IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 10 Ver.VII (Oct. 2015), PP 115-121
www.iosrjournals.org

Assessment of the Use of a Dental Mouth Mirror

NeerajSurathu1, Dr. IffatNasim2
1
II Year Bds Student (Saveetha Dental college, Chennai, India)
2
Department of Conservative Dentistry and Endodontics, Saveetha Dental College,Saveetha University, India

Abstract: An assessment of the use of a dental mouth mirror among students of a dental school. A study was
conducted to investigate the use of a dental mouth mirror among pre-clinical and clinical dental students in a
private dental school. 20 questions were fabricated in the form of a questionnaire to evaluate the use of a mouth
mirror first, among pre clinical students who were using the instrument as part of pre clinical exercises in Year
II of dental school and second, among clinical dental students in Year III of dental school who had just begun to
use the instrument in the treatment of patients. The use of a dental mouth mirror is important forseveral reasons
including retraction, illumination and indirect vision. The results obtained indicate that while most students
routinely used a dental mouth mirror, a few did not use a mirror to its full advantage during all procedures.
This may be resolved by enabling students to understand the usefulnessof such an instrument in improving the
ergonomics of dental treatment and enabling a better treatment outcome as a result of better visualization.
Keyword:Mouth mirror, retraction, visualization, illumination, indirect vision, dental school.

I. Introduction:
The dental mouth mirror is one of the most common instruments used in dentistry. It finds a common
place in the dental armamentarium for use in a variety of procedures in dentistry. The head of a dental mouth
mirror is usually round and the most commonly used sizes are number 4 and number 5. A number 2
mirrorispopular where smaller sizes are used such as in the back of the mouth when space is limited or in the
visualization of the pulp chamber. The three most important functions of the mouth mirror are retraction of the
buccal and lingual soft tissues, indirect and direct visualization and illumination when used along with alight
sources [1]. When used properly, a mouth mirror can improve the ability of the operator to see clearly, enabling
better diagnosis and treatment [1]. This is achieved by a combination of all the advantages offered by a mouth
mirror. In addition, a mouth mirror also helps better ergonomic position for the operator thereby preventing
occupational injury [3].The use of a mouth mirror is therefore fundamental to most dental treatment and every
dental student should ideally be taught to incorporate a mouth mirror as part of his pre clinical instrument use
during various procedures. A student should thereafter ideally transition his use of thedental mouth mirror into
clinical use during various treatment procedures on patients. The retraction of soft tissues using the mouth
mirror is also of benefit to the patient as it helps to prevent the injury from instruments such as rotating burs.

II. Materials And Method:

A carefullydesigned questionnaire was prepared and distributed to 120 II Year and III Year students in
Saveetha Dental College, a reputed dental school. The students were not obliged to return the forms but all
respondents returned the form immediately. This emphasized the ease of filling the questionnaire andthe design
of the questions. Students were generally asked what they found to be the most important use of a mouth mirror,
the degree of training received in the use of one and their level of comfort with the regular use of a mouth
mirror. Variables that could affect results such as year of study and gender were also recorded.Multiple
questions regarding preference of size, use of a mouth mirror for specific functions and difficulties with use of a
mouth mirror were also incorporatedinto the questionnaire. Statistical analysis was done using the Chi square
test and used for comparison of data to generate results.

III. Results:
Frequency Table
Ge nder

Cumulative
Frequency Percent Valid Percent Percent
Valid Male 57 47.5 47.5 47.5
Female 63 52.5 52.5 100.0
Total 120 100.0 100.0

TABLE 1: Participation of dental students based on gender

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 Assessment of the Use of a Dental Mouth Mirror

Which year of study

Cumulative
Frequency Percent Valid Percent Percent
Valid II Y EA R 58 48.3 48.3 48.3
III Y EA R 62 51.7 51.7 100.0
Total 120 100.0 100.0

TABLE 2: Participation of dental students based on year of study:

Oth er th an for diagno sis , w h er e e ls e do yo u us e m o uth m ir ro r

Cumulative
Frequency Percent Valid Percent Percent
Valid Retrac tion of sof t tiss ues 20 16.7 16.7 16.7
Illumination 1 .8 .8 17.5
Vis ion 12 10.0 10.0 27.5
All of the abov e 87 72.5 72.5 100.0
Total 120 100.0 100.0

TABLE 3: Opinion of dental students of use of mouth mirror other that diagnosis

How do you feel about your college training in using m outh m irr or

Cumulative
Frequency Percent Valid Percent Percent
Valid Adequate 76 63.3 63.3 63.3
Inadequate 44 36.7 36.7 100.0
Total 120 100.0 100.0

TABLE 4: Opinion of dental students on the adequacy of college training

Do you pr efe r m outh m irr or in all your proce dure s

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 104 86.7 86.7 86.7
No 16 13.3 13.3 100.0
Total 120 100.0 100.0

TABLE 5: Answers given by dental students regarding the regular use of mouth mirror
Most com m on re as on not to us e m outh m irr or during pr ocedur e is?

Cumulative
Frequency Percent Valid Percent Percent
Valid Inc onv enience 74 61.7 61.7 61.7
Lac k of practice 46 38.3 38.3 100.0
Total 120 100.0 100.0

TABLE 6: Reasons given by dental students for why they do not use mouth mirror

Do you pr efe r any par ticular m outh m irr or siz e

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 42 35.0 35.0 35.0
No 78 65.0 65.0 100.0
Total 120 100.0 100.0

TABLE 7: Opinion of dental students regarding preference of mouth mirror size

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 Assessment of the Use of a Dental Mouth Mirror

While handling m axillary te eth do you us e indir ect vision

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 105 87.5 87.5 87.5
No 15 12.5 12.5 100.0
Total 120 100.0 100.0

TABLE 8: Opinion of dental students on whether they use indirect vision

Do you think indire ct vis ion plays an im por tant r ole in er gonom ics

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 44 36.7 36.7 36.7
No 76 63.3 63.3 100.0
Total 120 100.0 100.0

TABLE 9: Opinion of dental students on the mouth mirrors influence on ergonomics

Do you pe rs onally fee l w ith practice indire ct vis ion can be im pr oved?

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 111 92.5 92.5 92.5
No 9 7.5 7.5 100.0
Total 120 100.0 100.0

TABLE 10: Opinion of dental students on whether indirect vision can be improved

Acco rd ing to the de gr ee o f illu m inatio n available in your w o rk

en vir on m en t, do yo u think you r ind ire ct visio n is affecte d?

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 90 75.0 75.0 75.0
No 30 25.0 25.0 100.0
Total 120 100.0 100.0

TABLE 11: Opinion of dental students on whether illumination affects indirect vision

While giving pr os thes is/re stor ation do you obse rve any colour changes w ith
indir e ct vision?

Cumulative
Frequency Percent Valid Percent Percent
Valid Rarely 91 75.8 75.8 75.8
Frequently 25 20.8 20.8 96.7
Alw ay s 4 3.3 3.3 100.0
Total 120 100.0 100.0

TABLE 12: Opinion on usefulness of indirect vision to detect colour changes on prosthesis

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 Assessment of the Use of a Dental Mouth Mirror

Is your accu racy im pr oved w ith in dire ct vis io n?

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 60 50.0 50.0 50.0
No 60 50.0 50.0 100.0
Total 120 100.0 100.0

TABLE 13: Opinion of dental students on improvement of accuracy with indirect vision

Wh ile u sin g m ou th m irr or in th e o ral cavity, h ow d o you d efog yo ur m outh m ir r or ?

Cumulative
Frequency Percent Valid Percent Percent
Valid 3 w ay s yringe 30 25.0 25.0 25.0
Wipe w ith glov es 46 38.3 38.3 63.3
Us e c otton 44 36.7 36.7 100.0
Total 120 100.0 100.0

TABLE 14: Opinion of dental students on different ways of defogging mouth mirror

Do you ster ilis e your m irr or after ever y us e?

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 114 95.0 95.0 95.0
No 6 5.0 5.0 100.0
Total 120 100.0 100.0

TABLE 15: Answer on whether the mouth mirror is sterlised after every use

What is the shelf life of your m outh m irr or ?

Cumulative
Frequency Percent Valid Percent Percent
Valid 2 months 31 25.8 25.8 25.8
4 months 43 35.8 35.8 61.7
6 months 46 38.3 38.3 100.0
Total 120 100.0 100.0

TABLE 16: Opinion of dental students on the shelf life of the mouth mirror

Ar e you aw are o f any of th e follow ing diffe re nt type s of m ou th m irr or s?

Cumulative
Frequency Percent Valid Percent Percent
Valid Front surface 2 1.7 1.7 1.7
Concave s urf ac e 4 3.3 3.3 5.0
Plane surf ace 11 9.2 9.2 14.2
All of the abov e 103 85.8 85.8 100.0
Total 120 100.0 100.0

TABLE 17: Opinion of dental students on the awareness of different mouth mirror types

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 Assessment of the Use of a Dental Mouth Mirror

Which proce dure you fe el is m andator y to us e m outh m ir ror?

Cumulative
Frequency Percent Valid Percent Percent
Valid Cavity preparation of maxillary teeth 8 6.7 6.7 6.7
Working on lingual surf ace of maxillary anterior teeth 1 .8 .8 7.5
Tooth preparatio n of posterior teeth 24 20.0 20.0 27.5
All of the above 87 72.5 72.5 100.0
Total 120 100.0 100.0

TABLE 18: Opinion on which procedure they feel is mandatory to use mouth mirror

Male Female
Cavity preparation of maxillary teeth 8.8 4.8
Working on lingual surface of maxillary anterior teeth 0 1.6
Tooth preparation of posterior teeth 22.8 17.5
All of the above 68.4 76.2

The results of the questionnaire were carefully analysed and tabulated according to variousparameters
that were measure using the questions in the questionnaire. The results were analysed using the Chi Square test.
The study included 57 males and 63 females adding upto120 questionnaires that were distributed as a result the
study sample included 47.5% males and 52.5% females differentiated by year of study 48.3% of the
respondents were IIyear students while 51.7% were III yearstudents. Most respondentsutilized the mouth mirror
for most of its important functions such as retraction, illumination and vision. There was a marked preference
howeverfor use of a mouth mirror mainly for retraction among those who did not use it for all three purposes.
With regard to adequacy of training to use a mouth mirror, only 63.3% of respondents felt adequately
trained with regard to the use of a mouth mirror. 36.7% of respondentsstated that they did not feel adequately
trained to utilise a mouth mirror. 61.7% of respondents actually found it inconvenient to use a mouth mirror and
38.3% expressed lackof practice as a reason for not using a mouth mirror. Nevertheless 86.7% of respondents
actually preferred a mouth mirror in all their procedures and only 13.3% did not use one in all procedures.
With regard to the actual use of a mouth mirror, there was a wide variation in preference for a
particular mouth mirror size with 35% of the respondents preferringa particular size whereas 65% indicated no
preference. When using a mouth mirror on maxillary teeth, a total of 87.5% percent of the respondents preferred
to use the mouth mirror for indirect vision but only 36.7% of respondents actually thought that indirect vision
played an important role in ergonomics. This was also indicated by the fact that 92.7% of the respondents that
indirect vision could be improved with practice. 75% of respondents also felt that the degree of illumination
available in their work environment directly influenced the quality on indirect vision. But only 50% of
respondents felt that their accuracy would actually be improved. Only 3.3% of the respondentsused indirect
vision to observecolor changes while giving a prosthesis or restoration. 20.8% of the respondents used a mouth
mirror for this function frequently if not always, but the major 75.8% never used a mouth mirror for this
purpose through indirect vision.
While using a mouth mirror in the oral cavity, it is common to see fogging of a mouth mirror either
from water spray or patient breath. 38.3% of respondents used their glovesto wipe a mirror and clear the surface
for better vision. 36.7% of respondents used cotton and only 25% of respondents used a 3-way syringe. With
regard to the sterilizationofa mouth mirror after use, 95% of the respondents felt that it was important to do so

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 Assessment of the Use of a Dental Mouth Mirror

while the remaining 5% felt that it was unnecessary and did not do so. 38.3% of therespondents found that they
were able to use a mouth mirror for at least 6 months while 35.8% found that they were able to use one for only
4 months. 25.8% felt that theycould use the mouth mirror for 2 months.
With regard to the availability of different types of mouth mirrors, 85.8% of respondents were aware of
the existence of different mirrors with different surfaces. 9.2%were aware of only a plane surface while 3.3%
were only aware of a concave surface and only 1.7% were aware of a front surface.
With regard to types of procedures that influence mouth mirror use, respondents were asked to
comment on whether they felt mouth mirror was mandatory in cavity preparationof maxillary teeth, lingual
surface of maxillary anterior teeth and tooth preparation of posteriorteeth. 72.5% of respondents used the mouth
mirror for all three purposeslisted above. 20% felt that it was mandatory to use a mouth mirror during tooth
preparation of posterior teeth, while 6.7% found it necessary for using it during cavity preparationof maxillary
teeth. Only 0.8% of respondents found that it was mandatory to use the mouth mirror while working on the
lingual surface of maxillary anterior teeth.
95.8% of respondents felt that their patients had no complaints regarding use of a mouth mirror,
whereas 4.2% felt that they did have complaints. All of the respondentsindicatedthat their patients, if they had
complaints, found it inconvenient to have a mouth mirror used.

IV. Discussion:
The study seemed almost equally balanced depending on the gender of the questions survey. There was
only a minor difference between male and female respondents. In anycase the influence of gender on the use of
the mouth mirror should ideally be very minimal, although it perhaps can be argued that females are more adept
at the use of a mirror and are therefore possibly more likely to use a mouth mirror.
The study was also equally balanced with regard to II year pre clinical students and III year clinical
students who were surveyed. This means that those using a mouth mirror in a pre clinical environment and
those employing it for us in clinical dentistry on patients equally influenced the study.
72.5% of respondentsutilised the mouth mirror for all three functions discussed above 16.7% of
respondents used the mouth mirror only for retraction. While 10% of respondentsuseda mouth mirror only for
indirect vision, a disappointing 0.8% only used the mouth mirror for illumination [Table 3]. This suggests that
most students are not using the mouth mirror to itsmaximum advantage and are either unaware of its potential
for use or are simply not employing it for all its functions. The use of mouth mirror for retraction is undoubtedly
one ofits common uses but the use of a mouth mirror for indirect vision should be something that every dental
student uses it for. 17.5% of the respondents were obviously not using the mouth mirror for vision at all and this
means that they are possibly working only with direct vision. Surprisingly, an overwhelming percentage of
63.3% of respondents were unaware of theergonomic advantages that the mouth mirror offered [Table 9]. This
ergonomic advantage is obviously gained mostly through indirect vision, although retraction also plays a role [3].
These respondents are likely to have long-term injuries as a result of poor ergonomics and operating posture.
Poor ergonomics can also have an influence on treatment outcomes as well as the comfort of
the patient during procedures. It could be argued however that 87.5% of respondents did use indirect vision
when working on maxillary teeth even if they were unaware of the ergonomicadvantages that this offered.
Nevertheless 92.5% of respondents felt that their indirect vision could be improved with practice indicating that
a majority was not completely comfortable with the use of indirect vision [Table 10]. This could be for many
reasons but one of the factors that emerge from this survey was that 25% of respondents were not aware thatthe
degree of illumination in the work environment would affect indirect vision [Table 11]. 50% of respondents did
not feel that indirect vision affected their accuracy whereas the reality is that several procedures in dentistry
could only be performed accurately with indirect vision given compromised operating position in several
situations [Table 13]. Surprisingly 72.5% of respondents feltthat it was mandatory to use indirect vision for
cavity preparation of maxillary, working on lingual surfaces of maxillary anterior teeth and tooth preparation of
posterior teeth[2].[Table 18]
Most respondents (75.8%) rarely used indirect vision to observe color changes with a prosthesis or
restoration. These respondents were obviously unaware of the extended uses of indirect vision. There iscertainly
scope to make students more aware of the advantages of indirect vision and focused training on the use of
indirect vision will help many students incorporate thisergonomically useful technique into their clinical
technique.
One of the most common difficulties with indirect vision is the fogging of the mouth mirror and all
respondents seemed to use some technique or the other to wipe theirfoggedmirrors with most of them opting to
wipe the mirror. Very few used the 3-way syringe although this is possibly a very common technique when
assistance is available. Students couldpossibly be educated as well about the use of defogging sprays, which
prevent a mouth mirror from becoming fogged by affecting surface tension of the mirror.

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 Assessment of the Use of a Dental Mouth Mirror

A few respondents (1.7%) were unaware of the existence of special types of mirrors, particularly front
surface and concave surface mirror. The use of these special mirrors can enhance the accuracy factor that
indirect vision brings to dentistry. It was also heartening to note that most respondents believed in sterilizing
their mouth mirror after every use [Table 17]
However a large percentage of respondents were using mouth mirrors for a prolonged period. Mouth
mirrors become easily corroded or the mirror surface developsscratchesfrom use. It is very important to replace
mirrors regularly if one is to gain maximum advantage from using them. Good instruments also increase a
clinician's ability to enjoyhis work and instruments that have been damaged affect the ability of a clinician to be
accurate. This directly affects treatment outcome and results in professional dissatisfaction.
Most respondents in the study (95.8%) did not feel that patients had any complaints with regard to the
use of the mouth mirror during the treatment procedure.A very small percentage of respondents mentioned that
their patients found the use of mouth mirror inconvenient. The reality is that the mouth mirrors canactuallyhelp
to make a treatment procedure more comfortable for a patient, if used correctly.

V. Conclusion:
The study clearly demonstrates deficiencies in the understanding of the use of a mouth mirror by dental
students. There are also definite voids in the use of this very usefulinstrument even among respondents who
clearly understand its advantages. It is therefore obvious that pre clinical education should focus on stressing the
advantagesof use of mouth mirror while more pre clinical and clinical training is necessary to help students to
clearly experience them. Dentistry often involves many years of long hours of intensely focused work in a poor
ergonomic environment. The use of a mouth mirror particularly in indirect vision is probably the most
importantskill that will save any dentist from ergonomic related injury. It is therefore an essential skill to
understand and master.

References:
[1]. www1.umn.edu/perio/dent5612-04/module_04.pdf
[2]. www.jdentaled.org/content/75/9/1280.full.pdf
[3]. www.ohcow.on.ca/uploads/Resource/Workbooks/ERGONOMICS%20AND%20DENTAL%20WORK.pdf

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