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