There are many auxiliary or alternative fulcrums that aid in scaling areas that have difficult accessibility. These include:
Cross arch: The fulcrum finger is placed in the same arch on the teeth, but on the opposite quadrant in which you are working (Figure 61).
Figure 61. Cross Arch.
Opposite arch: The fulcrum is placed in the opposite arch from which you are working (Figure 62).
Figure 62. Opposite arch.
Finger-on-finger: The fulcrum is placed on a finger of the opposite hand which is resting on the same arch as you are working (Figure 63).
Figure 63. Finger-on-finger.
Reinforced fulcrum: The fulcrum is placed on the same arch as you are working and close to the working area. The index finger from the opposite hand is pressed onto the shank of the instrument and gently applies pressure. This increases the lateral pressure when scaling (Figure 64).
Figure 64. Reinforced Fulcrum.
Extraoral fulcrums: The back of the hand or a finger is placed extra-orally to stabilize and obtain the most correct instrument angulation for activation and stroke (Figure 65).
Figure 65. Extraoral Fulcrum.
Alternative fulcrums provide enhanced access to the working area, increase the likelihood of proper instrument angulation and activation and also help to provide increased power in the stroke. But they can also increase the risk of patient or operator injury and instability in the working area.7