Fundamentals of Periodontal Instrumentation & Advanced Root Instrumentation (Seventh Edition)

Module 5— Mirror and Finger Rests in Mandibular Posterior Sextants.

Fundamentals of Periodontal Instrumentation & Advanced Root Instrumentation

(Seventh Edition)

Lesson Plans

Module 5— Mirror and Finger Rests in Mandibular Posterior Sextants

Goals of the Lesson:

Cognitive: Students will identify correct positioning, mirror use, grasp, and finger rests in the mandibular posterior sextants.

Motor: Students will be able to demonstrate correct positioning, mirror use, grasp, and finger rests in the mandibular posterior sextants.

Affective: Students will understand the importance of proper positioning, mirror use, grasp, and finger rests to the safety of both patient and hygienist.

Learning Objectives:

The lesson plan for each objective starts on the page shown below.

5-1Position equipment so that it enhances neutral positioning...... 3

5-2Maintain neutral positioning when practicing finger rests in the mandibular posterior sextants...... 5

5-3While seated in the correct clock position for the treatment area, access the mandibular posterior teeth with optimum vision while maintaining neutral positioning. 7

5-4Demonstrate correct mirror use, grasp, and finger rest in each of the mandibular posterior sextants while maintaining neutral positioning of your wrist. 9

5-5Demonstrate finger rests using precise finger placement on the handle of a periodontal instrument...... 13

5-6Recognize incorrect mirror use, grasp, or finger rest, and describe how to correct the problem(s)...... 15

5-7Understand the relationship between proper stabilization of the dominant hand during instrumentation and the prevention of (1) musculoskeletal problems in the clinician’s hands and (2) injury to the patient. 17

5-8Understand the relationship between the large motor skills, such as positioning, and small motor skills, such as finger rests. Recognize the importance of initiating these skills in a step-by-step manner. 18

You Will Need:

Gather the following materials and teaching aids for the following lessons:

5-1A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument

5-2A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument

5-3A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument

5-4A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument;textbook module 5; Self Evaluation on page 156

5-5A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument

5-6PPt slides and projector

Legend:IB: Image Bank; PPt: PowerPoint; PF: Practical Focus; TT: Teaching Tip; Note: All ancillary assets can be found on the book’s companion website at: thePoint.lww.com/GehrigFundamentals7e.

Objective 5-1

Position equipment so that it enhances neutral positioning.Date:

Lecture Outline

/

Figures, Tables, and Features

/

Resources and

In-Class Activities

/

Outside Assignments

Evaluation

/

Instructor’s Notes

Content / Text page / PPt slide
Body Positioning
Clinician in correct “clock” position
Patient chair and head positioned
Light in proper place
Wrist position for instrumentation
Neutral wrist position
Correct grasp / 133, 135,
136, 139,
144, 147 / 5A 10-13 / Figures
Mandibular right posterior sextant, facial aspect: Position overview (rh)
p. 136, IB
Mandibular left posterior sextant, lingual aspect: Position overview (rh)
p. 136, IB
Mandibular left posterior sextant, facial aspect: Position overview (rh)
p. 139, IB
Mandibular right posterior sextant, lingual aspect: Position overview (rh)
p. 139, IB
Mandibular left posterior sextant, facial aspect: Position overview (lh)
p. 144, IB
Mandibular right Posterior sextant, lingual aspect: Position overview (lh)
p. 144, IB
Mandibular right posterior sextant, facial aspect: Position overview (lh)
p. 147, IB
Mandibular left posterior sextant, lingual aspect: Position overview (lh)
p. 147, IB
Tables
5-1: Reference Sheet: Mandibular Posterior Sextants, p. 142, IB (rh)
5-2: Reference Sheet: Mandibular Posterior Sextants, p. 150, IB (lh) / In-Class Activities
In a clinical setting, have students complete the technique practice for the mandibular posterior sextants. This objective and objectives 5-2, 5-3, 5-4 and 5-5 are all interrelated for success of the technique practice. Please refer to objective 5-4 for details about clinical technique practice.
Materials
A dental unit, clinician chair, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument
Resources
Online video at http//: thePoint.lww.com/GehrigFundamentals7e
Sources of dental manikins and periodontal typodonts include:
Kilgore International

and
Columbia Dentoform
/ Outside Assignments
.

Legend: IB: Image Bank; PPt: PowerPoint; PF: Practical Focus; TT: Teaching Tip; Note: All ancillary assets can be found on the book’s companion website at: thePoint.lww.com/GehrigFundamentals7e.

Objective 5-2

Maintain neutral positioning when practicing finger rests in the mandibularposterior sextants.Date:

Lecture Outline

/

Figures, Tables, and Features

/

Resources and

In-Class Activities

/

Outside Assignments

Evaluation

/

Instructor’s Notes

Content / Text page / PPt slide
Positioning
Ensure body, patient, and equipment are positioned correctly (large motor skills)
Nondominant hand
Establish finger rest for mirror hand
Dominant hand
Establish finger rest near tooth to be worked on
Evaluate finger rest
  • Stability
  • Straight fulcrum finger
  • Correct grasp
  • Correct positioning
/ 133, 142, 150 / 5A 5-8 / Figures
Flow Chart: Establishing a Finger Rest
p. 133, PPt 5A 15, IB / Resources
Phrases to Facilitate Teaching of Instrumentation (available online)
Suggestions for Problem Identification During Instrumentation (available online)
In-Class Activities
In a clinical setting, have students complete the technique practice for the mandibular posterior sextants. This objective and objectives 5-2, 5-3, 5-4 and 5-5 are all interrelated for success of the technique practice. Please refer to objective 5-4 for details about clinical technique practice. / Outside Assignments
Have students write a brief paragraph about the differences they anticipate between working in the anterior and posterior sextants.
After finishing this module, ask students to look at this paragraph again and discuss which of their assumptions were confirmed and which were incorrect.
Students may discuss concerns about the relative difficulty of working in the two areas. They may mention one area being more comfortable to work in than another area, or one being easier to see. Some students may enjoy working on molars, while other may prefer the anterior teeth.

Legend:IB: Image Bank; PPt: PowerPoint; PF: Practical Focus; TT: Teaching Tip; Note: All ancillary assets can be found on the book’s companion website at: thePoint.lww.com/GehrigFundamentals7e.

Objective 5-3

While seated in the correct clock position for the treatment area, access the mandibular posterior teeth with optimum vision while maintaining neutral positioning. Date:

Lecture Outline

/

Figures, Tables, and Features

/

Resources and

In-Class Activities

/

Outside Assignments

Evaluation

/

Instructor’s Notes

Content / Text page / PPt slide
Accessing the mandibular posterior sextants with optimum vision
Mandibular right posterior sextant
  • Facial aspect
  • Position: 9 o’clock (rh), between 1 and 2 o’clock (lh)
  • Retract buccal mucosa with mirror
  • Lingual aspect
  • Position: between 10 and 11 o’clock (rh), 3 o’clock (lh)
  • Use mirror to push tongue away gently so that lingual surfaces may be seen in mirror
Mandibular left posterior sextant
  • Facial aspect
  • Position: between 10 and 11 o’clock (rh), 3 o’clock (lh)
  • Retract buccal mucosa with mirror
  • Lingual aspect
  • Position: 9 o’clock (rh), between 1 and 2 o’clock (lh)
  • Use mirror to push tongue away gently so that lingual surfaces may be seen in mirror
/ 136-138, 139-141,
144-146, 147-149, / 5A 4–6 / Figures
Mirror –Mandibular right posterior sextant, facial aspect: (rh)
p. 137, PPt 5A 5-6, IB
Mirror -Mandibular left posterior sextant, lingual aspect: (rh)
p. 138, IB
Retraction-Mandibular left posterior sextant, facial aspect: (rh)
p. 140, IB
Mirror-Mandibular right posterior sextant, lingual aspect: (rh)
p. 141, IB
Mirror-Mandibular left posterior sextant, facial aspect: (lh)
p. 145, IB
Mirror-Mandibular right posterior sextant, lingual aspect: (lh)
p. 146, IB
Retraction-Mandibular right posterior sextant, facial aspect: (lh)
p. 148, IB
Mirror-Mandibular left posterior sextant, lingual aspect: (lh)
p. 149, IB
Tables
5-1: Reference Sheet:Mandibular posterior sextants (rh)
p. 142, IB
5-2: Reference Sheet: Mandibular posterior sextants (lh)
p. 150, IB / In-Class Activities
In a clinical setting, have students complete the technique practice for the mandibular posterior sextants. Objectives 5-1, 5-2, 5-3, 5-4 and 5-5 are all interrelated for success of the technique practice. Please refer to objective 5-4 for details about clinical technique practice.
Materials
A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument / Outside Assignments

Legend: Image Bank; PPt: PowerPoint; PF: Practical Focus; TT: Teaching Tip; Note: All ancillary assets can be found on the book’s companion website at: thePoint.lww.com/GehrigFundamentals7e.

Objective 5-4

Demonstrate correct mirror use, grasp, and finger rest in each of the mandibular posterior sextants while maintaining neutral positioning of your wrist. Date:

Lecture Outline

/

Figures, Tables, and Features

/

Resources and

In-Class Activities

/

Outside Assignments

Evaluation

/

Instructor’s Notes

Content / Text page / PPt slide
Correct mirror use
Hold mirror in nondominant hand
Usages
  • Indirect vision
  • Retraction
  • Usually cheek, buccal mucosa, or tongue
  • Indirect illumination
Correct grasp
Mandibular posterior teeth
  • Palm down
  • Handle rests on outside of index finger
Correct finger rest
Mandibular right posterior sextant
  • Facial aspect
  • Second molar
Right-handed rest: Occlusal surface
Left-handed rest: Occlusofacial line angle
  • First premolar
Right-handed rest: Incisal surface of a mandibular anterior tooth
Left-handed rest: Incisal edge of an anterior tooth
  • Lingual aspect
  • Second molar
Right-handed rest: Occlusal surface
Left-handed rest: Occlusofacial line angle
  • First premolar
Right-handed rest: Incisal edge of an anterior tooth
Left-handed rest: Incisal edge of a mandibular anterior tooth
Mandibular left posterior sextant
  • Facial aspect
  • Second molar
Right-handed rest: Occlusofacial line angle
Left-handed rest: Occlusal surface
  • First premolar
Right-handed rest: Incisal edge of an anterior tooth
Left-handed rest: Incisal surface of a mandibular anterior tooth
  • Lingual aspect
  • Second molar
Right-handed rest: Occlusofacial line angle
Left-handed rest: Occlusal surface
  • First premolar
Right-handed rest: Incisal edge of a mandibular anterior tooth
Left-handed rest: Incisal edge of an anterior tooth
Alternate positions and finger rests
  • Variations of basic skills for treatment areas difficult to access
/ 135–150, 151-153 / 5A 3–13, 16-21 / Figures
Mandibular right posterior sextant, facial aspect: Task 1—second molar, facial aspect (rh)
p. 137, IB
Mandibular right posterior sextant, facial aspect: Task 2—first premolar, facial aspect (rh)
p. 137, IB
Mandibular left posterior sextant, lingual aspect: Task 1—second molar, lingual aspect (rh)
p. 138, IB
Mandibular left posterior sextant, lingual aspect: Task 2—first premolar, lingual aspect (rh)
p. 138, IB
Mandibular left posterior sextant, facial aspect: Task 1—second molar, facial aspect (rh)
p. 140, IB
Mandibular left posterior sextant, facial aspect: Task 2—first premolar, facial aspect (rh)
p. 140, IB
Mandibular right posterior sextant, lingual aspect: Task 1—second molar, lingual aspect (rh)
p. 141, IB
Mandibular right posterior sextant, lingual aspect: Task 2—first premolar, lingual aspect (rh)
p. 141, IB
Mandibular left posterior sextant, facial aspect: Task 1—second molar, facial aspect (lh)
p. 145, IB
Mandibular left posterior sextant, facial aspect: Task 2—first premolar, facial aspect (lh)
p. 145, IB
Mandibular right Posterior sextant, lingual aspect: Task 1—second molar, lingual aspect (lh)
p. 146, IB
Mandibular right Posterior sextant, lingual aspect: Task 2—first premolar, lingual aspect (lh)
p. 146, IB
Mandibular right posterior sextant, facial aspect: Task 1—second molar, facial aspect (lh)
p. 148, IB
Mandibular right posterior sextant, facial aspect: Task 2—first premolar, facial aspect (lh)
p. 148, IB
Mandibular left posterior sextant, lingual aspect: Task 1—second molar, lingual aspect (lh)
p. 149, IB
Mandibular left posterior sextant, lingual aspect: Task 2—first premolar, lingual aspect (lh)
p. 149, IB
Flow chart:Establishing a finger rest
p. 133, PPt 5A 15, IB
Boxes
5-1: Handle position for mandibular posterior teeth (rh)
p. 136, PPt 5A 8, IB
5-2: Handle position for mandibular posterior teeth (lh)
p. 144, IB / In-Class Activities
In the clinical setting, students should practice establishing correct position, mirror use, grasp, and finger rests for each treatment area.
Each student should have the textbook module open resting on a spare clinician stool or chart, so that he or she can work through the technique practice step-by-step following the instructions in the book.
Suggest that students proceed in a deliberate step-by-step manner and verbalizing out loud the details of each step “me, my patient, my equipment, my nondominant hand, my dominant hand, my finger rest”.
Remind students to use the arm muscles—not finger power—to retract with the mirror.
Remind students that they must be able to see the treatment areas in the mirror; some students resist learning to use indirect vision.
Once the mirror hand is in position, the student should hold the instrument in a modified pen grasp in the dominant hand outside the mouth. Next, move the hand into the mouth and establish a fulcrum. Remind students that they might have to move the finger rest closer or farther away from the tooth being worked on to obtain a comfortable position. Once the finger rest is established the student should pause and very deliberately analyze his or her grasp in the mouth. The student should be able to self-identify any errors in the grasp and correct them.
The purpose of this module is to practice mirror use and finger rests. Students should be discouraged from moving the instrument tip and pretending to clean the teeth. Students will learn proper instrumentation activation in a later module.
Students should practice the treatment areas until it is second nature for them to be given a treatment area and to establish correct position, mirror, grasp, and finger rest. Finger rests should be practiced until they are committed to cognitive and motor memories.
Students should be required to do a self- evaluation of their own skills using the Self Evaluation in the module. The ability to self-evaluate is an important skill for students to develop.
Materials
A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument; textbook module 5; Self Evaluation on pages 156.
Online video at: http//:thePoint.lww.com/GehrigFundamentals7e / Outside Assignments
Drop Box Assignment:
Have students write their own instructions for establishing correct mirror use, grasp, and finger rests in the mandibular posterior sextant. They may choose to focus on one tooth. Encourage students to use everyday language rather than technical terms, as if they were explaining the techniques to a family member, friend, or patient.

Legend: IB: Image Bank; PPt: PowerPoint; PF: Practical Focus; TT: Teaching Tip; Note: All ancillary assets can be found on the book’s companion website at: thePoint.lww.com/GehrigFundamentals7e.

Objective 5-5

Demonstrate finger rests using precise finger placement on the handle of

a periodontal instrument.Date:

Lecture Outline

/

Figures, Tables, and Features

/

Resources and

In-Class Activities

/

Outside Assignments

Evaluation

/

Instructor’s Notes

Content / Text page / PPt slide
Right-handed clinician: Modified pen grasp
  • Thumb and index finger opposite one another
  • Thumb and index finger do not overlap
  • Middle finger pad rests lightly on shank
  • Middle finger pad touches ring finger
  • Thumb, index and middle fingers in “knuckles-up” position
  • Ring finger is straight and supports weight of hand
Left-handed clinician: Modified pen grasp
  • Thumb and index finger opposite one another
  • Thumb and index finger do not overlap
  • Middle finger pad rests lightly on shank
  • Middle finger pad touches ring finger
  • Thumb, index and middle fingers in “knuckles-up” position
  • Ring finger is straight and supports weight of hand
/ 72–74 / 3A 8-16, 20-31 / Figures
Modified Pen Grasp for Right-Handed Clinician (Side View) p. 73, IB
Modified Pen grasp for Right-Handed Clinician (Front View)
p. 73, IB
Modified Pen Grasp for Left-Handed Clinician (Side View)
p. 74, IB
Modified Pen Grasp for Left-Handed Clinician (Front View)
p. 74, IB
Thumb and index finger, PPt. 3A 10-11, IB
Middle finger
PPt 3A 24, 26, 27, IB
Ring finger
PPt 3A 30-31, IB
Establishing Finger Rest, p. 97, IB / In-Class Activities
Students should practice the treatment areas until it is second nature for them to be given a treatment area and to establish correct position, mirror, grasp, and finger rest. Finger rests should be practiced until they are committed to cognitive and motor memories.
Materials
A dental unit, clinician stool, manikin with flexible cheeks and tongue; periodontal typodont; mirror; periodontal probe or pencil to act as instrument; textbook module 4; Self Evaluation on page 130.

Legend: IB: Image Bank; PPt: PowerPoint; PF: Practical Focus; TT: Teaching Tip; Note: All ancillary assets can be found on the book’s companion website at: thePoint.lww.com/GehrigFundamentals7e.

Objective 5-6

Recognize incorrect mirror use, grasp, or finger rest, and describe how to correct the problem(s).

Date:

Lecture Outline

/

Figures, Tables, and Features

/

Resources and

In-Class Activities

/

Outside Assignments

Evaluation

/

Instructor’s Notes

Content / Text page / PPt slide
Incorrect mirror use
Using instrument shank for retraction
Using finger muscles for retraction
Corrections
  • Place back of mirror head against buccal mucosa with reflective surface facing facial surfaces of teeth
  • Use arm muscles for retraction
Incorrect grasp
Failure to maintain neutral hand position
Failure to use proper grasp for area of teeth being treated
Failure to maintain control of instrument
Corrections
  • Review neutral hand position and adjust accordingly
  • Check to see if your palm is down and the instrument handle is resting against your index finger (see Box 5-1)
  • Maintain concentration while using instruments
Incorrect finger rests
  • Finger rest selected too close to or far away from tooth being worked on
  • Finger rest on a compromised tooth
  • Finger rest on an insecure tooth surface
  • Ring finger bent
Corrections
  • Select finger rest that is comfortable for your hand size and that also provides stability as you work
  • Always select a stable tooth
  • For teeth in the mandibular posterior sextants, rest fingertip on an incisal surface, incisal edge, occlusofacial line angle, or occlusal surface
  • Keep ring finger straight
/ 155–156 / 5B 1–3 / Figures
Practical focus: Photo 1
p. 155, PPt 5B 2, IB
Practical focus: Photo 2
p. 155, PPt 5B 3, IB
Self Evaluation: Mirror and rests in mandibular posterior sextants
p. 156 / In-Class Activities
Prepare a PPt slide show with examples of correct and incorrect positioning, grasp, and finger rests. Ask students to critique each slide and explain how to correct problems when present.
Materials
PPt slides and projector / Outside Assignments
Ask students to prepare a list of the mirror techniques, instrument grasp, or finger rest that they have the most trouble with. They may list positions that are hard for them to maintain, or techniques that are hard to remember. Have the student write the correction below and ask them to include a sentence or two about how they plan to improve their technique.

Legend: IB: Image Bank; PPt: PowerPoint; PF: Practical Focus; TT: Teaching Tip; Note: All ancillary assets can be found on the book’s companion website at: thePoint.lww.com/GehrigFundamentals7e.