Sim. Lab Activity 2 Working in Balance (WIB): Access, Visibility and Isolation JANET WEBER, RDH, M.Ed.

Working End Shank Handle

Three Types of Dental Mirrors Front Surface (Eliminates “ghost” images) Plane Surface ( May produce a double image) Magnifying (concave surface)

Various sizes of mirrors available: Identified by numbers.The larger the number, the larger the mirrors diameter. Range from 5/8 to 2 inches in diameter Handles have different sizes also.

Rational for AVI (Access, Visibility & Isolation) Allows to safely and accurately perform procedure

Mouth mirror has several uses Indirect Vision-allows clinician to see surfaces he/she is working on. For example: distal surfaces of posterior teeth and lingual surfaces of anterior teeth. Illumination- Reflection of from the dental overhead light to any area of the oral cavity can be accomplished by using the mouth mirror.

Transillumination Reflection of light through the teeth from the lingual aspect while the clinician veiws the facial aspect. Retraction The mirror is used to protect or prevent interference by the cheeks, tongue, or lips.

Technique Grasp: Nondominant hand Modified Pen Grasp 1. Grasp the handle of the mirror between the pads of the thumb and the index finger. 2. With the side of the middle finger against the shank.

Warm water, rub along the buccal mucosa to coat mirror with saliva, detergents also available. – Minimize fog….

Air/Water Syringe Purpose: enhance visibility, improve instrument stabilization, dry intra-oral structures and remove saliva and debris Compressed air/ super soaker Technique: Held in the dominant hand in a palm grasp. In this grasp, all four fingers contact the handle in the palm of the hand while the thumb is used to activate the syringe. Supplement air drying with the use of saliva ejector or folded gauze or cotton rolls in the vestibule

Tips disposable/sterilized Test buttons outside of the patients mouth. Use short controlled blasts of air/avoid sharp blasts of air

Forceful application of air may direct saliva and debris out of the oral cavity contaminating work area and operatory and creating aerosols. Directing air toward the back of patients throat could cause coughing or discomfort. Remember we sterilize the tip and disinfect the handle.

Gaining Access and Visibility Bite blocks Tongue blades Saliva ejector

Do you need another break?

Now- Let’s learn a little about Grasp and Fulcrum

Technique Establish proper grasp and fulcrum Remember grasp is modified pen grasp Insert mirror head parallel to the occlusal plane and either moving right or left bring over occlusal surface of teeth once touch the buccal mucosa, turn the face of the mirror toward the soft tissue.

Modified Pen Grasp The modified pen grasp with both first and second fingers holding the handle, opposed by the thumb. The third finger is in position to rest on the tooth to create stability and to act as a finger rest to move the instrument and hand as a unit.

Pen Grasp Typical pen grasp, with the thumb and index finger grasping handle. The middle finger supports the instrument from underneath. The pen grasp varies from person to person.

Modified pen Grasp The modified pen grasp uses the pads of the thumb and index finger, with the side of the middle finger against the shank or placed lower on the handle.

Modified pen grasp pen grasp

Grasp Thumb and index fingers are across from one another at the junction of the handle and shank Slight bend in the index finger Pad of fingers should be in contact All fingers should stay in contact No blanching (white nuckles)

Fulcrum -stabilization Provides leverage for stroke Point where all movement comes from Helps control stroke Maintains regular amounts of pressure Prevents trauma Controls length of stroke Transmits a feeling of security to patient

Fulcrum Place fulcrum as close to the working area as possible Should be in the same arch or quadrant Use firm pressure ALWAYS use fulcrum!

Fulcrum When working on the maxillary arch – Palms Up When working on the mandibular arch- Palms Down

Problems Missing teeth- – Use gauze Strong lips or tongue – Use cotton roll Person can only open half way – Use mirror for indirect vision, etc.

Avoid hitting patients teeth Avoid excess pressure on the floor of the mouth

Mirror Technique May need to be tipped toward the maxillary or the mandibular arch for better illumination Review: Direct- light on area being observed Indirect-light near area or mirror reflects light onto area Transillumination- light reflects from mirror through the tooth surface