module 3- instrument grasp

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Module 3—Instrument Grasp

Section 1Grasp for Periodontal Instrumentation

Copyright © 2017 Wolters Kluwer • All Rights Reserved

Modified Pen Grasp

-Facilitates precise control of instrument-Allows detection of rough areas on tooth surface-Lessens musculoskeletal stress

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Modified Pen Grasp (cont.)

The recommended method for holding a periodontal instrument

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Parts of an Instrument

A. handle B. shank C. working-end

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At first glance, it may appear that a periodontal instrument is held in the same manner as the grasp used for writing. This is NOT the case. The modified pen grasp is much more precise than the grasp for writing.

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Successful instrumentation technique depends to a great degree on the PRECISE placement of each finger in the modified pen grasp.

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Finger Identification for Grasp

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Thumb and Index Finger

-Function is to hold the instrument

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Thumb and Index Finger (cont.)

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The thumb and index finger are opposite each other at or near the junction of the handle and shank.

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Hold the handle in a relaxed manner.Grasp the handle lightly.Blanched fingers indicate a grasp that is too tight.

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Joints of Index Finger and Thumb in Neutral Position

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Incorrect Finger Placement

When the index finger and thumb are NOT across from each other on the handle, the instrument is difficult to control.

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Overlap of Thumb and Index

When the thumb and index finger overlap, it is difficult to roll the instrument.

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Incorrect Grasp

-Causes the finger pads to lift off of the handle-Makes it difficult to control the instrument-Makes it difficult to roll the handle between the fingers

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Handle Rests Against Hand

The instrument handle rests against the hand to stabilize the instrument.

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Incorrect: No Handle Rest

Holding the handle in a pinch-grip away from the hand creates a weak, unstable grasp.

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Middle Finger

-Functions are to guide the working-end and feel vibrations from the working-end to shank

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Middle Finger (cont.)

One side of the pad of the middle finger rests LIGHTLY on the shank.

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With the middle finger on the shank, the clinician is able to feel vibrations transmitted from the working-end.

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Incorrect: Middle Finger on Handle

-Middle finger should NOT rest on the instrument handle-Middle finger is not used to hold the instrument-Reduces tactile information to hand-Reduces control of the instrument

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The other side of the finger pad of the middle finger rests against—or slightly overlaps—the ring finger.

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-One side of pad on the shank-Other side of pad against ring finger, for stability

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Ring Finger

-Functions are to stabilize and support the hand for control and strength

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Ring Finger (cont.)

The fingertip of the ring finger balances firmly on the incisal or occlusal surface of a tooth.

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Ring Finger (cont.)

The ring finger acts as a support beam for the hand in the mouth.

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Stands Straight and Tall

-Ring finger advanced ahead of the other fingers in the grasp

-Ring finger held straight to act as a support beam for hand

-Fingernail length must not impede ability to keep ring finger upright

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Incorrect Ring Finger

-Held in a curved, limp manner-Provides no stability for hand-Makes it difficult to control instrument stroke

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“United We Stand”

The index, middle, and ring finger should be in contact at least at one point.-Provides stability and strength in the grasp

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Little Finger

-Has no function in the grasp

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Little Finger (cont.)

-Has no function in the grasp-Held in a relaxed manner close to ring finger

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Successful instrumentation technique depends to a great degree on the PRECISE placement of each finger in the modified pen grasp.

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Modified Pen Grasp

-Allows precise control of working-end-Facilitates good tactile conduction

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Incorrect Split Fulcrum

-No point of contact between middle and ring fingers in the grasp-Creates a weak grasp-Stresses the muscles of hand

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Impact of Finger Length on Grasp

-A clinician’s finger length determines the location where he or she grasps the instrument handle-Each clinician must adjust finger rest and grasp according to their own hand size and finger length

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-With shorter fingers the clinician will tend to hold knuckles of the index finger and thumb in a more curved “knuckles up” position, and grasp the instrument higher on the handle

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-With longer fingers the clinician might hold the knuckles of the index finger and thumb in a less curved “knuckles flat” position, and grasp the instrument nearer to junction of handle and shank

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Proper Glove Fit

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Proper Glove Fit (cont.)

-Important to avoid muscle strain during instrumentation-Gloves should be loose fitting across palm and wrist area-Better to wear right- and left-fitting gloves-Tactile sensitivity is enhanced with thin gloves and good fit at fingertip area-Nitrile gloves provide more grip friction than latex gloves

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-Gloves should be loose fitting across palm and at wrist area-Index finger of other hand should slip easily under wrist area of gloved hand

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-Gloves should not be tight fitting across palm or wrist area

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Joint Hypermobility of the Hand

-Joints easily move beyond the normal range expected-Described also as “double-jointed” or joint laxity-Clinician counteracts joint hyperextension by bending thumb and index finger in grasp

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Joint Hypermobility of the Fingers

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Proprioception

-A person’s ability to sense their body, its position and movement through space-Example: close your eyes and touch your finger to your nose-Studies show individuals with joint hypermobility have reduced proprioceptive sensitivity in joints of the hands

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Hypermobility and Grasp

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Hypermobility and Grasp (cont.)

-Individual with hypermobility must learn to grasp the instrument without the joint of thumb and index finger collapsing inward-Do not want to grasp the instrument with too much force-A Lycra or silicone sleeve – Silipos sleeve – can assist grasping the instrument handle

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Silicone Sleeve

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Joint Hyperextension of Ring Finger

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Finger Rest with Silicone Sleeve

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Other Predisposing Conditions for Hand Injuries

-Arthritis in hands may cause a hygienist to reduce work hours-Treatment and physical therapy may improve the arthritis-Women may have weak muscle strength in hands, especially with petite hands-Hand strengthening exercises are beneficial to improve hand muscles for all

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Fingernail Length

-Long fingernails reduce hand strength during instrumentation-Results in decreased pinch grip strength-Long fingernails may interfere with correct grasp and finger rest technique

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Long Fingernails and Grasp

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Summary

-Modified pen grasp is recommended for holding a periodontal instrument-Correct grasp requires precise finger placement on the instrument

-Correct grasp allows precise control of working end, a wide range of movement, and good tactile conduction

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Analyze the grasps shown in these slides.

Practical Focus

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Photo 1

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Photo 2

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Photo 3

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Photo 4

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Photo 5

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Photo 6

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Photo 7

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Photo 8

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Photo 9

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Photo 10

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module 3- instrument grasp

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