Lecture 4:Dental instruments and equipment

Question 1

4 main types of hand instruments

Answer 1

Periodontal probe
Explorer
Scaler (supragingival curette)
Curette (subgingival curette)

Question 2

4 parts of the dental instrumnets

Answer 2

Handle– the part you grasp
Shape used depends on personal preference
Shank– joins working end to the handle
Length and curvature determines the teeth instrument able to access
Terminal shank– part of shank closest to the working end
Working end– portion of instrument that comes in contact with the tooth

Question 3

What do the numbers on the sides of dental instruments mean

Answer 3

When the design name and number are stamped along the length of the handle, each working end is identified by the number closest to it.
When the design name and number are stamped around the instrument handle, the first number (on the left) identifies the working end at the top and the second number identifies the working end at the bottom of the handle

Question 4

Explorers are used for

Answer 4

Usually found on a double ended hand held instrument with the dental probe on the opposite end
Used to
detect plaque and calculus
explore for cavities and tooth resorption
check for exposed pulp chambers

Question 5

Explorers function by

Answer 5

Function by gliding along the tooth surface searching for irregularities
Its design increases operator’s tactile sensitivity

Question 6

2 main types of explorers

Answer 6

Shepherds hook (most common)
Pigtail explorer– curved so only the tip can come in contact with the tooth

Question 7

Periodontal probes are

Answer 7

Several different varieties available each with a different system of calibrated measurement (see text)
may be colour coded
Used to determine the amount of gingival pocketing

Question 8

Function of gingival probes and how to use it

Answer 8

Function = determines depth of the sulcus
Inserted into gingival crevice and is gently walked along the entire circumference of the tooth
Weight of the instrument only!

Question 9

Scalers are used for

Answer 9

Have 3 sharp sides and a sharp tip
Function = used for scaling calculus from the surface of the crown
Useful in removing calculus from narrow but deep fissures
Such as on the buccal surface of the 4th premolar
Scalers are used for supragingival calculus removal only!
Use subgingival can result in damage to the gingiva and periodontal ligaments
The ends of the instrument are mirror images so can be used on opposite tooth surfaces

Question 10

Scalers are composed of

Answer 10

Sharp tip
The face
Lateral surface
Cutting edge – working part of the scaler

Question 11

What do scalers look like

Answer 11

As with all hand instruments, scalers must be sharpened regularly, to be effective
Several types of scalers exist (see text)
Most common is the sickle scaler
Denoted as H6/7; S6/7 or N6/7 depending on the manufacturer
The end of the scaler is hooked behind the calculus and the instrument is pulled toward the tip of the crown
This pulls the calculus and all fragments away from gingival margin
Calculus should NEVER be pulled towards the gingiva!

Question 12

Curettes are used for

Answer 12

Used for the removal of both supragingival and subgingival calculus

Question 13

Curettes look like

Answer 13

Have 2 sharp sides and a rounded toe
The point of the curette (the toe) is rounded
The face of the curette is the concave side
The cutting edge is the edge between the lateral surface and the face
Curettes have a rounded back
Designed so that each end is a mirror image

Question 14

2 types of curettes

Answer 14

Universal curette – can be adapted to almost all dental surfaces
Area specific curette – adaptable to different areas of the mouth
i.e. – Gracey curette
The higher the number of the instrument, the further back in the mouth it is used

Question 15

Calculus removal forceps function and looks like

Answer 15

Function : used initially to remove large pieces of gross calculi
Has tips of different lengths and shapes
Longer tip placed over the crown; shorter tip placed under the calculus
Calculus is sheared off tooth when handles are brought together
Caution must be used to ensure the enamel surface of the tooth or the gingiva are not damaged

Question 16

Why keep dental instruments sharp

Answer 16

Dental instruments should be kept sharp and true to their original design
Dental procedures are most effective when using sharp instruments because:
reduces fatigue
improves deposit removal
saves time
improves tactile sensitivity
minimizes patient discomfort

Question 17

When to sharpen dental instruments

Answer 17

Repeated use of a dental instrument wears away minute particles of metal from the blade causing the cutting edge to take on a rounded shape resulting in a dull, ineffective blade.
A dull blade results in the loss of ability to “feel” the sharp edge “grabbing” onto a surface.
It may then seem that the blade is “sliding” over the surface or deposit which means you have to work harder to remove deposits.
For best results, dental instruments should be sharpened lightly after each use rather than reconditioning or recontouring after repeated use.

Question 18

Curette and scaler care

Answer 18

Working edge can be dulled as a result of constant use and through steam sterilization
Sharpen each instrument after cleaning and disinfecting and before each use
Cleaning:
Rubber gloves should be used while cleaning instruments
Scrub the instrument using a scrub brush and detergent, under cold water
Use hot water to rinse the detergent off
Dry
Alternatively, ultrasonic instrument cleaners may be used
Ideally, several instrument packs should be available so that the instruments can be cleaned, sharpened, and sterilized between uses.
Sterilization reduces the risks of cross-infection among patients and from patient to staff members
If an instrument is sharp, its two planes come together at a precise angle
Visual inspection and sharpening sticks are appropriate methods to check for sharpness

Question 19

Sharpening equipment

Answer 19

Stone(s)
Lubrication
Safety equipment
Instruments to be sharpened

Question 20

Flat stones are

Answer 20

Arkansas
India
Ceramic

Question 21

Arkansas stone

Answer 21

Arkansas stone- used for final sharpening of an instrument that is already close to sharpness

Question 22

India stone

Answer 22

India stone- used for “coarse” sharpening of an overly dull instrument or for changing the plane of one or more of the sides of the instrument

Question 23

Ceramic stone

Answer 23

may also be used for fine sharpening
With ceramic stones, water is generally used instead of oil

Question 24

Steps in using flat stones

Answer 24

Sharpening with the India stone is followed by the use of an Arkansas stone
Both stones require oil for effective use

Question 25

Conical stone

Answer 25

A round Arkansas stone Used to provide a final sharpening to the instrument by working on its face

Question 26

3 principles of sharpening

Answer 26

establish the proper angle lubricate the stone wear safety glasses

Question 27

Why to establish the proper angle when sharpening

Answer 27

Before starting to sharpen, establish the proper angle between the stone and the surface to be ground The plane of the surface being ground should be used as a guide Do not tilt the stone so that it cuts unevenly across the surface being ground

Question 28

Why to lubricate the sharpening stone

Answer 28

This avoids unnecessary heat, which changes the temper of the instrument, making the steel softer A light touch is essential Excessive pressure will heat the edge, even though the stone is lubricated Sharpen the instrument at the first sign of dullness

Question 29

Why wear glasses when sharpening dental equipment

Answer 29

This is the most important principle or precaution ALWAYS wear safety glasses Metal particles and the lubricant will be flying through the air and inevitably will strike eyes or face The safety glasses are for your protection; WEAR THEM!

Question 30

How to test sharpness by visual inspection

Answer 30

The instrument is held and rotated towards a bright light source If the instrument is dull, the edge is rounded and reflects light If the instrument is sharp, the edge does not reflect light

Question 31

How to test sharpness on a sharpening stick

Answer 31

Use an acrylic or plastic rod, or syringe casing To test, the edge of the instrument is drawn across the rod A dull blade glides over the surface without catching at it A sharp blade easily catches as the instrument is drawn over the surface

Question 32

Power scalers are

Answer 32

Convert electrical or pneumatic energy into a mechanical vibration When the power scaler is placed against calculus, the vibration shatters it, freeing it from the tooth surface This vibration creates a tremendous amount of heat that can potentially damage the tooth The scaler comes equipped with a water delivery system which produces a fine jet spray that cools the tooth

Question 33

How to use a power scaler

Answer 33

The operator should use a light touch and keep the tip moving while traveling the circumference of the tooth, not stopping in any area Power scalers operate in the range of 8,000 to 45,000 cycles per second

Question 34

Types of power scalers

Answer 34

Ultrasonic scaler – converts sound waves into mechanical vibration Sonic and rotary scalers – convert air pressure into mechanical vibration

Question 35

How do ultrasonic scalers work

Answer 35

Ultrasonic instruments function in a way similar to that of 2 identically tuned tuning forks: When one is caused to vibrate, the other starts to vibrate in resonance Magnetostrictive and piezoelectric are 2 types of devices in the hand piece which can pick up the sound wave and turn it into a vibration

Question 36

Ultrasonic metal strips/stack work by

Answer 36

Vibrate at 18,000, 25,000 and 30,000 cycles per second Amplitude of tip movement in these units is between 0.01 and 0.05 mm (narrow motion) Generally, lower amplitudes are better because they cause less damage to the tooth Working tip is all sides, which results in an uneven motion and an elliptic pattern 2 lengths of inserts are available (remember when ordering and inserting!)

Question 37

Ultrasonic Ferroceramic Rod work by

Answer 37

Vibrate at 42,000 cycles per second Have an amplitude of 0.01 to 0.02 mm with a circular type motion (extremely narrow) All sides of the tip are equally active (about 13 mm of the tip)

Question 38

Ultrasonic and Combination Electric Motor Handpieces work by

Answer 38

Used for polishing and simple cutting of teeth Electrical motor handpieces are generally not as effective as the air powered high-speed and low-speed handpieces

Question 39

Piezoelectric works by

Answer 39

Uses crystals in the handpiece to pick up the vibration Frequency ranges from 25,000 to 45,000 cycles per second. Amplitude of these units is approximately 0.2mm, which results in a wide, back-and-forth tip motion (higher risk of damage to tooth) approximately 3 mm of the working tip is active Energy nodes: vibration energy is not distributed evenly down the tip of piezoelectric ultrasonic scalers Motion of the piezo tip is not uniform: tip moves farther in one direction than in the other, which means that during use the most active side of the tip must be placed on the part of the tooth where the calculus is to be removed

Question 40

Inserting magnetostrictive ultrasonic inserts

Answer 40

If a metal strip/stack unit is used, the unit must be turned on and the handpiece filled with water before insertion of the insert If a ferroceramic rod unit is used, it should be drained before insertion of the insert With either insert type, forcing the insert into a handpiece that is incorrectly set up can damage the insert

Question 41

Ultrasonic medicaments in irrigation solutions

Answer 41

Many piezoelectric and Magnetostrictive units have reservoirs for an irrigating solution A variety of solutions may be placed in the containers The most popular and effective solution is 0.12% chlorhexidine In-line reservoirs may be spliced onto the waterline, allowing irrigation solutions to be used in units that do not have their own containers An alternative is to use a garden sprayer “bug buster” for the water supply These units must be pressurized by hand

Question 42

Sonic scalers are

Answer 42

Operate at 6,000 cycles per second and have an amplitude of 0.5 mm (slow, wider motion) Motion is elliptic, in a figure eight motion All sides of these tips are active during cleaning, but cleaning may not be even Compressed air has a cooling effect so less likely to cause heat-related damage to teeth than ultrasonic cleaners

Question 43

How do sonic scalers work

Answer 43

Air enters sonic scaler, passes through the shaft, and exits from small holes on the shaft that are covered by a metal ring Air exits the hole at an angle and causes the ring to start spinning Because the ring doesn’t fit the shaft tightly, it begins to wobble This wobbling sets off a vibration that is transmitted down the shaft to the tip

Question 44

Two driving mechanisms used for polishing and drilling

Answer 44

electrical power air power

Question 45

Electrical power used for polish and drilling

Answer 45

Least expensive Operate at lower speeds than air powered but have higher torque (the ability to overcome resistance to movement) Cannot use water – unless an expensive unit

Question 46

Two types of air power for drilling and polishing

Answer 46

Air compressor→pumps air either directly into the dental unit or into a storage tank for slow release to the dental unit Compressed gas→either room air or nitrogen Because of the associated hazards, oxygen and carbon dioxide should not be used Oxygen is explosive and carbon dioxide may be toxic

Question 47

How air power uses for drilling and polishing

Answer 47

Take the room air and compress it to drive the handpieces Most work by pumping air into an air-storage tank The compressor pumps air into the tank until the pressure inside the tank reaches between 80 and 100 psi (pounds per square inch) Air is bled from the tank as it is used by the handpiece at a lower pressure, usually 30 to 40 psi When the pressure drops below the minimum pressure in the tank (around 60 psi) the compressor turns on again and refills the tank

Question 48

Air compressor care

Answer 48

Most air-compressor systems use oil for lubrication The oil level must be monitored frequently to ensure it is adequate, or the compressor can cease up Some systems use a dipstick for checking the oil; others have a porthole in the side of the oil reservoir Always use the type of oil recommended by the manufacturer Compression of air into the storage tank may cause condensation Air storage tanks have a drain cock that can be turned to let the water out of the tank Failure to do so not only can ruin the compressor it also allows water to fill the tank decreasing the effectiveness of the system

Question 49

Air compressor system handpieces

Answer 49

Low and high speed hand pieces

Question 50

Low speed air hand pieces

Answer 50

Polishing with prophy angles Performing other dental procedures with contra angles

Question 51

High speed handpieces in air power is

Answer 51

Cutting teeth during extractions Making access holes into teeth in root canal therapy

Question 52

All hand pieces in air power use

Answer 52

All handpieces use a rubber gasket to ensure a water-air tight seal Make sure the gasket is connected when connecting the handpiece

Question 53

Low speed attachments on air power

Answer 53

Prophy angle - allows the use of a prophy cup for polishing teeth during cleaning Special files - used for engine-driven root canals Slow-speed burs - for cutting and smooth restoration Contra angle - is used to change either the direction or speed of rotation

Question 54

Care for low speed handpieces

Answer 54

Must be lubricated at the end of use Lubrication is inserted first in the smaller of the two large holes using the oil or spray that comes with the handpiece WD40© may be sprayed into the handpiece every two weeks to remove residues, followed by the recommended lubricant Prophy and contra angles (attachments to the handpieces) Generally, prophy heads should be lubricated weekly with prophy angle lubricant Some prophy angles are self-lubricating Consult manufacturer’s instructions for correct procedures

Question 55

High speed handpieces work by

Answer 55

Turn at 300,000 to 400,000 revolutions per minute Used for cutting teeth for exodontics, making root canal entries, and other procedures

Question 56

two types of bur handpieces for high speed

Answer 56

Push button to open the chuck Bur is removed or replaced by pressing the button Chuck key to open the chuck Key is twisted counterclockwise to loosen and remove bur and clockwise to tighten

Question 57

Burs

Answer 57

Burs should be treated like sharps and disposed of in the sharps container They should be removed from the handpiece when not in use If the bur is removed from the handpiece a blank should be put in its place to prevent damaging the chuck if handpiece gets accidentally turned on

Question 58

Bur selection

Answer 58

It is very important that you know the type of handpiece that the bur is to be used in to prevent damaging the bur (ie: slow or high speed) Remember burs used for extractions and other treatments are the responsibility of the veterinarian There are several types of burs available (see text), which types are used depends on the skills of the veterinarian in your practice

Question 59

Care of high speed hand pieces

Answer 59

Lubrication Should be lubricated daily with a spray-type cleaner and lubricant recommended by the manufacturer Turbine maintenance Internal portion of the high-speed handpiece that spins at extremely high speeds

Question 60

Three way syringe do

Answer 60

Come with most dental units Two buttons: Water spray→ used to irrigate a tooth surface and clear away prophy paste, tooth shavings, and other debris Air spray→ used to dry the field Caution must be used to prevent flushing air into tissues; air can create subcutaneous emphysema, or enter a blood vessel creating an embolism Pressing both together creates a mist

Question 61

Lighting and magnification in dentals

Answer 61

“If you can’t see it, you can’t do it” Surgical lights produce a wide-ranging, even lighting A headlamp will give spotlighting Focal lighting is achieved by the use of fiber optic lights built into a handpiece Binocular eyeglasses produce the best type of magnification 3 powered magnification, with a focal length of between 15 and 18 inches, enlarges the subject without excess distortion

Question 62

Signs high speed hand pieces need to be replaced

Answer 62

Subject to wear over time and must be replaced – signs: Chuck won’t tighten around bur Increased noise or vibration Roughness when handling Intermittent stopping of handpiece Handpiece won’t function