Equipment and instrumentation

Chapter 1


Equipment and instrumentation





General considerations


Dentistry poses a health hazard for both operators and patients. There is the possibility of both indirect contagion (hands, nails, skin, clothes, instruments) as well as the dangers associated with the bacterial aerosol created by some procedures, e.g. scaling, but also by sneezing, coughing and by the water coolant and compressed air used. Consequently, dental procedures should be performed in a separate room that is carefully designed and maintained to minimize these hazards. The room must have adequate light and ventilation. A bright light source is required. Investing in a dental light is mandatory. A good dental light is expensive, but definitely worth the money.


Ergonomic considerations are of paramount importance in the layout of the dental operatory. All equipment and instruments should be within easy reach of the operator. Posture is important! Ideally, the operator should be seated (Fig. 1.1).



It is essential to protect operator and staff. The veterinarian and the assistant should wear designated operating clothes. Moreover, facemasks and appropriate eye wear (spectacles or face shield) to protect them from the bacterial aerosol and other debris are essential. There is a risk of infection of skin wounds if the operator works in a dirty environment without gloves. The oral cavity is never a sterile site, so the use of surgical gloves is recommended. In addition, hand disinfection should be practiced frequently.


Important patient considerations are as follows:



• General anesthesia with endotracheal intubation is essential. This prevents inhalation of aerosolized bacteria (and other debris) and asphyxiation on irrigation and cooling fluid. Chapter 2 covers anesthesia and analgesia for the patient undergoing oral and dental surgery.


• A pharyngeal pack (Fig. 1.2) is also recommended during oral and dental treatment. Remember to remove the pack prior to extubation!



• The animal should be positioned on a surface that will allow drainage to prevent it becoming wet and hypothermic. This can be achieved by the use of a ‘tub-tank’ or placing the animal’s head on a disposable ‘nappy’, which is frequently replaced. Most animals benefit from a heating pad.


Some important equipment and instrumentation considerations are as follows:



• There are different degrees of cleanliness required for oral/dental procedures, ranging from visually clean to sterile.


• Some equipment and instruments need to be ‘clean’, i.e. units, lamps, tub tables, etc., and need to be wiped clean with an all-purpose disinfectant.


• Any instrument that will be used inside the oral cavity but without penetrating the oral mucosa, e.g. examination instruments, burs, scalers, curettes, must be exceptionally clean, as defined by the European Standard (EN)/International Organization for Standardization (ISO), Document 15883. This degree of cleanliness is achieved by mechanical cleaning followed by heat or chemical treatment. This is best achieved using a disinfector, where both cleaning and disinfection occur automatically. Another alternative is placing the instruments in an ultrasound bath or ordinary dishwasher followed by disinfection in an autoclave. A third option is to use chemicals for cleaning and disinfection. The last option is usually limited to equipment/instrumentation where heat disinfection is not suitable, e.g. instruments with plastic handles.


• Instruments that penetrate the oral mucosa or the pulp system of the tooth need to be sterile, as defined by the European Standard (EN), Document 556. This entails packaging and sterilization, as detailed by the European Standard (EN)/International Organization for Standardization (ISO), Document 14937.


• Suitable (clean, extremely clean, sterile, as required by the procedure) instruments should be available for each patient. Ideally, several pre-packed kits with the required instruments for different procedures, e.g. examination, periodontal therapy, extraction, should be available.


• Power equipment requires regular maintenance (daily, weekly) in the practice and regular servicing by the supplier. Draw up checklists for these chores. Check maintenance and servicing requirements with the supplier.



Equipment and instrumentation for oral and dental examination


There is a wide selection of dental equipment and instrumentation available on the market. Our recommendation is to identify your needs and then invest in a bit more than you think you will require. The better you get at performing dentistry and oral surgery, the more demanding of your equipment you will become. There is also an element of personal preference, so test different options before making a decision. Finally, be prepared to upgrade.


Details of how to perform an oral examination and recording are covered in Chapter 6. The following will outline equipment and instrumentation requirements. Personal preferences have been inserted as a guide, where appropriate.



Periodontal probe


The periodontal probe is a narrow rounded or flat, blunt-ended, graduated instrument (Fig. 1.3). Because of its blunt end, it can be inserted into the gingival sulcus without causing trauma (Fig. 1.4). The periodontal probe is used to:





A narrow, rounded rather than flat, probe is our preferred choice, as it is easier to enter the gingival sulcus without causing damage with the rounded probe, especially in cats, where the flat probe is impossible to use.





Dental record sheets


Recording and dental record sheets are covered in Chapter 6. A complete dental record is required for diagnostic and therapeutic purposes, as well as for medico-legal reasons.



Equipment and instrumentation for periodontal therapy


Periodontal disease therapy is detailed in Chapter 9.



Scaling


Scaling describes the procedure whereby dental deposits (plaque, but mainly calculus) are removed from the supra- and subgingival surfaces of the teeth. Scaling may be performed using a combination of mechanical and hand instruments. The use of mechanical (powered scalers) requires less treatment time than hand instruments. Moreover, mechanical instrumentation is less fatiguing to the operator than hand instrumentation. However, mechanical scalers cannot replace hand scaling. If only powered scalers have been used, post-treatment examination using compressed air to retract tissues and dry calculus demonstrates residual deposits. Occasionally, mechanical scalers will plane over the surface of a calculus rather than dislodge it. The sharpened blade of a hand instrument is more likely to break the calculus away from the tooth surface. Hand instruments should be used to remove large, bulky supragingival deposits before going on to powered scalers. Also, hand instruments are required to remove subgingival dental deposits.



Hand scaling instruments


Scalers and curettes (Fig. 1.5) are used to remove dental deposits from the tooth surfaces. Each has a handle, a shank and a working end (tip). They require frequent sharpening to maintain their cutting edges. Instrument sharpening is covered later in this chapter.



Instrument (scaler and curette) handles are available in a variety of shapes and styles. Weight, diameter and surface texture of handles are factors that need to be considered when selecting hand instruments. Round, hollow handles are recommended because they are lighter in weight, which increases tactile sense and minimizes hand fatigue. A larger diameter handle is advisable for ergonomic comfort. A handle with a smooth surface must be grasped more firmly to maintain control over the working end, leading to hand fatigue. Textured handles (ribbed, diamond-textured or knurled) allow the operator to maintain control over the instrument more comfortably. They also maximize sensory feedback.


The part of the instrument that extends from the working end to the handle is called the functional shank. Functional shanks may be angled, curved or straight. They also vary in length (short, moderate, long) and flexibility. Straight shank instruments are commonly used on the accessible anterior teeth. Posterior teeth need angled shanks for better adaptation of the working end to the tooth surfaces. Instruments with short functional shanks can be used on anterior teeth, while moderate to long shanks are needed to reach posterior teeth and to access periodontal pockets. Instruments with rigid shanks are used to remove heavy calculus deposits. Instruments with more flexible shanks (e.g. Gracey curettes) are used for removal of fine, light calculus and give better tactile sensation (feedback). The terminal shank is the smaller portion of the functional shank. It extends between the working end and the first bend in the shank. It is essential to locate the terminal shank on an instrument when you are trying to identify the working end and sharpen its cutting edges.


The working end refers to that part of the instrument that is used to carry out the function of the instrument. Working ends can be made of stainless steel or of carbide steel. The working end of a sharpened instrument is called the blade. Carbide blades may hold their cutting edge(s) longer but tend to corrode easily if not cared for properly. The blade is made up of the following components:


Related posts:

  1. Preventive dentistry
  2. Anatomy of the teeth and periodontium
  3. Dental diseases in lagomorphs and rodents
  4. Tooth extraction

Stay updated, free articles. Join our Telegram channel
Tags:
Oct 9, 2016 | Posted by in GENERAL | Comments Off on Equipment and instrumentation

Full access? Get Clinical Tree
Get Clinical Tree app for offline access