Moisture Control Chapter 36 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 36 Lesson 36.1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives  Define and spell the Key Terms.  List isolation techniques used to decrease moisture during a dental procedure.  Describe the two types of oral evacuation systems used in dentistry.  Describe the grasp and positioning of the tip of the high-volume evacuator (HVE). (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives (Cont’d)  Demonstrate the grasp and positioning of the HVE during a procedure.  Discuss the use of the air-water syringe.  Perform limited and full-mouth rinses.  Place cotton rolls for isolation. Copyright © 2009, 2006 by Saunders, an imprint of 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 © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Saliva Ejector  Small strawlike oral evacuator used for less invasive dental procedures  Indications for use:  Preventive procedures such as prophylaxis, fluoride treatments, and sealant placement  Helps control saliva and moisture accumulation under the dental dam  For the cementation of a crown or bridge  During an orthodontic bonding procedure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Placement of Saliva Ejector  Bend and shape the saliva ejector for stationary placement.  Position the ejector under the tongue.  Position the ejector opposite the side on which the dentist is working. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Saliva ejector. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

High-Volume Evacuator  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 the tongue and cheek from the field of operation  Reduces bacterial aerosol caused by the high- speed handpiece Copyright © 2009, 2006 by Saunders, an imprint of 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 © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Grasps used for operating the HVE. Top, thumb-to-nose grasp; bottom, pen grasp. Copyright © 2009, 2006 by Saunders, an imprint of 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 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 © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Operator and assistant positions in high-volume evacuation. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

The Air-Water Syringe  Used for convenience and accuracy to complete the rinsing process  Guidelines 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, it’s time to rinse and dry the site.  When completing a limited area or full-mouth rinse, move the tip while spraying the area. Copyright © 2009, 2006 by Saunders, an imprint of 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 a procedure Performed frequently throughout a procedure Accomplished quickly and efficiently Accomplished quickly and efficiently  Full-mouth rinse Freshens the patient's entire mouth Freshens the patient's entire mouth Completed at the end of a procedure Completed at the end of a procedure Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Isolation of Teeth  Criteria for Isolation Techniques  Easy to apply  Safe for soft and hard tissues  Comfortable for the patient  Provides retraction for better visualization for the operator  Prevents moisture contamination  Isolates the area of concern Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Cotton-Roll Isolation  Advantages  Easy application  No additional equipment required  Flexible, permitting adaptation to different 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 © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Cotton-roll isolation in the mandibular quadrant. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dry-Angle Isolation A triangular absorbent pad placed over the Stensen duct blocks the flow of saliva and protects the tissues in this area. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Dry-angle placement in the buccal mucosa. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 36 Lesson 36.2 Chapter 36 Lesson 36.2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives  Describe the dental dam and its role in moisture control.  List the equipment and supplies for dental dam application.  Identify the equipment and supplies used for dental dam application. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Learning Objectives (Cont’d)  Describe the special preparation and placement of the dental dam.  Have the dental dam prepared correctly for a procedure.  Place the dental dam as an expanded function.  Remove the dental dam as an expanded function. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

The Dental Dam A thin stretchable latex material that acts as a barrier when appropriately applied to selected teeth. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

The Dental Dam (Cont’d)  Indications for use  Infection-control barrier  Safeguard for the patient's mouth  Protection from accidental inhalation or swallowing of debris  Protection from contamination for the tooth  Moisture-control device  Tool with which to improve access  Tool with which to improve visibility  Tool with which to increase dental-team efficiency Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dental Dam Material  Dental dam materials  Latex or latex-free material  Available in a continuous roll or in two precut sizes (6 × 6 inches for adults and 5 × 5 inches for children)  Available in a wide range of colors, from light to dark (dark is preferred because of the contrast)  Available in various scents and flavors  Three thicknesses (gauges): thin (light), medium, and heavy Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Dental dam material. (From Boyd L: Dental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of 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 various plastic and metal frames  U-shaped frame  Young frame  Otsby frame Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Dental dam frames. (From Boyd L: Dental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of 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 © 2009, 2006 by Saunders, an imprint of 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 © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Dental dam punch. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Size of holes for punching the dental dam and the coordinating teeth for the size of punched holes. (Adapted from Baum L, Phillips RW, Lund MR: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Dental dam stamp. (From Boyd L: Dental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dental Dam Forceps  Used in the placement and removal of the dental dam clamp  The beaks of the forceps fit into holes on the jaws of the clamp.  A sliding bar keeps the handles of the forceps in a fixed position.  The handles are squeezed to release the clamp.  The beaks of the forceps are turned toward the arch being isolated. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Dental dam forceps. Copyright © 2009, 2006 by Saunders, an imprint of 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 (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Types of dental dam clamps. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dental Dam Clamps (Cont’d)  The clamp is designed to fit on the cervical area of the tooth below the height of contour at, or slightly below, the cementoenamel junction.  Winged clamps have 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 © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dental Ligature An important safety measure that makes it possible to retrieve a clamp should it accidentally become dislodged and then inhaled or swallowed by the patient Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig Ligature placed on the bow of the clamp for protective purposes. Copyright © 2009, 2006 by Saunders, an imprint of 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 punched  Clamp selected, ligated, and positioned on forceps  Clamp placed  Dam placed  Frame placed  Dam secured and inverted Copyright © 2009, 2006 by Saunders, an imprint of 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 the forceps in the clamp.  Remove the dam and frame as a unit.  Evaluate the patient.  Evaluate the dam. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.