Module 3

Instrument Grasp
MODULE OVERVIEW
This module introduces the correct grasp for holding a periodontal instrument. It
begins by explaining the parts of a periodontal instrument and proper glove
selection for instrumentation. Covered next is the correct finger placement for the
modified pen grasp. This module also contains exercises designed to help develop
and maintain the strength of the hand muscles.

MODULE OUTLINE
SECTION 1

Instrument and Finger Identification

51

Parts of the Periodontal Instrument

Finger Identification for the Grasp
SECTION 2

Grasp for Periodontal Instrumentation

53

The Modified Pen Grasp

Fine-Tuning Your Grasp
Summary Sheet: Correct Finger Placement
SECTION 3

Glove Use

56

Proper Glove Fit for Instrumentation

Summary Sheet: Effective Glove Use
SECTION 4
SECTION 5

Exercises for Improved Hand Strength

Skill Application

58
61

Practical Focus
Skill Practice Checklist Module 3: Instrument Grasp

KEY TERMS
Handle
Shank

Working-end
Modified pen grasp

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LEARNING OBJECTIVES
1. Given a variety of periodontal instruments, identify the parts of each instrument.
2. Understand the relationship among correct finger position in the modified pen grasp, the
prevention of musculoskeletal problems, and the control of a periodontal instrument
during instrumentation.
3. Demonstrate correct finger position for the modified pen grasp.
4. Describe the function each finger serves in the modified pen grasp.
5. Recognize incorrect finger position in the modified pen grasp and describe how to
correct the problem(s).
6. Select the correct glove size for your hands and explain how the glove size selected
meets the criteria for proper glove fit.
7. Understand the relationship between proper glove fit and the prevention of
musculoskeletal problems in the hands.
8. Perform exercises for improved hand strength.

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INSTRUMENT GRASP

51

SECTION 1

Instrument and Finger Identification

A correct instrument grasp requires precise finger placement on the instrument (Table 3-1). To
follow the instructions for the grasp, you must be able to identify (1) the parts of a periodontal
instrument and (2) the fingers for use in the modified pen grasp.

PARTS OF THE PERIODONTAL INSTRUMENT

Handlethe part of a periodontal instrument used for holding the instrument.
Shanka rod-shaped length of metal located between the handle and the working-end of a dental
instrument. The shank is an extension device that increases the length of the instrument so that the
working-end can be positioned on the tooth root. Look closely at the instrument handle; usually
you will be able to see a line or edge where the handle joins the shank. The shank is generally
much smaller in diameter than the handle. The shank may be straight, or it may be bent in one or
more places.
Working-Endthe part of a dental instrument that does the work of the instrument. The
working-end begins where the instrument shank ends. The shank is circular and smooth, but the
working-end is shaped or flattened on some of its surfaces. The working-end may terminate in a
sharp point or a rounded surface. It may be thin and wirelike or look somewhat like a tiny
measuring stick. In some cases, the working-end is a small mirror. An instrument may have one or
two working-ends.

A
B

A
B

A
A. Handle
B. Shank
C. Working-End

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BASIC SKILLS

FINGER IDENTIFICATION FOR THE GRASP

M
T

T
R

LEFT-HANDED CLINICIAN

RIGHT-HANDED CLINICIAN

Finger Identification and Placement in Modified Pen Grasp. The index finger (I) and thumb (T) hold
the instrument handle. The middle finger (M) rests on the instrument shank. The ring finger (R) advances ahead of the other fingers to act as a support for the hand and instrument.

TABLE 3-1.

Finger Placement and Function

Digit(s)

Placement

Function

Index and Thumb

On the instrument handle

Hold the instrument

Middle Finger

Rests lightly on the shank

Helps to guide the working-end

Feels vibrations transmitted from the
working-end to the shank

Ring Finger

On oral structure; often a

tooth surface

Stabilizes the hand for control and

strength

Advances ahead of the other

fingers in the grasp
Little Finger

Near ring finger, held in a

natural, relaxed manner

Has no function in the grasp

INSTRUMENT GRASP

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SECTION 2

Grasp for Periodontal Instrumentation

THE MODIFIED PEN GRASP

The Modified Pen Grasp. The modified pen

grasp is the recommended grasp for holding
a periodontal instrument. This grasp allows
precise control of the working-end, permits a
wide range of movement, and facilitates good
tactile conduction.

RIGHT-Handed Clinician: Modified Pen Grasp

Right-Handed Clinician: Side View

Right-Handed Clinician: Front View

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BASIC SKILLS

LEFT-Handed Clinician: Modified Pen Grasp

Left-Handed Clinician: Side View

Left-Handed Clinician: Front View

FINE-TUNING YOUR GRASP

Successful instrumentation technique depends to a great degree on the precise placement of each
finger of your dominant hand in the modified pen grasp. Use the illustrations below and the
Summary Sheet on the next page to fine-tune your grasp.

Finger Placement in the Grasp

Rests on
ring finger

Contacts
shank

Rests on
tooth

Contacts
shank

Contacts
handle

Contacts
handle

Handle rests
anywhere in
this area

Handle rests
anywhere in
this area

Contacts
handle

RIGHT-Handed Clinician

Rests on
ring finger

Contacts
handle

LEFT-Handed Clinician

Rests on
tooth

INSTRUMENT GRASP

TABLE 3-2.

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Summary Sheet: Correct Finger Placement

Digit

Recommended Position

Index and Thumb

The finger pads rest opposite each other at or near the junction of the
handle and the shank.
The fingers do not overlap; there is a tiny space between them.
These fingers should hold the handle in a relaxed manner. If your fingers
are blanched, you are holding too tightly.
The index finger and thumb curve outward from the handle in a Cshape; this position places the finger pads on the handle in the best
position for instrumentation.
These fingers should not bend inward toward the handle in a U-shape.
This U-shape causes the pads to lift off of the handle, making it difficult
to roll the instrument during instrumentation.

Middle

One side of the finger pad rests lightly on the instrument shank.The
other side of the finger pad rests against (or slightly overlaps) the ring
finger.
Not used to hold the instrument.You should be able to lift your middle
finger off the shank without dropping the instrument. If you drop the
instrument, then you are incorrectly using the middle finger to help hold
the instrument.

Ring

Fingertip, not the pad, of the dominant hand balances firmly on the tooth
to support the weight of the hand and instrument.When grasping the
dental mirror, the rest may be on a tooth or against the patients lip or
cheek area.
The ring finger of the dominant hand advances ahead of the other
fingers in the grasp. It is held straight and upright to act as a strong
support beam for the hand.The finger should not feel tense, but it
should not be held limply on the tooth.

Little

This finger should be held in a relaxed manner.

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BASIC SKILLS

SECTION 3

Glove Use
PROPER GLOVE FIT FOR INSTRUMENTATION
Proper glove fit is important in avoiding muscle strain during instrumentation (see Summary Sheet
on next page). In fact, surgical glove-induced injury is a type of musculoskeletal disorder that is
caused by improperly fitting gloves. Symptoms include numbness, tingling, or pain in the wrist,
hand, and/or fingers. This disorder is caused by wearing gloves that are too tight or by wearing
ambidextrous gloves. It is best to wear right- and left-fitted gloves that are loose fitting across the
palm of the hand and wrist.

Correct Glove Fit. Gloves should be loose

fitting across the palm and wrist areas of
the hand. The index finger of your opposite
hand should slip easily under the wrist area
of the gloved hand.

Incorrect Glove Fit. Gloves that are tight

fitting across the palm and/or wrist area of
your hand can cause muscle strain during
instrumentation.

INSTRUMENT GRASP

TABLE 3-3.

Summary Sheet: Effective Glove Use

Recommendations
Type

Latexthe most durable; good flexibility; some individuals are allergic to latex
Nitrileprovides good dexterity and is tougher than latex
Neoprene or Polymermuch less durable than latex
Vinylleast durable; not flexible, breaks rather than gives

Hand Care

Maintain short fingernails to prevent punctures

During nonworking hours, apply hand lotions to maintain skin integrity

Lotions

Avoid using lotions under gloves that can compromise the integrity of the glove
material. Avoid petroleum-based lotions or those containing lanolin, cocoa
butter, mineral oil, or jojoba oil.

Jewelry

Remove jewelry before donning gloves; it presents a puncture hazard

Jewelry interferes with thorough washing and rinsing of hands and increases the
risk of skin irritation

Size

Select right- and left-hand fitted gloves that come in a full range of sizes (i.e.,
5-1/2, 6, 6-1/2, etc., rather than S, M, L)
Gloves should never be tight across the palm or at the wrist

Use

Change gloves every hour; the probability of punctures increases over time
Gloves have been worn too long if hands are sweaty or skin is wrinkled
Wash and rinse hands thoroughly in between glove changes

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BASIC SKILLS

SECTION 4

Exercises for Improved Hand Strength

Well-conditioned muscles have improved control and endurance, allow for freer wrist movement,
and reduce the likelihood of injury. The hand exercises shown here will help you to develop and
maintain muscle strength for instrumentation.
Directions: These exercises use Power Putty, a silicone rubber material that resists both squeezing
and stretching forces. For each exercise illustrated, squeeze or stretch the Power Putty for the
suggested number of repetitions. The exercise set, for both hands doing all nine exercises, should
take no more than 10 to 20 minutes. When exercising, maintain your hands at waist level.

CAUTION: Not all exercise programs are suitable for everyone; discontinue any
exercise that causes you discomfort and consult a medical expert. If you have or
suspect that you may have a musculoskeletal injury, do not attempt these exercises without the permission of a physician. Any user assumes the risk of injury
resulting from performing the exercises.The creators and authors disclaim any
liabilities in connection with the exercises and advice herein.

1. Full Grip (flexor muscles). Squeeze putty with

your fingers against the palm of your hand. Roll
it over and around in your hand, and repeat as
rapidly and with as much strength as possible.
Suggested Repetitions: 10

2. All Finger Spread (extensor and abductor

muscles). Form putty into a thick pancake shape
and place on a tabletop. Bunch fingertips
together and place in putty. Spread fingers out
as fast as possible. Suggested Repetitions: 3

3. Fingers Dig (flexor muscles). Place putty in the

palm of your hand and dig fingertips deep into
the putty. Release the fingers, roll putty over
and repeat. Suggested Repetitions: 10

INSTRUMENT GRASP

59

4. Finger Extension (extensor muscles). Close one

finger into palm of hand. Wrap putty over tip
of finger and hold loose ends with the other
hand. As quickly as possible, extend finger to
a fully opened position. Regulate difficulty by
increasing or decreasing thickness of putty
wrapped over the fingertip. Repeat with each
finger. Suggested Repetitions: 3

5. Thumb Press (flexor muscles). Form putty into

a barrel shape and place in the palm of your
hand. Press your thumb into the putty with as
much force as you can. Reform putty and
repeat. Suggested Repetitions: 5

6. Thumb Extension (extensor muscles). Bend

your thumb toward the palm of the hand;
wrap putty over the thumb tip. Hold the loose
ends down and extend the thumb open as
quickly as possible. Regulate difficulty by
increasing or decreasing the thickness of putty
wrapped over tip of thumb. Suggested
Repetitions: 3

7. Fingers Only (flexor muscles). Lay putty across

fingers and squeeze with fingertips only. Keep
the palm of your hand flat and open. Rotate
putty with thumb and repeat. Suggested
Repetitions: 10

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BASIC SKILLS

8. Finger Scissors (adductor muscles). Form putty into the

shape of a ball and place between any two fingers.
Squeeze fingers together in scissorlike motion. Repeat
with each pair of fingers. Suggested Repetitions: 3

9. Finger Splits (abductor muscles). Mold putty around

any two fingers while they are close together. Spread
fingers apart as quickly as possible. Repeat exercise
with each pair of fingers. Suggested Repetitions: 3

Hand exercises are reprinted with permission of SportsHealth.

Power Putty is available in four levels of rigidity: soft, soft/medium, medium/firm,
and hard.
Power Putty can be purchased in sport stores or directly from: SportsHealth, 527
West Windsor Road, Glendale, California 91204 USA, (818) 240-7170.

INSTRUMENT GRASP

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SECTION 5

Skill Application
PRACTICAL FOCUS
Evaluate the modified pen grasp in photographs 1 to 9 below. Indicate if each grasp is correct or
incorrect. For each incorrect grasp element describe (1) what is incorrect about the finger placement
and (2) what problems might result from the incorrect finger placement.

PHOTO 1

PHOTO 4

PHOTO 2

PHOTO 5

PHOTO 3

PHOTO 6

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BASIC SKILLS

PHOTO 7

PHOTO 8

PHOTO 9

Examine the gloved hands pictured in photograph 10 below. Evaluate the glove fit for the right and
left hands.

RIGHT

LEFT
PHOTO 10

INSTRUMENT GRASP

SKILL PRACTICE CHECKLIST MODULE 3

63

Instrument Grasp

Module 3 has a skill practice checklist rather than a Skill Evaluation. Use the Checklist to help you assess your
ability to grasp an instrument outside the mouth.Your ability to use a modified pen grasp in the mouth will be
evaluated in Modules 4, 5, and 6.
Student:

1  Grasp with mirror hand

Instructor:

2  Grasp with instrument hand

Date:

DIRECTIONS: For each grasp, the student uses Column S and the instructor uses Column I. For each grasp,
indicate the preliminary skill level as: S (satisfactory), I (improvement needed), or U (unsatisfactory).

CRITERIA:
Identifies handle, shank, and working-end(s) of mirror or instrument
Describes the function each finger serves in the grasp
Describes criteria for proper glove fit
Holds handle with pad tips of index finger and thumb
Thumb and index finger positioned opposite one another on handle
Thumb and index finger do not touch or overlap
Pad of middle finger rests lightly on shank
Pad of middle finger touches the ring finger
Thumb, index, and middle fingers are bent and relaxed (form C shape)
Ring finger is straight and supports weight of hand
Instrument handle rests against hand
Grasp is relaxed (no blanching of fingers)

Grasp 1
S
I

Grasp 2
S
I

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BASIC SKILLS

SKILL PRACTICE CHECKLIST MODULE 3

Instrument Grasp

Student:

EVALUATOR COMMENTS

Box for sketches pertaining to written comments.