explorer

Objectives

• The main goal is to understand what an explorer instrument does and to identify its different designs.

• We will learn about the unique characteristics of each explorer design and discuss their advantages or limitations.

• It's important to recognize the visual signs that help dental professionals choose the correct working end of the explorer for specific areas in the mouth.

• We will also describe the features of an 'assessment stroke,' which is used for detection.

• Finally, we will learn the goals, steps, and correct ways to record various patient assessments, understanding how they fit into providing complete patient care. These assessments include:

  • Medical, dental, and social history (understanding the patient's background).

  • Vital signs (checking basic body functions like blood pressure).

  • Exams outside and inside the mouth (looking for problems visually).

  • Examinations of hard tissues (checking teeth for issues).

  • Periodontal examinations (checking gums and supporting structures).

  • Risk assessments (identifying potential health risks).

  • Necessary radiographs (X-rays).

Function of the Explorer

• An explorer is a dental tool used for checking teeth; it has a flexible, thin, wire-like end.

• This tool is made from a bendable metal that can transfer tiny vibrations from its tip to the clinician's fingers, allowing them to 'feel' the tooth surface.

• Explorers are used to find different things on and around the teeth, such as:

  • Calculus deposits located below the gum line (also known as tartar).

  • Unusual or abnormal features of the teeth (dental anomalies).

  • The natural shapes and structures of the teeth (anatomic features).

  • Evaluating existing dental restorations (fillings, crowns), checking for tooth decay, and assessing sealants (protective coatings).

Parts of the Instrument

• Tip: The very end part of the explorer that touches the tooth surface is called the tip. Only about 1 to 2 millimeters of its side are used to detect calculus deposits.

  • On some explorers, like the 11/12 type, this tip is angled at a 90-degree bend to the part connected to it, which is useful for going under the gum.

  • It's important to remember that the sharp point of the explorer is generally not used for detection; rather, it's the side of the tip that is adapted to the tooth.

• Lower Shank: This is the section of the explorer's handle that is closest to the explorer tip.

Designs of Explorers

• Explorers come in many different shapes and sizes, and dental professionals need to know when and how to use each basic type.

• Not all explorer designs are suitable for use under the gum line (subgingival areas).

• Some common types include:

  • Pigtail and Cowhorn designs.

  • Orban type.

  • 11/12 type.

Pigtail Explorer

• This explorer gets its name because its working end looks like a pig's tail or a bull's horns.

• It is mainly used to find calculus in gum pockets that are normal or shallow, meaning they don't go deeper than the top third of the tooth root.

• Disadvantage: A problem with this design is that its curved lower shank can pull the gum tissue away from the root surface, which might make it harder to feel small deposits effectively.

Orban-Type Explorer

• The Orban-type explorer is easily recognized by its tip, which is bent at a 90-degree angle to a straight lower shank.

• It is used for:

  • Detecting calculus under the gum line on the front surfaces of anterior teeth.

  • Checking the cheek-side (facial) and tongue-side (lingual) root surfaces of back teeth (posterior teeth).

• Advantage: Its bent tip allows the smooth, rounded back of the tip, not the sharp point, to be gently pressed against the soft tissue at the bottom of the gum pocket or sulcus.

• Disadvantage: The straight design of its shank makes it challenging to use effectively on the corners (line angles) and the side surfaces (mesial and distal) of posterior teeth.

11/12-Type Explorer

• This explorer features a tip bent at a 90-degree angle to the lower shank, combined with a long, intricate shank design that has several curves.

• Benefits:

  • Its complex shank design makes it easy for the explorer to reach all surfaces of both front and back teeth, including deep areas.

  • The smooth back of its tip is designed to stay in constant contact with the soft tissue at the base of the gum sulcus or pocket, preventing injury.

• Usage: This explorer is highly effective and versatile; it can be used throughout the entire mouth, whether the gum pockets are healthy and shallow or deep due to periodontal disease. It adapts well to different pocket depths.

Assessment Stroke

• An assessment stroke, also called an exploratory stroke, is a specific movement used to feel and find calculus deposits or any other rough spots on the tooth surface.

• When working under the gum line with dental instruments, the clinician relies heavily on their sense of touch (tactile sensitivity) to locate calculus deposits that cannot be seen because they are hidden beneath the gum edge.

• Tactile sensitivity: This refers to the dental professional's ability to feel and identify irregularities on the tooth, such as calculus deposits. These sensations are transferred as subtle vibrations from the explorer tip, up through the instrument's shank, and into the handle, where they are felt by the clinician's fingers.

Subgingival Exploring

• When performing assessment strokes under the gum line, they should be:

  • Many short, overlapping strokes are used to cover the entire area thoroughly.

• Grasp: The instrument should be held with a relaxed grip, and the middle finger should rest lightly on the shank to maximize tactile sensitivity.

• Adaptation: Only 1 to 2 millimeters of the side of the explorer's tip should be kept in contact with the tooth surface to optimize sensitivity.

• Lateral Pressure: Apply very light, feather-like pressure against the tooth surface.

• Strokes: Use smooth, continuous sweeping motions, making sure the explorer tip remains in contact with the tooth root surface at all times during the stroke.

• Stroke length: Each individual stroke should be short, about 2 to 3 millimeters long. Many overlapping strokes should be used in multiple directions to ensure complete coverage of the root surface.

Technique Errors in Exploring

• Common errors to avoid include:

  • Do not hold the explorer with a tight, tense grip, sometimes called a “death grip.”

  • Avoid pressing too hard with your middle finger on the shank of the instrument.

• Both of these errors will reduce the important tactile information that is felt by your fingers, making it harder to detect irregularities.

• Tip management: It is crucial not to pull the explorer tip out of the gum sulcus or pocket while making an upward stroke. The tip must always remain beneath the gum line because repeatedly removing and reinserting it can damage the delicate gum tissue.

Exploring Proximal Surfaces

• When exploring the side surfaces of teeth (proximal surfaces), always ensure that the explorer tip is leading the movement.

• Avoid moving the explorer backward or “backing” into a proximal surface. Leading with the tip ensures that the strokes effectively reach underneath the contact area where teeth touch each other.

Tooth Surface Sequence Steps

1. Step 1: Begin at the distofacial line angle (the corner where the back and cheek-side surfaces meet) and work your way towards the distal surface. This starting point is often called the “GET READY ZONE.”

2. Step 2: Gently lower the instrument handle to insert the explorer beneath the gum margin. Make very light, feather-light strokes as you move towards the distal surface of the tooth.

3. Step 3: As you get closer to the distal surface, slightly roll the instrument handle between your fingers. This small adjustment helps maintain proper adaptation of the explorer tip to the curved tooth surface.

4. Step 4: Position the explorer tip in the middle third of the tooth's crown, preparing to explore the facial (cheek-side) and mesial (front-side) surfaces.

5. Step 5: Again, lower the instrument handle and gently insert the explorer beneath the gum margin. Perform a series of feather-light strokes across the entire facial surface.

6. Step 6: As you approach the mesiofacial line angle (the corner where the front and cheek-side surfaces meet), roll the instrument handle again. This action helps maintain the correct adaptation of the tip.

7. Step 7: Explore at least halfway across the mesial surface, always approaching from the facial aspect.

Common Types of Calculus Formations

• Calculus (tartar) can form in different shapes and sizes, including:

  • Spicules: Small, isolated pieces of calculus.

  • Ledge: A continuous, shelf-like band of calculus.

  • Ring: A continuous band of calculus encircling the tooth.

  • Veneer: A thin, smooth coating of calculus on the tooth surface.

Normal Conditions

• When the tooth surface is smooth and healthy under normal conditions, your fingers will not feel any bumps or roughness as the explorer passes over it.

Small Calculus Deposits - Spicules

• When the explorer moves over small calculus deposits, you will feel a gritty sensation, much like the feeling of “inline skating over a few tiny pieces of gravel.”

Large Ledge of Calculus

• If there is a large ledge of calculus, the explorer tip will feel like it goes up and over a raised bump and then returns to the tooth surface. This sensation is similar to “skating over a speed bump in a parking lot.”

Overhanging Restoration

• An overhanging restoration means that a filling or crown extends beyond the natural curve of the tooth. When the explorer encounters this, it will have to move away from the tooth surface and over the edge of the restoration, which can be imagined as “skating over a part of a sidewalk that is higher than the section next to it.”

Deficient Margin on Restoration

• A deficient margin on a restoration means there's a gap or depression where the filling or crown meets the tooth. The explorer tip will dip down into this area to trace the outline of the restoration, feeling similar to “skating onto a section of pavement that is lower than the surrounding pavement.”

Carious Lesion

• A carious lesion, or a cavity, is a decayed area on the tooth. When the explorer tip reaches a carious lesion, it will dip into a rough depression. You can think of this sensation as “skating into a pothole.”

Compressed Air for Calculus Detection

• Using compressed air is a helpful way to visually check for calculus. When supragingival calculus (above the gum line) is dried with air, it often appears rough and chalky, making it easier to spot.

Detection of Dental Caries

• A carious lesion is simply an area on the tooth's top (crown) or root that has decayed.

  • In the past, sharp explorers were commonly used and sometimes even pushed into pits or grooves on teeth to find decay.

  • It is extremely important to find the disease process of caries very early on to stop it from getting worse. Detecting caries when it is still in the 'noncavitated' stage (before a hole forms) is crucial because at this point, the tooth might still be able to repair itself through remineralization.

Cavitated Versus Noncavitated Lesions

• Cavitated lesion: This type of lesion means that the outer layer of the tooth crown or root surface has been lost, forming a physical hole or defect. These usually need to be repaired with a dental filling or restoration.

• Noncavitated lesion: This is an early stage of decay where the tooth has lost some minerals (demineralization) but a physical hole has not yet formed. These lesions are often reversible or can be stopped from getting worse with proper treatment, such as fluoride application.

Caries Detection Aids

• Currently, no single specialized method can perfectly detect all types of carious lesions every time.

• Visual signs, however, remain effective for finding decay in both the enamel (outer layer) and dentin (inner layer) of the tooth.

• Effective ways to detect caries today include looking at the tooth (visual detection), using X-rays (radiographs), employing laser fluorescence technology, and using electrical caries measurements.

Prerequisites for Early Caries Diagnosis

• To accurately diagnose caries early, several essential conditions and tools are needed:

  • Good, bright lighting is necessary to see the tooth clearly.

  • Tooth surfaces must be clean, free from sticky biofilm and any other deposits.

  • A three-way syringe (dental air/water syringe) should be used to view the tooth both when it is wet and when it has been dried with air.

  • The dental professional must have sharp eyesight to spot subtle changes.

  • A blunt explorer or a periodontal probe should be used for examination, as sharp explorers are generally avoided for caries detection today.

  • Bitewing radiographs (a specific type of X-ray) are also important for seeing decay between teeth.