preclinic - instrumentation essentials, explorers, calculus detection

if a clinician’s large motor skills, such as position, are not correct, it is still possible for their small motor skills, such as the finger rest, to be correct? t/f

false, it is impossible for their smaller motor skills to be correct

do we use pen grasp or modified pen grasp?

modified pen grasp

what does the correct instrument grasp allow for?

• precise control of the working-end of an instrument

  • reduces tissue trauma

  • increases patient comfort

• permits a wide range of movements

• facilitates good tactile sensitivity (allows clinician to feel the texture of the teeth)

also lessens musculoskeletal stress and prevents finger fatigue

where does the handle rests?

from “V” of hand to 2nd knuckle

the handle can rest btwn 1st and 2nd knuckle. t/f

false, can rests anywhere btn 2nd and v

what are the functions of the index and thumb, middle, ring, and little finger?

index and thumb - hold instrument

middle - helps guide working-end, feels vibrations transmitted from working-end to shank

ring - stabilizes and supports the hand for control and strength

little - has no function in grasp

middle and ring finger should be separated when holding the instrument?

false, the pad of the middle finger will rest on ring finger to allow for better control and a feeling of sturdiness

if middle and ring finger split apart, what is this known as?

split grasp (leads to less control)

why is the ring finger an important digital?

balances firmly on tooth structure to support weight of hand and instrument

ring finger of dominant hand advances ahead of other fingers in the grasp? t/f

true

how should the ring finger be positioned?

held upright and rigid to act as a strong support beam for hand

using a soft C-shape made by the thumb and index is important when exploring because it …

increases tactile sensitivity

if you grasp too tight on an explorer, what will happen?

• finger blanching (thumb and index won’t have “soft C”)

• decreased tactile sensitivity

  • fatigue

if you grasp too loosely on an explorer, what will happen?

lack of control and security

if your middle finger is too close to the working end on an explorer, what will happen?

• limits action of instrument

• decreased tactile sensitivity

(should not extend past first bend in shank)w

what is a fulcrum?

a finger rest used to stabilize the clinician’s hand during periodontal instrumentation

what does fulcruming help with?

• improves preciision of instrumentation strokes

• prevents sudden movements that could injure patient

  • reduces muscle load to clinician’s hand

what is the function of fulcrum?

• serves as support beam for hand during instrumentation

• enables hand and instrument to move as a unit as strokes are made against the tooth

• allows precise control of stroke pressure and length during periodontal instrumentation

what is intra-oral fulcrum and extra-oral fulcrum?

intra-oral fulcrum: provdes stabilization of clinician’s dominant hand by placing fingertip of ring finger on tooth near the tooth being instrumented

• 1-4 teeth away from the tooth being instrumented

extra-oral fulcrum: provides stabilization of the hand outside the patient’s mouth (cheek, chin)

when do we use extra-oral fulcrum?

mirror utilization

what is an advanced fulcrum?

variations of intra or extra-oral fulcrum used to gain access to hard to read areas

why does your finger rest vary?

• varying size of patient’s oral cavity

• edentulous areas - can use cotton troll

• mobile teeth - may want to avoid

• patient may have limited opening

  • difficult to access areas

what is the sequence for establishing a finger rest?

me

my patient

my equipment

my nondominant hand

my dominany hand

my finger rest

pause to evaluate my finger rest

location for intraoral fulcrum

1-4 teeth away from tooth being worked on

established out of the line of fire

never rest directly above tooth surface being worked on

rest for intraoral fulcrum

incisal edge or occlusal surface

occlusofacial line angle

occlusolingual line angle

what is instrumentation?

a fine motor (psychomotor) skill

• involves small movements

what are the stages of psychomotor development

1. observing

2. imitating

3. practicing

4. adapting

what type of muscle action employs the hand, wrist, ad arm - moving as a unit - to produce a rotating motion used to move the working-end across a tooth surface?

wrist-rocking motion

what is digital activation (aka finger activation)?

the instrument is activated by making push-pull movements with the thumb and other fingers

digital activation is usually recommended. t/f

false, not recommended but can be used w power scalers

what does activation control?

controls the length of stroke, which should be small - only a few millimeters w each stroke

rotating the ___ and ___ as a unit provides the power needed to instrument and allows the clinician to remain in a neutral position; the workload is on the ___ and ___ rather that the hand and fingers

hand and wrist

forearm and wrist

what are motions used for explorers?

back and forth

rock up and down

during each stroke of the instrument, the fulcrum shoudl remain pressed against the toooth to act as a ____-____ for the motion

pivot-point

what is the purpose of rolling the instrument handle?

to maintain precise contact of working-end to tooth surface as it moved around tooth

pivoting on fulcrum assists clinician in what?

keeping the working-end against tooth as it moved around tooth

2 ways to move the working end around the tooth

1. rolle instrument btwn thumb and index fingers

   1. pivot on fulcrum finger

function of explorer

used to detect, by tactile means, the texture and character of tooth surfaces before (assess type and amounf of deposits on teeth), during, and after periodontal instrumentation (assess progress and completeness of instrumentation)

if explorer moves over tooth surface irregularities, what are signs you will know?

working-end quivers

what can explorer help with as well?

give you subgingival eyes through sense of touch

what is the design of explorers?

• made of flexible metal that conducts vibrations from working-end to clinician’s finger resting on instrument shank and handle

• circular in cross-section and may have unpaired (dissimilar) or paired working-ends

what is 11/12 explorer used for? (mirror images)

subgingival explorer (can be used supragingivally)

considered a universal explorer

shepher hook explorer is used to examine ___ and ___ and supragingival smooth surfaces; examine margins of restorations; used in ___ detection

pits and fissures

caries

is EXD 11/12 and shepher’s hook single or double ended?

11/12 - double ended

shepherd’s hood - single ended

the last portion of the shank just before the working end

terminal shank

begins below the working end and extends to the last bend in the shank nearest the handle

functional shank

how many mm of the working end are you using?

1-2mm

what terminal shank side should you use for anterior and posterior teeth?

anterior - seatbelt

posterior - parallel

what tooth should you use to check working end?

premolar tooth ebcause it is easily seen

what is the angulation of the explorer?

angulation of the side of tip should be 5 degrees or less

guidelines prior to insertion - explorer

1. establish a fulcrum near the tooth you want to explore

2. find correct working end

3. adapt working end so that the side of tip is against the tooth surface (last 1-2 mm)

4. angulation of the side of tip should be 5 degrees or less (relationship of side of tip to the tooth)

5. use rocking motion to insert the instrument subgingivally to the base of the sulcus or pocket

what are 2 strokes used?

vertical (up and down) and oblique (diagonal) through wrist activation/rocking

what is the difference between “assessment stroke” or “exploratory stroke” AND “working stroke”?

assessment or exploratory stroke - feather light and controlled stroked

working stroke - requires pressure (for calculus removal)

when in posterior sextants, where do you start first?

distal of the tooth (tip face distally) and then mesial buccal and mesial (tip face mesially)

where should you start on anterior sextants?

at 9 o clock, farthest canine to closest canine at midline

at 11 o clock, right canine to left

overscaling can cause

• tooth sensitivity

• gingival tissue trauma

• longer appointments + fatigued clinician

  • loss of confidence of patient in clinician’s skills

armamentarium for calculus detection

mirror

explorer

good lighting

compressed air

radiographs

common calculus formations

veneer (thins, feels like roughness)

spicule

ledge

ringfingerlike formation

residual calculus

remnants of calculus that has been unintentionally left behind following scaling procedures