Instrumentation Skills Flashcards
Carpel Tunnel aetiology
- Common stress injury occurring in the hand and upper arm.
- Repeated flexion and extension of the wrist.
- Simultaneous forceful finger pressure over a long period of time.
- Irritation of the flexor tendons.
- Results in mechanical injury to the median nerve.
Carpel Tunnel symptoms
- Tingling.
- Burning pain.
- Numbness in fingers.
- Weakened hand grip.
- Palm skin becomes dry and translucent.
- Radiates to forearm, elbow, upper arm, shoulder, neck, in later stages.
Carpel Tunnel risk factors
- Un-ergonomic instruments.
- Tight gloves.
- Cold vibration.
- Poor organisation of work.
- Inappropriate working conditions.
Carpel Tunnel prevention
- Use ergonomic instruments with large diameter.
- Slip free elastic handles.
- Light grip.
- Minimise extreme movements.
- Perform strengthening exercises.
- Rests.
- Appointment spacing.
Carpel Tunnel treatment
- Rest.
- Immobilisation of the wrist.
- Hydrocortisone injections.
- Low salt diet.
- Vitamin B.
- Surgery.
Ideal seating position
- Feet flat on floor.
- Thighs parallel to floor.
- Straight back.
- Head erect.
- Arms at waist level.
- Body weight evenly distributed.
Operator-Unit-Patient positioning
- Light at arms length but not near head of operator or patient.
- Too close gets in the way and generates heat.
- Low bracket table for visibility, and away from patient.
- Patients mouth level with operators waist.
Some sextants have 1 possible seating position. Some have 2. What are the reasons to learn both possible positions for some sextants?
- Surgery design may not allow for certain positioning.
- Patients arches and teeth vary in size and alignment.
- Some tooth surfaces difficult to reach from favourite position if they are rotated.
Seating positions
- Upright - Conversation and OHI.
- Semi upright - Medically compromised patients - Breathing difficulties, third trimester pregnancy, spinal or cardiovascual complaints.
- Supine - Scaling, RSD, treatment.
- Trendelenburg - First aid purposes.
Instrument grasps:
- Modified pen grasp.
- Palm grasp.
Instrument grasps provide…
- Maximum control of the instrument.
- Prevention of finger fatigue.
- Increase in tactile sensitivity.
Modified pen grasp used for
- Exploring.
- Probing.
- Scaling.
- Root planing.
- Holding the mirror.
Advantages of modified pen grasp
- Allows precise control of the instrument.
- Allows wide range of movement.
- Good tactile conduction.
No disadvantages.
Palm grasp used for
- Holding rubber dam forceps.
- Holding the triple syringe.
- Using the porte polisher.
Advantages of palm grasp
- Increases strength of grasp.
- Increases control of heavier instruments.
Disadvantages of palm grasp
- Limited range of movement.
- Limited tactile conduction.
Modified pen grasp finger placement
- Thumb and index finger hold the handle in a curved shape with light grip for easier rotation.
- Middle finger rests lightly on shank for tactile sensation and to guide the instrument. The side of the finger does not touch the shank.
- The ring finger is the fulcrum. It stabalises the hand. Keep straight in a locked position.
- Little finger serves no function or offers some support. Hold is a comfortable and relaxed manner.
Palm grasp finger placement
- All fingers hold the instrument.
- Thumb stabalises the hand in the patients mouth.
What is a fulcrum?
- The support or point of rest on which a lever turns in a moving body.
- The fulcrum is the tooth.
- The lever is the finger.
- The moving body is the instrument.
Indirect illumination
Using the mirror to illuminate an area.
Transillumination
- Reflection of light through teeth.
- Can reflect light from the overhead light through lower anterior teeth to see the translucency of enamel.
- Dental caries and calculus deposits appear opaque.
Instrument shank should be parallel to…
The long axis of the tooth.
Sickle scalers
- Sickle scaler H6/H7 - Supragingival calculus from interproximal surfaces 3-3.
- Posterior mini sickle S204 - posterior upper and lower teeth 4-8.
Chisel/push scaler
Supragingival calculus from interproximal surfaces of anterior teeth (mainly lower) 3-3.