Probe + Explorer

Pig Tails Explorer

-Calculus detection in normal sulci or shallow pockets extending no deeper than the cervical-third of the root -Disadvantage: The curved lower shank causes considerable stretching of the tissue away from the root surface.

Explorers are used for:

-Subgingival calculus deposits -Dental anomalies -Anatomic features of the teeth -Assess dental restorations, decay and sealants

Assisted Probing

-The Florida Probe is an example of a computer-assisted probe. -Computerized probes are connected to a computer, which creates a computerized dental chart. -The automated system records the assessment data on a computerized chart. -Some software allows for voice recognition.

Common Types of Calculus Formations

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The Probe tip is

1-2 mm of the side of the probe •The probe tip is kept in contact with the tooth surface throughout the walking stroke. •The probe tip should NOT be held away from the tooth. •The probe working-end is positioned as parallel as possible to the root surface. •The probe must be parallel in the mesiodistal dimension and the faciolingual dimension.

A healthy sulcus is

1-3 mm in depth

Walking Stroke Technique

1. Insert the probe and lightly run the tip along the tooth surface until it encounters the soft tissue base of the sulcus or pocket. 2. The junctional epithelium that forms the base of a sulcus or pocket feels soft and flexible when touched with the probe tip. 3. Create a walking stroke by moving the probe tip up and down in short bobbing strokes. 4. Move forward in 1-mm increments.

Subgingival Exploring

Assessment strokes should be short in length and involve many overlapping strokes.

When two teeth are in contact—side by side—a special technique is used to probe the area directly beneath the contact area.

Step 1: Walk the probe between the teeth until it touches the contact area. Step 2: Slant the probe slightly so that the tip reaches under the contact area. In this position, gently press downward to touch the soft tissue base.

The probe is NOT removed from the sulcus with each stroke. (T/F)

TRUE •Repeatedly removing the probe can traumatize the tissue. •Bob along that soft tissue base all around the tooth. •Walking strokes with the probe should cover the entire circumference of the sulcus or pocket base. •It is common for the depth of a pocket to be deeper in one place. •Walk around the entire circumference to avoid missing a deeper area.

Probe Technique

The distance in millimeters from the gingival margin to the base of the sulcus or periodontal pocket as measured with a probe

Parts of Explorer

The tip is 1 to 2 mm of the side of the explorer. The tip is adapted to the tooth for detection of calculus deposits. This explorer has a tip that is bent at a 90-degree angle to the lower shank. -Ideal for subgingival use -Point not used for detection The lower shank of an explorer is the section of the shank that is nearest to the explorer tip.

Periodontal pocket:

a gingival sulcus that has been deepened by disease; depth is greater than 3 mm -forms from apical migration of the junctional epithelium and destruction of periodontal fibers and bone

Walking stroke:

a series of bobbing strokes that are made within the sulcus or pocket while keeping the probe tip against and in alignment with the root surface

Tactile sensitivity

ability to detect tooth irregularities, such as calculus deposits, by feeling vibrations transferred from the explorer tip to the instrument shank and handle.

Gingival pocket

deepening of gingival sulcus caused by detachment of coronal portion of junctional epithelium and swelling of tissue

Sulcus

groove

Junctional epithelium

is the tissue that forms base of the sulcus

Cavitated lesion

loss of the outer surface layer of the crown or root surface, usually needing restoration

Noncavitated lesion

result of demineralization of an area of tooth surface, usually is reversible or arrested with treatment

Probing:

the act of walking the tip of a probe along the base of a sulcus or pocket for the purpose of assessing the health status of the periodontal tissues

In a healthy gingiva,

the sulcus is going to be tight.

Assessment Stroke

used to detect calculus deposits or other tooth surface irregularities on the tooth surface. It is also called an "exploratory stroke."

Detection of Dental Caries

•-A carious lesion is a decayed area on the tooth crown or root •-Historically sharp tip of an explorer used for caries detection •-Tip was forced into pit or fissure for caries detection •-Identify the disease process early in order to halt progression of caries •-Early detection at noncavitated stage is important to allow for remineralization

Prerequisites for Early Caries Diagnosis

•-Good lighting •-Clean tooth surface free of biofilm and deposits •-Three-way syringe with air/water to view tooth wet and dry •-Sharp eyes •-Blunt explorer or periodontal probe •-Bitewing radiographs

Probe in Diseased Sulcus

•A probing depth deeper than 3 mm indicates a periodontal pocket. Bleeding and exudate may also be noted

Technique Errors: Exploring

•AVOID a firm, tense, "death grip." •AVOID applying pressure with the middle finger against the shank. •Both of these errors reduce tactile information to the fingers. •Do NOT remove the explorer tip from the sulcus or pocket as you make an upward stroke. Keep the tip beneath the gingival margin. •Removing and reinserting the tip repeatedly can injure the gingival tissue.

Explorer Function

•An assessment instrument with a flexible wire-like working-end •Made of flexible metal that conducts vibrations from the working-end to the clinician's fingers

Deficient Margin on Restoration

•Explorer dips in to trace the restoration. •"Skating onto a section of pavement that is lower than the surrounding pavement"

Overhanging Restoration

•Explorer must move away from tooth and over the restoration. •"Skating over a section of a sidewalk that is higher than the adjacent section"

Carious Lesion

•Explorer tip dips in to a rough depression. •"Skating into a pot hole"

Explorer Designs

•Explorers are available in many different designs. •The clinician should be knowledgeable about the recommended use of each basic design type. All design types are not well suited to subgingival use. -Pigtail and cowhorn -Orban type -11/12 type

Probe Function

•Findings from an examination with a periodontal probe are used to determine the health of the periodontal tissues. •Probes are used like miniature rulers for making intraoral measurements. •Measure sulcus and pocket depths •Measure clinical attachment levels •Determine the width of the attached gingiva •Assess for the presence of bleeding •Measure the size of oral lesions •Measure longitudinal response of periodontium to treatment

Technique Tips for Exploring

•Grasp—relaxed grasp, middle finger rests lightly on shank •Adaptation—1 to 2 mm of side of tip •Lateral Pressure—feather-light pressure against tooth •Strokes—fluid, sweeping strokes •Keep the tip in contact with the root surface as you move across the tooth. •Keep strokes short, about 2 to 3 mm in length. •Make many overlapping, multidirectional strokes to assess the entire root surface.

Probe Measurement

•Measurements are recorded for six specific sites or zones on each tooth. •Record six areas or zones per tooth. •Record one reading per zone (the deepest). •Round up measurements to nearest full millimeters.

Exploring Proximal Surfaces

•On proximal surfaces, lead with the explorer tip. •Do NOT "back" into proximal surface. •Strokes reach under contact area.

Various factors can affect accuracy of probing measurements:

•Position of gingival margin •Interference from calculus deposits, overhanging restorations •Amount of pressure applied •Misread probe calibrations

Probe in a Healthy Sulcus

•Probe inserted into a healthy gingival sulcus. •In health, the probing depth should be from 1 to 3 mm in depth. •No bleeding noted.

Probe Design

•The working-end of a probe is marked in millimeter increments. •There are many different patterns of millimeter markings. •Color-coded probes are marked in bands. •Do not assume that all probes have the same pattern of millimeter markings. •A millimeter ruler can be used to determine the marking pattern of a particular probe.

Orban-Type Explorer

•Tip bent at 90 degrees to the lower shank •Straight lower shank •*Subgingival calculus detection on: -Anterior root surfaces -Facial and lingual root surfaces of posterior teeth •Advantage-Bent tip allows the back of the tip (instead of the point) to be directed against the soft tissue base of the sulcus/pocket •Excellent for use on anterior teeth •Disadvantage-Straight shank makes it difficult to use on the line angles, mesial, and distal surfaces of posterior teeth

11/12-Type Explorer

•Tip bent at 90-degree angle to lower shank •Long, complex shank design it easy to reach root surfaces of anterior and posterior teeth •Smooth back of tip is in contact with soft tissue base of sulcus or pocket •Complex shank excellent for anterior and posterior teeth •**This explorer works well throughout the mouth and can be used in healthy sulci and deep periodontal pockets. •Can be used in shallow sulci and deep pockets

Caries Detection Aids

•To date, no one form of diagnosis is reliable for detecting all carious lesions. •Visual signs have proven to be good indicators of enamel and dentin lesions. •Currently visual detection, radiographs, laser fluorescence, and electrical caries measurements are some options.

Compressed Air for Calculus Detection

•Use compressed air for visual inspection. •When dried, supragingival calculus appears rough and chalky.

Small Calculus Deposits - Spicules

•You will feel a gritty sensation as the explorer passes over the small calculus deposit. •"Inline skating over a few pieces of gravel"

Large Ledge of Calculus

•You will feel the tip move out and around the raised bump and return back to the tooth surface. •"Skating over a speed bump in a parking lot"