Lecture 2

––––– ACTIVATION / INSTRUMENTATION –––––

⭐ Instrumentation strokes

TINY movements; working end moves only a few mm per stroke.

⭐ 2 types of motion activation

Wrist-rocking + Digital.

⭐ Wrist-rocking

Hand + wrist + arm move as ONE unit; rotating/door-knob motion.

⭐ Wrist-rocking used for

ALL calculus removal with hand instruments.

Wrist-rocking advantage

Less fatigue; workload on forearm/wrist instead of fingers.

⭐ Digital activation

Thumb + index + middle fingers make push-pull movements.

⭐ Digital activation used for

Probes + explorers + ultrasonic instruments; when strength is NOT required.

Digital activation NOT recommended for

Calculus removal with hand instruments.

⭐ Rolling

Turn handle between thumb + index while middle finger stays on functional shank.

Purpose of rolling

Maintains working-end contact/adaptation as instrument moves around tooth.

⭐ Pivoting

Tiny swinging motion of hand/arm while balancing on fulcrum.

Purpose of pivoting

Maintains adaptation around line angles/proximal surfaces.

⭐ Fulcrum during activation

Stabilizes hand + controls working end + acts as a “brake” at end of stroke.

⭐ 3 instrumentation strokes

Assessment + Calculus removal + Root debridement.

Assessment/exploratory stroke

Feather-light + moderate length; detects calculus; NO lateral pressure.

⭐ Calculus removal stroke

SHORT + controlled + biting; FIRM lateral pressure.

Root debridement stroke

Lighter shaving stroke; moderate/light pressure; slightly longer than calculus-removal stroke; uses curets.

⭐ 3 pressure forces

Pinch pressure + Fulcrum pressure + Lateral pressure.

––––– DENTAL MIRROR –––––

⭐ Mirror hand

NON-DOMINANT hand.

⭐⭐ 4 functions of mouth mirror

Indirect vision + Retraction + Indirect illumination + Transillumination.

Indirect vision

View surfaces/structures that cannot be seen directly.

Retraction

Moves cheek, lip or tongue to expose tooth surfaces.

Indirect illumination

Reflects light onto teeth/tissues in dark areas.

⭐ Transillumination

Reflects light THROUGH teeth to detect abnormalities.

⭐⭐ Transillumination teeth

ANTERIOR ONLY; posterior teeth are too bulky.

Transillumination caries/restorations

Appear as DARK shadows.

⭐ Lip retraction

Use INDEX FINGER; more comfortable than mirror.

Mirror stabilization

Ring + index fingers; may stabilize on chin, cheek or tooth.

Extraoral fulcrum

Stabilization point OUTSIDE mouth.

Intraoral fulcrum

Stabilization point on a TOOTH.

––––– PERIODONTAL PROBING –––––

⭐ Periodontal probe

Blunt, rod-shaped working end calibrated in MILLIMETERS.

Main probe function

Measures intraoral structures + evaluates periodontal health.

⭐ Probe can measure

Sulcus/pocket depth + clinical attachment level + attached gingiva + bleeding + oral lesions.

⭐ Healthy probing depth

1–3 mm + NO bleeding.

⭐⭐ Periodontal pocket

Probing depth >3 mm.

⭐ Probing depth

Gingival margin → base of sulcus/pocket.

⭐ Probing

Walking probe tip along BASE of sulcus/pocket to assess periodontal health.

⭐⭐ Walking stroke

Series of bobbing strokes while tip stays against/aligned with root surface.

⭐ Probe adaptation

Tip stays in CONTACT with tooth throughout walking stroke.

⭐ Probe position

Keep probe parallel to long axis/root surface.

⭐ Proximal probing

ANGLE probe beneath contact area to measure proximal depth.

Important

Do NOT remove probe from sulcus with every stroke → can traumatize tissue.

⭐⭐ Probing pressure

10–20 g.

⭐⭐ Record probing

6 sites/zones PER TOOTH.

⭐ What reading is recorded?

DEEPEST reading in each zone.

⭐ Decimal measurement

ROUND UP to nearest whole mm.

⭐ UNC-15 probe

Marked every mm from 1–15 mm.

WHO probe

Ball end; markings = 3.5, 5.5, 8.5, 11.5 mm; used for periodontal screening.

Goldman-Fox

Flat working end; 1–10 mm with 4 + 6 missing.

⭐ Probe markings rule

NEVER assume probes have same markings.

⭐ Basic probing sequence reminder

Me → My patient → My light → Grasp → Finger rest → Adaptation.

––––– INFORMED CONSENT –––––

Informed consent

Patient receives complete information to make informed decision to ACCEPT or REFUSE treatment.

Consent includes

Recommended treatment + risks/outcomes + alternatives/consequences + costs.

⭐ Best legal consent

WRITTEN consent; signed by patient + hygienist.

Informed refusal

Patient may refuse treatment after being fully informed; DOCUMENT refusal.