Copyright © 2005 by Elsevier Inc. All rights reserved. Moisture Control Chapter 36

Copyright © 2005 by Elsevier Inc. All rights reserved. Moisture Control The objective is to maintain an intraoral environment that keeps the operating field free of excess water, saliva, blood, tooth fragments, and excess dental materials.

Copyright © 2005 by Elsevier Inc. All rights reserved. Saliva Ejector Small, straw-like oral evacuator used for less invasive dental procedures Indications for use: –Preventive procedures such as a prophylaxis, fluoride treatment, sealants –Helps control saliva and moisture accumulation under the dental dam –For the cementation of a crown or bridge –During an orthodontic bonding procedure

Copyright © 2005 by Elsevier Inc. All rights reserved. Placement of Saliva Ejector Bend and shape saliva ejector for stationary placement. Position under the tongue. Position saliva ejector opposite the side on which the dentist is working.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Saliva Ejector

Copyright © 2005 by Elsevier Inc. All rights reserved. High-Volume Evacuator “HVE” Used for most dental procedures, especially when the dental handpiece is in use Indications for Use –Keeps the mouth free of saliva, blood, water, and debris –Retracts tongue and cheek away from the field of operation –Reduces the bacterial aerosol caused by the high- speed handpiece

Copyright © 2005 by Elsevier Inc. All rights reserved. Types of HVE Tips Operative Suction Tips –Designed with a straight or slight angle in the middle –Beveled working end –Made of durable plastic or stainless steel Surgical Suction Tips –Much smaller in circumference –Made of stainless steel

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Grasping the HVE

Copyright © 2005 by Elsevier Inc. All rights reserved. Guidelines for Positioning the HVE Place the evacuator before the dentist positions the handpiece and mouth mirror. Position the HVE on the surface of the tooth that is closest to you. Position the tip as close as possible to the tooth being worked on. Position the bevel of the tip so that it is parallel to the tooth surface. Keep the edge of the tip even or slightly beyond the occlusal or incisal edge.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Positioning of the High-Volume Evacuator

Copyright © 2005 by Elsevier Inc. All rights reserved. The Air-Water Syringe Used for convenience and accuracy to complete the rinsing process. Criteria for Use –Direct the tip toward the tooth being worked on. –Keep a close distance between the operative site and the syringe tip. –Use air on the mouth mirror continuously when indirect vision is involved. –When you hear the handpiece stop, time to rinse and dry the site. –When completing a limited area or full-mouth rinse, move the tip while spraying the area.

Copyright © 2005 by Elsevier Inc. All rights reserved. Rinsing the Oral Cavity Maintains a clear operating field for the dentist and keeps the patient comfortable. Two types of rinsing procedures –Limited Area Rinsing Performed frequently throughout procedure. Accomplished quickly and efficiently. –Full-Mouth Rinse Freshens the patient's entire mouth. Completed at end of procedure.

Copyright © 2005 by Elsevier Inc. All rights reserved. Isolation of Teeth Criteria for Isolation Techniques –Easy to apply –Not injure soft and hard tissues –Comfortable for the patient –Provide retraction for better visualization for the operator –Prevent moisture contamination –Isolate the area of concern

Copyright © 2005 by Elsevier Inc. All rights reserved. Cotton Roll Isolation Advantages –Easy application –No additional equipment is required –Flexible so it can be adapted to fit areas of the mouth Disadvantages –Does not provide complete isolation –Does not protect the patient from aspiration –May stick to the oral mucosa –Must be replaced frequently because of saturation –Limited retraction

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Cotton Roll Isolation

Copyright © 2005 by Elsevier Inc. All rights reserved. Dry Angles A triangular absorbent pad placed over the Stensen's duct blocks the flow of saliva and protects the tissues in this area.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Dry Angle Placement

Copyright © 2005 by Elsevier Inc. All rights reserved. The Dental Dam A thin stretchable latex material to act as a barrier when appropriately applied to select teeth.

Copyright © 2005 by Elsevier Inc. All rights reserved. The Dental Dam-cont’d Indications for Use –Infection control barrier –Safeguard the patient's mouth –Protect the patient from accidentally inhaling or swallowing debris –Protect the tooth from contamination –Provide the moisture control needed –Improve access –Provide better visibility –Increase dental team efficiency

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Material Types of Dental Dam Materials –Made of either latex or latex-free material. –Available in a continuous roll or in two precut sizes (6 × 6 adult or 5 × 5 pediatric). –Available in a wide range of colors from light to dark (dark preferred because of contrast). –Available in scented and flavors. –Dam thicknesses (gauges) are thin (light), medium, and heavy.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Dental Dam Material

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Frame Stabilizes and stretches the dam so it fits tightly around the teeth and out of the operator's way. Available in plastic and metal frames. –U-shaped frame –Young’s frame –Otsby frame

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Dental Dam Frame

Copyright © 2005 by Elsevier Inc. All rights reserved. Additional Dental Dam Equipment Dental Dam Napkin –Increases patient comfort by absorbing moisture between the patient's face and the dam. Lubricant –Water-soluble lubricant placed on the underside of the dam to help the dam material slide over the teeth and through the interproximal spaces.

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Punch Creates the holes in the dental dam that are needed to expose the teeth to be isolated.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Dental Dam Punch

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Sizes of Holes for punching dental dam (Adapted from Baum L, Phillips RW, Lund MR: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Dental Dam Stamp and Template

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Forceps Used in the placement and removal of the dental dam clamp. –Beaks of the forceps fit into holes on the jaws of the clamp. –Sliding bar keeps the handles of the forceps in a fixed position. –Handles are squeezed to release the clamp. –Beaks of the forceps are turned toward the arch being isolated.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Dental Dam Forceps

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Clamps The primary means of anchoring and stabilizing the dental dam. Parts of the Clamp –Bow: Rounded portion of the clamp. –Jaws: Prongs that seat around the tooth create the extension and balance necessary to stabilize the clamp.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Types of Dental Dam clamps

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Clamps Fitting the Clamp: Designed to fit on the cervical area of the tooth below the height of contour at, or slightly below, the CEJ –Winged clamps have extra extensions to help retain the dental dam. –Posterior clamps are for the maxillary and mandibular posterior teeth. –Anterior clamps retract the gingiva on the facial surface, and improve visibility.

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Ligature An important safety step that makes it possible to retrieve a clamp should it accidentally become dislodged and then inhaled or swallowed by the patient.

Copyright © 2005 by Elsevier Inc. All rights reserved. Fig Ligature

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Application Steps in Preparation and Placement –Dental dam equipment and supplies readied –Area of mouth examined for placement –Dam is punched –Clamp selected, ligated, and positioned on forceps –Placement of clamp –Placement of dam –Placement of frame –Dam secure and inverted

Copyright © 2005 by Elsevier Inc. All rights reserved. Dental Dam Removal Steps in Removal –Remove any ligatures that are stabilizing the dam –Using crown and bridge scissors, cut each hole creating one slit –Position forceps in clamp –Remove dam and frame as one unit –Evaluate patient –Evaluate dam