Mirror, Fulcrums, and Instrument Handle Positioning
Presented by:
Michelle R. Mould, RDH, MSDH Ed.
Objectives
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Identify and describe 3 common types of
dental mirrors
Define and demonstrate 4 uses of dental
mirrors
Explain the difference between a finger rest
and a fulcrum
Describe the characteristics of intraoral and
extraoral fulcrums
Review instrument handle positions for each
area of the mouth
Maintain neutral positioning during all aspects
of instrumentation
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Dental Mirror
Three types:
O Front surface
O Concave
O Plane or Flat surface
3
What Are Dental Mirror Uses?
O Retraction
O Indirect vision
O Indirect
illumination
O Transillumination
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Mirror Insertion
O Enter from straight
over patient chest
O Reflecting surface
always up
O Move between arches
into cheek
O Roll handle and
retract – “loosen”
cheek
O Establish rest
5
Be Careful NOT to:
OUCH – This hurts!!
O Hit teeth
O Pull against corner
of mouth
O Rest mirror head on
gingival tissues or
bone
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Techniques
O Reflecting surface
always towards teeth
O Double sided mirrors
you will LOVE these!
O Direct vision whenever
possible
O Indirect vision *Most
important!
O Defog
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This is CRITICAL. What is it?
O Wrist aligned with forearm
O “Pinky” side of palm rotated slightly
downward
O Fingers held with light pressure and rounded
O Prevents musculoskeletal injuries
O Just as important for NON-DOMINANT hand
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Neutral Hand Position
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Mirror Rest
O Tooth or area where hand or fulcrum finger
is placed to give stability
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Fulcrum O Intraoral or Extraoral
O Stability, support, balance
O Enables hand and instrument to move as unit
O Precise control of instrument stroke
O Decrease likelihood of injury to patient or clinician if
patient moves suddenly
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Extraoral vs. Intraoral
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Excess Pressure on Fulcrum
O Decreased stability
and control
O Over-tightened grasp
O Operator fatigue in
fingers, hand
O Patient fatigue
O TMJ, muscles
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Compressed Air
O What are the
benefits of using
compressed air
during an oral
examination?
O What grasp is used
with the air/water
syringe????
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Compressed Air
O What precautions do
you need to take
when using
compressed air in
the oral cavity?
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Instrument Handle Positions
O K1, K2, K3, “V”
O Palm-up vs. Palm-down (knuckles up/down)
O Mandibular anteriors – handle extends upward
O Maxillary anteriors – handle extends downward
O Mandibular and maxillary posteriors –
handle/knuckle placement is important - Review
Nield Text
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Operator Positioning
O Neck
O Back
O Shoulders
O Legs
O Feet
O Upper arm
O Forearm
O Wrist
O Hand
O Fingers
Positioning is very important in everything you!
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References
O Dong, H., Barr, A., Loomer, P., & Rempel, D., (2005).
The Effects of Finger Rest Positions on Hand Muscle
Load and Pinch Force in Simulated Dental Hygiene
Work, Journal of Dental Education. 69(4), 453-460.
O Nield-Gehrig, J.S., (2013). Fundamentals of
Periodontal Instrumentation and Advanced Root
Instrumentation, 7th Ed.
O Wilkins, E.M., (2013). Clinical Practice for the Dental
Hygienist. 11th Ed.
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