The first thing to remember is that we are not only looking to remove water and debris from the mouth but also to retract and protect the soft tissues using a 3 in 1 syringe or, if you haven’t got, one a reversed mirror head.
Perhaps the most important thing to say is that we dentists should hold back, not dive in with the hand piece but allow our nurse to go into the mouth first.
This will enable them to retract the tissues and get into a nice balanced position for aspiration, which will give much better vision to all of us.
Remember the rule: –
NURSE ALWAYS FIRST IN AND LAST OUT OF THE MOUTH
Let’s start with the Upper Left
You are aiming to use your retraction instrument to give you some space for your aspirator. Thus you retract the lip first, then place the aspirator alongside, at quite an angle pulling the cheek just gently out and bring the retraction down so you are actually opening up the whole side of the cheek rather than just a small area where your suction is in place.
This makes it so much easier for your dentist to see what he/she is doing, as all the shadows cast by the lip are gone. Dentists can now work by direct or indirect vision using the mirror down in the lingual sulcus of the lower teeth or actually outside the mouth in the dry zone.
Now – the Lower Left
The same as before, retract the lip first and place your suction tip right alongside the tooth being worked on and now gently slide your retraction forward quite a long way and you will see how it eliminates the shadows. Remember you need to sit really close to the patient as well as the dentist.
Dentists hold your mirror in the normal way, swivel by rolling it round and hold using 4 fingers against thumb.
Now tuck your elbow in across your chest place the reversed mirror head on top of the tongue and rather than retract it, depress the tongue right alongside the tooth you are working on.
Now – Upper Right
This is the one place where you sometimes swap and use your left hand to aspirate, as you don’t need to retract here as the dentist often does it. Occasionally if the lower lip is causing a shadow you can swap back and retract it. Remember to stay in position until the dentist is out of the mouth and you can remove the excess water and avoid the patient gulping down the last mouthful.
Your dentists will work using the direct or indirect vision retracting the lip with one of his/her fingers and using the mirror as before but in the lower buccal sulcus this time.
Now – Lower Right
Again start with retraction of the lip and then place your suction on the lingual side whilst protecting the tongue at the same time – again the lip retraction eliminates shadows to give your dentist better vision.
This is the easy one for a dentist who just retracts with one finger or a mirror if necessary and uses direct vision.
What are the benefits of these positions?
- The benefit to dentists is that they get much better vision and maintain good posture.
- The benefit to patients is that they are far more comfortable and not full of water and debris.
- The benefit to nurses is that they can enjoy a more active role and maintain good posture