Clinical Hygiene Tech - Exam 1

Angle of Declination

is the angle between the temple piece of the spectacle mounted magnification system and the actual line of sight chosen by the clinician

Ergonomics

Is the applied science concerned with the "fit" between people and their technological tools and environment

- The science of making things efficient

Musculoskeletal Disorders (MSDs)

Is a condition where parts of the musculoskeletal system - muscles, tendons, and nerves are injured over time

Neutral Posture

The joint is being used near the middle of its full range of motion

Static Posture

is defined as a fixed working position (maintaining the body in one position for an extended period of time)

Force

refers to the amount of effort created by the muscles as well as the amount of pressure placed on a body part

Repetitive Task

Three critical components:

1. Frequency

2. Duration

3. Recovery time

Foundational Building Black of Periodontal Instrumentation

Position

Instrument Grasp

Mirror

Finger Rests

Stroke Production

Neutral Seated position

The ideal seated position for the clinician

Weight evenly distributed. Seat back about 1 inch higher than front of seat. Hips slightly higher than knees.

Supine Position

For Maxillary treatment areas, the back of the dental chair is nearly parallel to the floor

chin - up position & toes slightly higher than the tip of the nose

Semi-Supine Position

For mandibular treatment areas the back of the dental chair is slightly upright

Chin- down position

Chin-Down position

The headrest is angled forward and down, so that the chin is lower than nose level; the occlusal or incised surfaces of the treatment area should be approximately parallel to the floor

Chin-up position

Patient head tilt for maxillary arch.Angle the headrest up into the back of the patients head so that the nose and chin are approximately level, The maxillary occlusal area are more perpendicular to the floor

Coaxial illumination sources

Spectacle-mounted or headband-mounted miniature lights that provide a beam of light that is parallel to the clinician's sight line.

working distance

distance between objective lens and specimen

Depth of Field

the distant range within which the object being viewed remains in sharp focus

Field of View

Is the total size of the object that can be viewed through the loupes

Blind Zone

Is an area of vision between the unmagnified peripheral field of vision and the magnified center of the field of vision

Clinician clock positions

The patients head is at the 12 o'clock position and the feet are at the 6 o'clock position

- Right handed clinicians sit from 8-1 o'clock

8 o'clock Position

Torso Position: sit facing patient with your hip in line with the patient's upper arm

Leg Position: thigh should rest against the side of the patient chair

Arm Positions: Hold your arms slightly away from your sides to reach the patient's mouth. Hold your lower right arm over the patient's chair, have patient turn their head

9 o'clock Position

- torso: facing side of patient's head, the midline of your torso is even with the patients mouth

- legs: either straddling patient chair or underneath headrest of chair

- arms: hold lower half of right arm in appx alignment with patient's shoulder, left hand & wrist over patient's right eye

10 to 11 o'clock position

- torso: sit at top right corner of headrest; the midline of your torso is even with temple region of patient's head

- legs: straddle corner of headrest

- arms: right arm directly across corner of patient's mouth, left hand & wrist above patient's nose

12 o'clock position

Torso position: sit behind the patient's head

Leg position: legs straddle the headrest

Arm position: both left and right handed operators can work from here access to the anterior surfaces

1 to 2 o'clock position

- torso: sit at top left corner of headrest, torso even with temple region of patient's head

- legs: straddle corner of headrest

- arms: left hand across corner of patient's mouth, right hand & wrist above patient's nose

Anterior Surfaces TOWARD

8-9 o'clock

Anterior Surfaces AWAY

11-1 o'clock

Mandibular anterior surfaces TOWARD

8-9 o'clock

chin down

Maxillary anterior surfaces TOWARD

8-9 o'clock

chin up

Mandibular anterior surfaces AWAY

11 to 1 o'clock

chin down

Maxillary anterior surfaces AWAY

11 to 1 o'clock

chin up

mandibular posterior aspects facing TOWARD

-9 o'clock

-Chin DOWN; the mandibular occlusal plane as parallel to the floor as possible.

Maxillary posterior aspects facing TOWARD

-Clinician in the 9 o'clock position.

-Patient chin UP; maxillary occlusal plane as perpendicular to the floor.

Mandibular posterior aspects facing AWAY

-Clinician in the 10 t0 11 o'clock position.

-Patient's chin DOWN; mandibular occlusal plane as parallel to the floor as possible.

Maxillary posterior aspects facing AWAY

-Clinician in the 10 t0 11 o'clock position.

-Patient chin UP; maxillary occlusal plane as perpendicular to the floor.

The modified pen grasp

-Facilitates precise control of instrument

-Allows detection of rough areas on tooth surface

-Lessens musculoskeletal stress

Handle

The part of a periodontal instrument used for holding the instrument

Shank

a rod-shaped length of metal located between the handle and the working-end of a dental instrument

generally circular, smooth, and much smaller in diameter than the handle

Working-End

Part of a dental instrument that does the work of the instrument. begins where the instrument shank ends

Index & Thumb

Placement: on the instrument handle

Function: Hold the instrument

Middle Finger

placement: rests lightly against the shank

FUNCTION: helps to guide the working end, feels vibrations transmitted from the working-end to the shank

Ring Finger

Position: On oral structure; often a tooth surface - advances ahead if the other fingers in the grasp

Function: Stabilizes and supports the hand for control and strength

Little Finger

Position: Near ring finger, held in a natural relaxed manner

Function: Has none

Front surface of Mirror

-Reflecting surface is on the front surface of the glass

-Produces a clear mirror image with no distortion

-Most commonly used type because of good image quality

-Reflecting surface of mirror is easily scratched

Concave Mirror Surface

reflecting surface is on the front surface of the mirror lens, produces a magnified image, magnification distorts the image

Plane (Flat) Surface Mirror

-reflecting surface is on the back surface of the mirror lens

-produces a double image (ghost image)

-double image may be distracting

Fulcrum

A fulcrum provides stabilization of clinician's hand driving periodontal instrumentation

extraoral fulcrum

A stabilization point outside the patient's mouth- usually on the patient's chin or cheek

Intraoral fulcrum

a stabilization point for the hand on a tooth surface

Functions of the Dental Mirror

1. indirect vision

2. retraction

3. indirect illumination

4. transillumination

Indirect vision

the use of a dental mirror to view a tooth surface or intraoral structure that cannot be seen directly

retraction of tongue

is the use of the mirror head to hold the patient's cheek, lip, or tongue so that the clinician cna view tooth surfaces that are otherwise hidden from view by these soft tissue structures

Retraction of the Lip

-the index finger is used to retract the lip away form the teeth

-more comfortable for patient than using a mirror for retraction of the upper and lower lip

indirect illumination

the use of the mirror surface to reflect light onto a tooth surface in a dark area of the mouth

Transillumination

The technique of directing light off of the mirror surface and through the anterior teeth

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

- Trans = through + Illumination = lighting up

Advanced Fulcrum

variations of an intraoral or extraoral finger rest used to gain access to root surfaces within periodontal pockets

Neutral Wrist Position

Ideal positioning of the wrist while performing work activities and is associated with decreased risk of musculoskeletal injury

Handle positions for mandibular anterior teeth

1. Hold the handle in a palm-down position

2. Rest the handle against the index finger somewhere on the bottom of index finger

Handle positions for maxillary anterior teeth

1. Hold the handle in a palm-up position

2. Rest the handle against the index finger somewhere in the area between index & thumb

Handle positions for mandibular posterior teeth

1. Hold the hand in a palm down position

2. Rest the handle against the index finger somewhere between the index and thumb

Handle positions for maxillary posterior teeth

1. Hold the hand in a palm up position

2. Rest the handle against the index finger somewhere between the index and thumb

Variations in Handle Design

Handle design is important in prevention of musculoskeletal injury during instrumentation

Handle Variations to consider:

- Instrument weight

- Handle diameter

- Taper

- Texture (knurling pattern) reduces pinch force

Simple Shank

-Has only one bend. With the working end tip facing the clinician, the shank is straight.

-Used on anterior teeth and on easily accessible areas.

Complex shank design

A shank that is bent in two planes (front-to-back and side-to-side) to facilitate instrumentation of posterior teeth.

Shank Bends

The shanks of most periodontal instruments are bent in one or more places to facilitate placement of the working-end against the tooth surface.

rigid shank

an instrument shank that will withstand the pressure needed to remove heavy calculus deposits

Flexible shank

An instrument shank that will not withstand the pressure needed to remove heavy calculus deposits but works well to remove small and medium-sized calculus deposits

Visual Information

Is of limited use when using instruments beneath the gingival margin since the clinician cannot see the working-end hidden subgingivally

Tactile Sensitivity

The clinician's ability to feel vibrations transmitted from the instrument working-end with his or her fingers as they rest on the shank and handle.

Functional shank

the portion of the shank that allows the working-end to be adapted to the tooth surface

Lower shank

the portion of the functional shank that is nearest to the working-end; also called the "terminal" shank

Simple shank with short functional length

supragingival use on anterior teeth

Simple shank with long functional length

subgingival use on anterior teeth

Complex shank with short functional shank length

supragingival use on posterior teeth

Complex shank with long functional length

subgingival use on posterior teeth

Paired & Unpaired Working-Ends

Unpaired have dissimilar working-ends

Paired have mirror image working-ends

Design Name

Identifies the school or individual originally responsible for designing or development an instrument or group instruments (Gracey)

Design Number

a number designation that when combined with the design name provides an exact identification of the working end

*Working end is identified by number closest to it

Face and Back

-The shaded surface on this illustration is the face.

-The surface opposite the face is the back of the

working-end.

Lateral surfaces

The surfaces of the working-end on either side of the face

Cutting edge

Is a sharp area of the working-end formed where the face and lateral surfaces meet

Rounded Toe

The cutting edges of a curet meet to form a rounded toe

Pointed Tip

The cutting edges of a sickle scaler meet at a point called a tip

Periodontal Probe

Probe used to locate and measure the depth of periodontal pockets; tapered to fit into the gingival sulcus with a blunt or rounded tip

Explorer

Is an assessment instrument used to locate calculus deposits, tooth surface irregularities and defective margins on restorations

- Explorers have flexible shanks and are circular on a cross section

Sickle Scaler

A periodontal instrument used to remove calculus deposits from the crowns of the teeth

- The working-ed of a sickle scaler has a pointed back, pointed tip and is triangular in a cross section

Curet

used to remove calculus deposits, semi circular in cross section, rounded toe, rounded back

- Two curet subtypes are the universal curet and area-specific curet

Thoracic Outlet Syndrome

Compression of the brachial nerve plexus, and vessels, causing discomfort in finger, hand or wrist

Caused by tilting head forward, hunching, or continuously reaching.

rotator cuff tendinitis

Inflammation of tendons in the shoulder, often casued by holding the elbow above waist level

Pronator syndrome

A disorder of the wrist due to compression of the median nerve, caused by holding the lower arm away from the torso

Extensor Wad Strain

A painful disorder of the fingers as a result of injury to the extensor muscles, often caused by extending fingers

carpal tunnel syndrome

compression of the median nerve in the wrist and hand, caused by bending the hand up and down or side to side, and pinch gripping

Ulnar Nerve Entrapment

Compression of the ulnar nerve in the lower arm and wrist, caused by bending the hand up and down or side to side and holding the little finer full span away from the hand

tenosynovitis

Inflammation of tendons on the side of the wrist and base of the thumb, often caused by gripping

Tendonitis

Inflammation of tendons, often casued by moving the hands up and down

Periodontal Instrumentation

a complex psychomotor skill that involves the precise execution of many individual component skills

Neutral Neck Position

- Goal: head tilt of 0 to 15 degrees

- AVOID: Head tipped too far forward, Head tilted to one side

Neutral Back Position

Goal: leaning forward slightly from the waist or hips.

Avoid: curved back.

neutral torso position

Goal: Torso in line with long axis of the body

avoid: leaning torso to one side and twisting the torso

Neutral Shoulder Position

Goal: shoulders even.

Avoid: shoulders hunched up toward ears.

Neutral Upper Arm Position

Goal: elbows at waist level held slightly away from the body.

Avoid: elbows held at or above waist level.