scaling, removal smaller deposits, exploring (feeling) Length Distance from working end/blade/cutting edge to junction of the shank & handle Most instruments 35-40mm (1/2in)

3. WORKING END Carries out the purpose/function of the instrument Some instruments remove deposits, some are used just for assessment or feeling To determine its use, need to know the parts of the working end

3. WORKING END Nield p.197 Parts of Working End Cutting Edge Fine line where 2 surfaces meet Ex: face and lateral surface meet to form the sharp cutting edge of a curet Lateral Surfaces Meet or are continuous to form the back of the instrument Face and Back Purple = face Gold = Back Nield p.197

INSTRUMENT USE Instrument grasp functions Dominant hand: hold and activate the treatment instrument Nondominant hand: mirror, suction, syringes

OBJECTIVE #3 MOUTH MIRROR

Mouth Mirror Competency

Mouth Mirror Uses Indirect vision: Looking through the dental mirror to see areas of the mouth Indirect illumination: reflecting light off dental mirror onto tooth/area Transillumination: transmission of light through a sample. Ex: detecting caries or enamel fractures by shining a specific light through the enamel Direct vision: Looking directly with eyes into oral cavity

Nield p.93

Nield p.94

Nield p.94

Nield p.95

Nield p.95

CRACKED TOOTH & TRANSILLUMINATION YOU TUBE http://www.youtube.com/watch?v=1wykNoiSNMU

Nield p.95

Nield p.94

Objective #4 Explorers: Shepherd’s Hook & ODU11/12 Nield CH 12 p.275-308

Explorers Designed for adaptation around the tooth Used to detect and assess: Supragingival calculus Subgingival calculus Cemental irregularities Dental caries Decalcification Irregularities in margins of restorations Secondary caries around restorations Morphologic crown and root anomalies External root absorption

Explorers Made of flexible metal that conducts vibrations from working-end to clinician’s fingers resting on the instrument sank or handle Circular in cross-section Working-end 1-2mm in length (tip) Do NOT use actual POINT to detect calculus, use the SIDE Nield p.281

Explorer Stroke Assessment or Exploratory Stroke Require high degree of precision Use LIGHT, CONTROLLED STROKES Tactile Sensitivity Ability to detect tooth irregularities by feeling vibrations transferred from explorer working end to handle

Insert assessment stroke Nield p.279

Nield p.297 WRIST POSITION WHILE EXPLORING More on Neutral Wrist Position at end of class Nield p.297

Nield p.297

Shepherd’s Hook Competency Point Value: 1 1. Uses Modified Pen Grasp   2. Uses proper fulcrum 3. Hand is straight with forearm 4. Keeps 1-2 mm of tip on tooth 5. Tip is angled 75°angle on groove/fissures 6. Repositions correctly as needed 7. Uses wrist to move instrument 8. Uses light but firm grasp 9. Mirror used correctly 10. Patient and operator position is correct 11. Light is positioned correctly *12. Utilizes proper infection control protocol TOTAL POINTS:

Shepherd’s Hook Resembles the long stick with a curved end that was used by ancient shepherd’s to catch sheep Uses Supragingival examination of the margins of restorations or to assess for sealant retention Examine grooves and pits of teeth NOT recommended for subgingival use

Shepherd’s Hook Technique Angled 45° onto tooth surface, not 90 ° Place explorer around grooves and in pits Actual point not used Keep 1-2mm of tip on tooth surface at all times

ODU 11/12 Competency

WHAT WE ARE DETECTING WITH ODU11/12 Nield p.298

WHAT WE ARE DETECTING WITH EXPLORING Nield p.298

Nield p.299

SUBGINGIVAL CONDITIONS INTEPRETATION OF SUBGINGIVAL CONDITIONS Nield p.299

Nield p.299

Nield p.300

SKILL BUILDING ANTERIOR Nield p.284 NEED TYPODONT & ODU11/12 Correct Working End For Anterior Teeth = ODU11/12 Wraps Around the Surface You Are Exploring

SKILL BUILDING POSTERIOR Nield p.288 Correct Working End For Posterior Teeth = ODU11/12 Wraps Around the Mesial Surface

Clock Positions & Instrumentation OBJECTIVE #5 Clock Positions & Instrumentation Nield p.47-52 Nield Video

Using Clock Positions for Instrumentation To learn which sides of the teeth you clean from what clock position RT-Handed Anterior Surfaces Away/Towards Posterior Surfaces Away/Towards LF-Handed

Anterior Surfaces Away RT clock position = 11-12 o’clock LF clock position = 12-1 o’clock

Anterior Surfaces Towards RT clock position = 8-9 o’clock LF clock position = 3-4 o’clock

Posterior Surfaces Away L RT clock position = 10-12 o’clock LF clock position = 12-2 o’clock L F

Posterior Surfaces Towards L Posterior Surfaces Towards L F RT clock position = 8-9 o’clock LF clock position = 3-4 o’clock

Patient Positioning Be sure to have your patient turn their heads toward or away from you so you can gain better access and visibility to different areas of the oral cavity