Mouth mirror magic

May 1, 2007
Years ago, I came to a very simple conclusion: Clinical dental practitioners are brilliant.

by Anne Nugent Guignon

Years ago, I came to a very simple conclusion: Clinical dental practitioners are brilliant. How else could they look at an image reflected in the surface of a mouth mirror and navigate effectively around the deep, dark crevices of the oral cavity?

Using a mouth mirror is not a skill that every Dick and Jane possess. Dental professionals acquire this basic skill either while working in a dental office or during the first few weeks of school. We train our brains to understand and interpret the image on the mirror surface. It takes practice and skill to understand how to travel around the mouth viewing images on the tiny mirror surface.

Mirrors are used to assist in indirect vision, illuminate a worksite, and aid in retracting a giant, squirmy tongue or rock-hard buccal mucosa. While you may not give this simple, universal tool much thought, there are ways to make your mouth mirrors more effective assets in daily practice.

From an ergonomic standpoint, it is important to keep your grasp on the handle of a mouth mirror as light as possible. Many clinicians have developed significant workplace-related musculoskeletal disorders from gripping a mirror handle too tightly, especially when retracting.

Most mouth mirrors are autoclavable and used repeatedly, resulting in a cost effective product. In contrast, single-use mirrors are an ideal product for situations such as screening large numbers of patients at a health fair. Single-use mirrors are also perfect for air-abrasion restorative techniques, where a poorly aimed nozzle can destroy the reflective surface in a millisecond.

Single-use mirror surfaces are not as crisp as a more durable mirror, but they reflect light and are an effective retraction tool.

There are several disadvantages to using single-use mirrors as the primary reflective tool. First, the quality of the reflective surface is not that of a standard mirror. Second, the overall cost of these mirrors is higher than purchasing and maintaining a high quality autoclavable mirror. Finally, they join the generation of unnecessary landfill waste.

Some mirrors screw into permanent handles that are all metal, metal/resin combinations, metal with silicone padding, or all resin. Clinicians concerned about instrument weight prefer all-in-one lightweight resin designs that feature medical-grade silicone padded handle grips.

Round mirror surfaces predominate. The mirror number indicates the relative diameter. Size four and five mirrors are the practical favorites for most clinicians, but the small diameter of a number three comes in handy when mirror size is an issue. Double-sided mirrors help with visualization, improve light reflection, and are ergonomically beneficial because of the unique bend in the mirror stem.

For years, there was little variation in the size, shape, or overall design of mouth mirrors. With the increased interest in ergonomics and visual acuity, however, there is more to mirrors these days than a shiny round surface. One manufacturer makes a disposable, one-time-use mirror with a rectangular head that fits nicely into tight areas, giving clinicians an enhanced view of the buccal surfaces of the maxillary molars, or the lingual surfaces of the mandibular posterior. The other side of the rectangular mirror has a surface that improves light reflection.

The surface quality in mouth mirrors varies by manufacturer. The reflective coating on the front surface of a dental mouth mirror is applied to the top of the glass rather than the backside, like a bathroom mirror. This provides an optimal reflective surface with minimal image distortion.

Rhodium, a hard silvery-white durable metal found in platinum ores, is the most reflective element in the periodic table. For years, specialty mirrors such as those found in lighthouses, high performance car headlamps, and searchlights relied on rhodium to produce high quality reflective surfaces.

Until recently, rhodium was also the reflective material of choice for high quality dental mirrors. However, recent advancements in reflective-surface technology have produced a mirror surface that is considerably brighter, crisper and with more accurate color rendition. A side-by-side clinical comparison with a rhodium mirror demonstrates the differences. The result is a more accurate clinical image with a higher reflective value.

Forty-three layers of metal oxides create the breakthrough technology found in Zirc’s Crystal mirror, which is available as either an all-metal cone socket screw-in mirror or an all resin mirror, with or without silicone handle grips. The manufacturer recommends drying the mirror surface prior to autoclaving to prevent surface spotting.

Combination mirror/suction devices serve double duty by providing illumination, as well as capturing fluid aerosols created around the clinical worksite. A new mirror/suction device featuring an ergonomically friendly swivel will be available to clinicians sometime in autumn 2007.

Intraoral dental photography uses reflective mirror surfaces made from either highly polished metal or front surface glass mirrors. Mirrors come in three shapes for various full and partial-arch occlusal, palatal, buccal, and lingual shots.

Fogging is a big issue with any type of mirror. Years ago clinicians were taught to slide the surface of the mouth mirror across a patient’s buccal mucosa, coating the mirror surface with saliva while warming the metal. While this works reasonably well for a short appointment, today’s epidemic of patients with xerostomia issues make this approach less practical.

Warming a mouth mirror under warm tap water will bring the temperature of the mirror closer to that of the patient’s oral cavity and reduce fogging. Mouthwash-dampened gauze or commercially prepared solutions also eliminate fogging. Periodically wiping the mirror surface with these solutions during an appointment will keep the image clear.

Finding a scratch-free mirror is every clinician’s dream. Even though scientists crack the most complex scientific mysteries, dental professionals are still stuck with mirrors that scratch. But we can slow down the inevitable aging process.

First of all, it’s downright cruel to throw lovely, new unscratched mirrors into an ultrasonic cleaning bath with dozens of other sharp instruments - a fast track to ruining their shiny new surfaces. Mirrors should be treated with respect. Consider processing them and all instruments in autoclavable boxes or cassettes in either an ultrasonic bath or instrument washer. If mirrors are batch-cleaned in a box in the ultrasonic cleaner, the mirror heads can be wrapped in dry gauze and placed in individual autoclavable bags containing other instruments. Or think about individually bagging mirrors to preserve surface integrity.

“Mirror, mirror on the wall, who’s the fairest one of all?” The fairest one in your comfort zone is just the right size with a crisp, clear, fog-free surface that is devoid of scratches and illuminates your dental hygiene world.

Anne Nugent Guignon, RDH, MPH, is the senior consulting editor for RDH magazine. She is an international speaker who has published numerous articles and authored several textbook chapters. Her popular programs include ergonomics, patient comfort, burnout, and advanced diagnostics and therapeutics. Recipient of the 2004 Mentor of the Year Award, Anne is an ADHA member who has practiced dental hygiene in Houston since 1971. You can reach her at [email protected] or (713) 974-4540. Her Web site is