Dental Hygiene: Instrumentation Techniques and Risk Assessment

Calculus Removal Instruments

Types of Strokes

  • Assessment:

    • Characteristics: Light, feather-like, long overlapping strokes.

  • Debridement:

    • Characteristics: Moderate shaving strokes; removes plaque and very thin areas of calculus.

  • Calculus Removal:

    • Characteristics: Firm, short biting strokes; effective for removing moderate to heavy calculus.

Types of Instruments

  • Sickles

  • Universal Curets

  • Area-Specific Curets

General Design Characteristics

Sickle

  • Components:

    1. Shank

    2. Back

    3. Tip

    4. Face

    5. Lateral Surfaces

    6. Cutting Edges

Curet

  • Components:

    1. Shank

    2. Back

    3. Toe

    4. Face

    5. Lateral Surfaces

    6. Cutting Edges

    • Universal and area-specific types exist.

Specific Design Characteristics

  • Sickle:

    • Blade angle: 90°

  • Scaler:

    • Blade angle: 90°

  • Universal Curet:

    • Blade angle: 70°

  • Area-Specific Curet:

    • Blade angle: 70°

Application of Sickles

  • Used specifically for anterior and posterior areas.

  • Functionality:

    • Effective on all surfaces (D, F/B, M, L).

  • Application:

    • Designed for supra and slightly subgingival use on enamel only.

  • Design features:

    • Standard/rigid shank for removal of medium to large calculus deposits.

    • Lower shank must be angled towards the tooth surface for proper angulation.

Choosing the Correct Working End for Anteriors & Posteriors

  • Correct Placement: Terminal shank parallel with the long axis.

  • Incorrect Placement: Auxiliary shank placements.

Universal Curets

  • Applications:

    • Designed for use in both anterior and posterior teeth.

    • Compatibility with all surfaces.

    • Usability in supra and subgingival conditions.

  • Design Characteristics:

    • Standard shank is typically more rigid than area-specific curets; enhances effectiveness against calculus.

Area-Specific Curets

  • Characteristics:

    • Specifically designed for both supra and subgingival use.

    • Require two instruments for each aspect of a posterior tooth (one per surface).

    • One instrument for anterior teeth utilizing both ends.

    • The standard shank is flexible; effective for light to moderate calculus removal.

    • Lower shank designed to be parallel to the tooth surface for a proper 70-degree angulation.

Gracey Curet Series

  • Gracey 1/2: Anterior teeth all surfaces.

  • Gracey 7/8, 9/10: Anterior teeth all surfaces (crowding) and posterior line angle to line angle.

  • Gracey 11/12, 15/16: Posterior teeth facial, lingual, and mesial surfaces.

  • Gracey 13/14, 17/18: Posterior teeth distal surfaces.

Instrument Application for Posterior & Anterior Teeth

  • For posterior teeth:

    • Use two double-ended instruments for both facial and lingual aspects of a sextant.

    • “Do not flip ends” to switch from distal to mesial.

  • For anterior teeth:

    • One instrument can accomplish complete coverage; similar directional use of ends as noted in explorers.

Specific Instrumentation Strokes

  • Assessment Stroke: Light, controlled for evaluation.

  • Calculus Removal Stroke: Short, precise strokes used for effective calculus extraction.

  • Debridement Stroke: Lighter, longer stroke to clear plaque biofilm and thin calculus remnants.

Calculus Removal Stroke Positioning

  • Neutral Positioning: Ensure correct clock positions, chin, chair, and head alignment.

  • Grasp: Adopt modified pen grasp without splitting; light until ready to activate stroke.

  • Fulcrum: Only intraoral within the sextant, close to the working area.

Stroke Activation

  • Movement transition achieved by pivoting on the fulcrum; utilizes wrist and forearm motion.

  • Angles:

    • Insertion angle: (0−40exto)(0 - 40^ ext{o}) between the instrument face and tooth surface.

    • Activation angle: (60−80exto)(60 - 80^ ext{o}) for effective calculus removal.

Common Mistakes and Reminders

  • Incorrect Angulation Effects:

    • Leads to misdirected cutting edges, slipping, and potential laceration.

  • Practice correct adaptation, confirming toe/tip engagement and preventing discomfort.

Assessing Instruments

  • Hold handles perpendicular to the floor to differentiate instruments.

  • Observe tips; pointed means sickle, rounded indicates curet.

Gingival Assessment and Description

  • Differentiate between health vs. disease states in gingiva.

  • Record characteristics: color, size/shape, texture, and consistency relevant to both healthy & diseased states.

    • ex: Healthy: pink, snug margins; Diseased: red, enlarged margins.

Fluoride Application Techniques

  • Armamentarium Required:

    • Prophy paste, prophy angle, handpiece, dental floss, gauze, mouth mirror, saliva ejector, air/water syringe, disclosing solution, cotton tipped applicators.

  • Procedure:

    1. Identify contraindications and provide patient overview.

    2. Position patient supine for comfort.

Important Points

  • Fluoride Applications:

    • Types include sodium fluoride (2% and 5%), stannous fluoride (8%), acidulated phosphate fluoride (1.23%), and silver diamine fluoride (38%).

    • Contraindications are critical; review patient’s health history for allergies and potential complications.

Power Scaling/Ultrasonics

  • Utilizes powered instruments for efficient biofilm, calculus, and stain removal.

  • Two classifications:

    1. Sonic: Operates at low frequencies; driven by air from the dental unit.

    2. Ultrasonic: Functions between 25,000 - 50,000 cycles/second; includes two subtypes:

    • Piezoelectric: Electrically powered by ceramic crystals.

    • Magnetostrictive: Electromagnetic energy activates metal stacks to vibrate.

  • Cleaning Mechanisms:

    1. Mechanical removal and water lavage; maintain control over the adjustments and application.

Risk Assessment and Management

  • Goal: Identify and mitigate hazards or risks leading to conditions like periodontal disease or dental caries.

  • Procedure: Follow ADPIE framework in clinical practice for effective delivery and risk management.

Conclusion

  • Reinforce proper techniques for scalers and curets to ensure effective patient care while maintaining safety rules and patient comfort.

  • Stay updated on the innovations in dental instruments and techniques for enhanced treatment effectiveness and patient outcomes.