Module 4 - Use of Dental mouth mirror

Why use dental mirror?

View tooth surfaces that can’t be seen with direct vision

• Lingual surfaces

Types of mirror surfaces

Front surfaces

• Reflecting surface is on front surface of glass

• Clear mirror image quality w/o distortion

• Reflecting surface is easily scratched

Concave (spoon)

• Reflecting surface is on front surface of mirror lens

• Magnified image

• Distorted due to magnification

Plane (Flat surface)

• Reflecting surface is on back surface of mirror lens

• Produce double image (ghost image)

• Double image = distracting

Stabilization of dental mirror

Fulcrum

• Stabilizes clinician’s hand during instrumentation

• An anchor point for your hands

Left hand clinicians (Stabilizing mirror)

• Use mirror in nondominant hand (right)

• Ring and index fingers — stabilizes mirror in mouth

• Rest fingers on patient’s ch8n or cheeks or tooth surface to stabilize mirror

Extraoral fulcrum

• Stabilization point outside the patient’s mouth (chin/ cheeks)

Intraoral fulcrum

• Stabilizing point inside the patient’s mouth (tooth surface)

• Optional w/ dental mirror, but recommended

Functions of dental mirror

1. Indirect vision

2. Retraction

3. Indirect illumination

4. Transillumination

Indirect vision

Cannot be seen directly

• Mirror is used to view lingual surfaces, working end is visible in mirror

Retraction

• Using mirror head to hold soft tissue out of the way

Retraction of tongue

• Using mirror head to hold patient’s cheek, lip, tongue to view tooth surfaces

Retraction of lip

• Index finger of non dominant hand retract lip away from facial aspect of anterior teeth

• Finger is more comfortable than mirror

• Mirror may be held in palm of hand when retracting with finger — avoids putting down mirror

Indirect illumination

• Use of mirror surface to reflect light onto tooth surface in dark areas of the mouth

Transillumination

• Directing light off mirror surface and through anterior teeth

• Trans = through

• Illumination = light up

As light is reflected off mirror surface, light beams pass back through the teeth

• Light path through teeth to detect abnormalities (ex: cracks, cavities, dark shadows)

How to perform transillumination

• Light: Over oral cavity (perpendicular) to anterior teeth — Patient chin down position (over mouth area)

• Position: 12 o’clock

  • Hold mirror behind central incisors so reflection is parallel to lingual surface

• View: Anterior teeth will appear to glow

  • Look directly at the teeth. NOT the mirror’s reflecting surface

Dangerous myth of direct vision

• Visual dominance is ergonomic risk — Student rely on visuals

  • Touch — greatest asset during periodontal instrumentation

  • Vision — greatest hinderance to effective instrumentation

  • Makes clinicians assume awkward position

Calculus deposits — Detected by touch

• Removal of plaque biofilm, calculus deposits under gingival margins in periodontal pockets

• Clinicians make many strokes w/ instrument to remove calculus — unnecessary strokes = MSD

• Able to “feel” calculus = fewer strokes

• Skilled clinicians = Apply force w/ grasp as they remove calculus

• During calculus detection = relax and hold handle = rest period for muscles and joints

Using direct vision

• Using direct vision and not looking into mirror = unnatural posture

• Static posture of trapezius muscles

Mastery of indirect vision is key

• Those who use mouth mirror for indirect visions have fewer headaches and reduced neck/shoulder pain

• Learn mirror use first on maxillary arch

• Those who started on mandibular arch cheated and used direct vision

• Poor indirect vision skills = attention focused on positioning the periodontal instrument = awkward body positions

Mastering indirect vision = better neutral positons

Mirror use for retraction

Step 1

• 1 to 2 o’clock for facial aspect of mandibular right posteriors

• Hold mirror in non dominant hand

• Put mirror head between dental arches w/ reflecting surface parallel to maxillary occlusal surfaces (Frisbee—style)

• Slide mirror back until its in line w/ second molar

Step 2

• Turn mirror handle until head is parallel to buccal mucosa

  • Back of the head is against inside of cheeks

• Establish extraoral finger rest on side of patient’s cheeks

• Use arm muscles for retraction

  • Don’t use finger muscles — difficult and tiring way to retract cheeks

Avoid hitting mirror against patient’s teeth or resting outer rim of mirror head against patient’s gingival tissues

• Use mirror head, not shank for retraction (don’t retract at corner of mouth)

Maxillary anteriors, lingual aspect, surfaces towards

• 3 to 4 o’ clock position

• Hold mirror in right hand, rest ring and pinkie on patient’s left cheek or premolar teeth

• Swivel mirror head so lingual surfaces reflect towards you in the mirror

Maxillary anteriors, lingual aspect, surfaces Away

• 11 to 1 o’ clock position

• Hold mirror in right hand, rest ring and pinkie on patient’s right cheek or incisal edges of maxillary anterior tooth

• Mirror head is not held near maxillary anteriors, positioned closer to tongue

• Swivel mirror head so surfaces away from you are seen

Maxillary left posterior sextant, facial aspect

• 3 o’ clock position

• Place the mirror head between dental arches, rest ring and pinkie on left side of patient’s face. Retract the buccal mucosa with mirror.

• Use mirror for indirect vision, to view distal suerfaces.

• Swivel mirror head until you can easily view distal surfaces in reflection.

Maxillary right posterior sextant, lingual aspect

• 3 o’ clock position

• Rest ring and pinkie on left sid eof patient’s mouth, near corner

• Position mirror head away from teeth, closer to tongue

• Use mirror for indirect vision, to view distal surfaces. Swivel mirror head until you can easily view the distal surfaces in reflection.

Maxillary right posterior sextant, facial aspect

• Sit 1 to 2 o’ clock position

• Slide mirror head between dental arches

• Rest ring and pinkie on right side of face

• Use mirror to retract buccal mucosa away

• Swivel mirror head until you can easily view the distal surfaces

• Swivel mirror head until you can view facial and mesial surfaces in the reflecting surfaces

Maxillary left posterior sextant, lingual aspect

• 1 to 2 o’clock position

• Rest ring and pinkine on right side of face, near corner of mouth

• Position mirror head near the tongue

• Swivel mirror head to view distal surfaces in mirror

• Swivel mirror head to view lingual and mesial surfaces

Mandibular anterior, lingual aspect, surfaces towards

• 3 to 4 o’ clock position

• Rest ring and pinkie on left side fo patient’s face near corner of mouth on premolar teeth

• Use mirror head to push tongue away gently to expose lingual surface of anterior teeth in mirror

Mandibular anteriors, lingual aspect, surfaces away

• 11 to 1 o’ clock positions

• Rest ring and pinkie on right side of patient’s face near corner or one of the premolars

• Use mirror head to push tongue back gently so lingual surfaces of teeth is seen in the mirror

Mandibular left posterior sextant, facial aspect

• 3 o’ clock position

• Rest finger on left side of patient’s face

• Retract buccal mucosa with mirror. Use mirror for indirect vision to view distal surfaces of the teeth

Mandibular right posterior sextant, lingual aspect

• 3 o’ clock position

• Rest finger on left side of patient’s face

• Use mirror to gently move the tongue away from teeth. Use indirect vision to view distal and lingual surfaces.

Avoid pressing down against floor of mouth with mirror head

Mandibular right posterior sextant, facial aspect

• 1 to 2 o’ clock

• Rest finger on right side of patient’s face

• Use mirror to retract buccal mucosa down and away from teeth

• View distal, facial, and mesial surfaces in the mirror’s reflecting surface

Mandibular left posterior sextant, lingual aspect

• 1 to 2 o’ clock position

• Rest finger on right side of patient’s face

• Use mirror to move tongue away from teeth, so lingual surfaces of teeth can be seen. Once in position, view distal, lingual, and mesial surfaces in mirror’s reflecting surfaces

How to stop fogging reflecting surface

• warm reflecting surface against patient’s buccal mucosa

• Ask patient to breathe through nose

• Wipe reflecting surface with commercial defogging solution

• Wipe reflecting surface with gauze square moistened mouthwash