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Chapter
Exam and Basic
1 Hand Instruments
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INTRODUCTION TO DENTAL HAND INSTRUMENTS
Dental hand instruments are made of metal alloy or plastic resin. They are named according to their use
or shape or named for the designer of the instrument.
Hand instruments may be single- or double-ended. Advantages of double-ended: two sizes of the same
design in one instrument, two different working ends in one instrument, or two directions of use in one
instrument (right/left).
There are three parts of a hand instrument:
1. Working end. The design determines the function and may be a beveled cutting edge (chisel), a point
(explorer), a nib (amalgam condenser), a blade (composite instrument) or beaks (pliers).
2. Shank. Portion of the instrument that connects the handle and the working end. The shank may be
straight or angled to provide better access to different areas of the mouth.
3. Handle or shaft. Rounded or hexagonal in different diameters and materials for better fit and grip.
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MIRROR, MOUTH
FUNCTION: To view tissues of the oral cavity and reflect light for better visibility
FEATURES: Front surface or plane reflective surface. Front surface mirrors reflect from the
front of the glass providing a distortion-free reflection.
Mirror sizes #2–#5 (3/4–15/16)
Magnifying and double-sided also available
Reusable handles in cone socket or simple stem design
TRAY SET-UP: Exam and Basic Set-up, component of most procedural tray set-ups
CLINICAL APPLICATION: Also used to retract and protect tongue and cheek
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EXPLORER
FUNCTION: To examine tooth surfaces for caries, calculus, or defects using sense of touch (tactile)
FEATURES: Thin, sharp working end comes in different designs
Common styles are the #1, 2 (pigtail), 11/12, 17, and 23 (Shepard’s hook)
May be single- or double-ended (different design on each side)
TRAY SET-UP: Exam and Basic Set-up, component
of most procedural tray set-ups
CLINICAL APPLICATION: Also used to:
Check fit of margins of restorations
Evaluate root surfaces and
furcation area in periodontal Image modified from University of Kentucky
exam (11/12) (296m-15, 2-109m)
Remove excess material from restoration or preparation
Remove excess cement
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A
#1
B
#2
C
#11/12
D
#17
E
#23
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COTTON PLIERS
FUNCTION: To place and remove small objects from the oral cavity (i.e., cotton pellets, root
canal instruments, wedges)
FEATURES: Serrated or nonserrated beaks, locking or nonlocking handles
Also known as College pliers or dressing pliers
TRAY SET-UP: Exam and Basic Set-up, component of most procedural tray set-ups
CLINICAL APPLICATION: Also used to retrieve materials from drawers and containers to avoid
cross-contamination
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PERIODONTAL PROBE
FUNCTION: To measure depth of
gingival sulcus
FEATURES: Blunt or rounded tip
Flat or cylindrical work-
ing end
Line or colored millime-
ter markings in variety of
increments
Metal or plastic in white
or yellow with colored Image modified from University of Kentucky (295m-07, 7-107m)
markings
TRAY SET-UP: Periodontal exam
May be part of Basic Set-up in some offices
CLINICAL APPLICATION: Also used to measure gingival recession
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SALIVA EJECTOR TIP
FUNCTION: To remove saliva and maintain dry field using low-volume evacuation
FEATURES: Disposable plastic
Some designed with attached tongue deflector
TRAY SET-UP: Exam and Basic Set-up, component of most procedural tray set-ups. Used primarily
when operator is working alone (sealants, coronal polishing, fluoride treatments,
taking impressions, cementing crowns)
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ORAL EVACUATOR TIP
FUNCTION: To maintain a dry working field by removing saliva, blood, and debris with high-
volume evacuation
FEATURES: Disposable plastic, sterilizable metal or plastic
Straight or angled with beveled ends
Surgical Aspirator (see Chapter 11 ORAL AND MAXILLOFACIAL SURGERY
INSTRUMENTS)
Also known as Aspirator, High Volume Evacuator, Suction, or Vacuum tip
TRAY SET-UP: Exam and Basic Set-up, component of most procedural tray set-ups
CLINICAL APPLICATION: Effective use of oral evacuator reduces microbial aerosols. Also assists in retracting
and protecting tongue and cheek. On/off control is located on the suction tubing.
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ISOLITE, i2 PER MANUFACTURER DRYFIELD
ILLUMINATOR
FUNCTION: To provide internal illumination, aspiration, throat protection, and tongue and
cheek retraction all in one device
FEATURES: Available in five sizes: pediatric, adult small, adult medium, adult medium deep
vestibule, and adult large
Disposable mouthpiece; autoclavable control
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ANESTHETIC SYRINGE
FUNCTION: To deliver local anesthesia to intraoral site
FEATURES: Aspirating and Non-aspirating
TRAY SET-UP: Restorative, Fixed Prosthodontic, Endodontic, Periodontic, Oral and Maxillofacial
Surgery Treatment Procedures
CLINICAL APPLICATION: An aspirating syringe has a harpoon on the end of the piston, the nonaspirating
syringe does not. With pressure, the harpoon imbeds in the rubber stopper of the
anesthetic cartridge. As the dentist begins the injection, he/she draws back on the
thumb ring, pulling the harpoon and the rubber stopper back and creating a
vacuum. This will draw in (aspirate) fluid from the farthest end of the needle. If
blood comes back into the cartridge, the dentist will reposition the needle to
prevent injecting anesthetic agent into a blood vessel.
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Thumb ring
Barrel Harpoon
Piston
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INTRALIGAMENT SYRINGE
FUNCTION: Alternative method of delivering local anesthesia; generally to supplement a nerve
block. Injection is made in the periodontal ligament space.
FEATURES: Delivers calibrated amount of anesthetic with each click of the lever
CLINICAL APPLICATION: Uses 30-gauge short needles and standard 1.8-ml anesthetic cartridges
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LOCAL ANESTHESIA ACCESSORIES
1. Anesthetic needles:
Two lengths—1 (short) and 1 5/8 (long)
Three gauges (diameter)—25 gauge, 27 gauge, and 30 gauge
Some manufacturers identify gauge by color-coding caps
Available with plastic or metal hubs
2. Anesthetic cartridges:
Glass vial containing anesthetic solution such as lidocaine (Xylocaine), mepivacaine (Carbocaine),
prilocaine (Citanest), and bupivacaine (Marcaine).
Aluminum cap with rubber diaphragm that needle penetrates at one end of cartridge.
Rubber stopper at the other end.
Cartridges are sterile and sealed in “blister packs.”
Color coded and labeled with type of anesthetic solution and amount of vasoconstrictor.
3. Recapper: Needles may be used more than one time during a procedure and must be recapped to avoid
accidental exposure. For safety, this must be done by using a recapper or the one-handed scoop technique.
4. Sharps container: Needles and other disposable sharps must be disposed of in a labeled, puncture-proof
container.
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Rubber diaphragm Rubber
stopper
1 2 Aluminum cap
One-handed scoop technique
Reprinted with permission from Carol R. Taylor,
Carol Lillis, RN, et al. Fundamentals of Nursing:
3 4
The Art and Science of Nursing Care. 6th Ed.
(4) Image courtesy of Crosstex, [Link] Philadelphia: Lippincott Williams & Wilkins, 2008.
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TRAY SET-UPS
• Assembling all instruments and materials needed for a procedure
• Instruments for a given procedure are sterilized together in a bag or a wrap. Instruments remain in the
sterile wrap until the time of use.
• Instruments are arranged on the tray from left to right in their order of use
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ORAL EXAM AND BASIC SET-UP
1. Mouth mirror
2. Explorer
3. Periodontal probe
4. Cotton pliers
5. Air/water syringe tip
6. Oral evacuator tip
7. Saliva ejector tip
8. 2 2 gauze
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LOCAL ANESTHESIA SET-UP
1. Topical anesthetic
2. Needle recapper
3. 2 2 gauze
4. Cotton applicator
5. Anesthetic syringe
6. Anesthetic needle
7. Anesthetic cartridge
8. Air/water syringe tip
9. Oral evacuator tip
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End Chapter 1