1. Copyright 2003, Elsevier Science (USA). All rights reserved. Chapter 36 Moisture Control Copyright 2003, Elsevier Science (USA) All rights reserved. No part of this product may be reproduced or transmitted in any form or by any means, electronic or mechanical, including input into or storage in any information system, without permission in writing from the publisher. PowerPoint ® presentation slides may be displayed and may be reproduced in print form for instructional purposes only, provided a proper copyright notice appears on the last page of each print-out. Produced in the United States of America ISBN 0-7216-9770-4

2. Copyright 2003, Elsevier Science (USA). All rights reserved. Objective: Maintain an environment that keeps the operating field free of excess water, saliva, blood, tooth fragments, and excess dental materials. Introduction

3. Copyright 2003, Elsevier Science (USA). All rights reserved.  The process of removing excess fluids and debris from the mouth.  Two systems: Saliva ejector High-volume evacuator (HVE)  The process of removing excess fluids and debris from the mouth.  Two systems: Saliva ejector High-volume evacuator (HVE) Oral Evacuation Systems

4. Copyright 2003, Elsevier Science (USA). All rights reserved.  Small, strawlike oral evacuator used during less invasive dental procedures.  Indications for use: Preventive procedures such as a prophylaxis or fluoride treatments. Helps control saliva and moisture accumulation under the dental dam. For the cementation of crown or bridge. During an orthodontic bonding procedure.  Small, strawlike oral evacuator used during less invasive dental procedures.  Indications for use: Preventive procedures such as a prophylaxis or fluoride treatments. Helps control saliva and moisture accumulation under the dental dam. For the cementation of crown or bridge. During an orthodontic bonding procedure. Saliva Ejector

5. Copyright 2003, Elsevier Science (USA). All rights reserved.  Placement of saliva ejector Bend and shape saliva ejector for placement. Position under the tongue. Position saliva ejector opposite the side on which the dentist is working.  Placement of saliva ejector Bend and shape saliva ejector for placement. Position under the tongue. Position saliva ejector opposite the side on which the dentist is working. Saliva Ejector  cont’d

6. Copyright 2003, Elsevier Science (USA). All rights reserved.  Used for most dental procedures, especially when the dental handpiece is in use.  Indications for use Keep the mouth free of saliva, blood, water, and debris. Retracts the tongue and cheek away from the field of operation. Reduces the bacterial aerosol caused by the high ‑ speed handpiece.  Used for most dental procedures, especially when the dental handpiece is in use.  Indications for use Keep the mouth free of saliva, blood, water, and debris. Retracts the tongue and cheek away from the field of operation. Reduces the bacterial aerosol caused by the high ‑ speed handpiece. HVE

7. Copyright 2003, Elsevier Science (USA). All rights reserved.  Oral evacuation 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.  Oral evacuation 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. HVE  cont’d

8. Copyright 2003, Elsevier Science (USA). All rights reserved.  Thumb-to-nose grasp  Pen grasp Right hand  Thumb-to-nose grasp  Pen grasp Right hand Grasping the HVE

9. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 36-4 Grasping the HVE.

10. Copyright 2003, Elsevier Science (USA). All rights reserved.  Criteria: Place the evacuator prior to the dentist positioning the handpiece and mouth mirror. Position the tip on the surface of the tooth that is closest to you. Position the tip as close 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 higher than the occlusal or incisal edge.  Criteria: Place the evacuator prior to the dentist positioning the handpiece and mouth mirror. Position the tip on the surface of the tooth that is closest to you. Position the tip as close 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 higher than the occlusal or incisal edge. Positioning the HVE

11. Copyright 2003, Elsevier Science (USA). All rights reserved.  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 after a procedure.  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 after a procedure. Rinsing the Oral Cavity

12. Copyright 2003, Elsevier Science (USA). All rights reserved.  Used for convenience and accuracy to complete the rinsing process.  Criteria for use: Direct the tip toward the tooth that is being worked on. Keep a close distance between the operative site and the syringe tip. Use the air on the mouth mirror continuously when indirect vision is involved. When you hear the handpiece stop, you know to rinse and dry the site. When completing a limited area or full-mouth rinse, move the tip while spraying the area.  Used for convenience and accuracy to complete the rinsing process.  Criteria for use: Direct the tip toward the tooth that is being worked on. Keep a close distance between the operative site and the syringe tip. Use the air on the mouth mirror continuously when indirect vision is involved. When you hear the handpiece stop, you know to rinse and dry the site. When completing a limited area or full-mouth rinse, move the tip while spraying the area. The Air-Water Syringe

13. Copyright 2003, Elsevier Science (USA). All rights reserved.  Criteria for isolation techniques: Be easy to apply and not injure soft and hard tissues. Be comfortable for the patient. Provide retraction for better visualization for the operator. Prevent moisture contamination. Isolate the area of concern.  Criteria for isolation techniques: Be easy to apply and not injure soft and hard tissues. Be comfortable for the patient. Provide retraction for better visualization for the operator. Prevent moisture contamination. Isolate the area of concern. Isolation of Teeth

14. Copyright 2003, Elsevier Science (USA). All rights reserved.  Formed, preshaped cotton positioned close to the salivary gland ducts absorbs the flow of saliva and excess water. Cotton Roll Isolation

15. Copyright 2003, Elsevier Science (USA). All rights reserved.  Advantages: Easy application. No additional equipment is required. Flexible so they 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 and can injure it. It must be replaced frequently because of saturation. Limited retraction.  Advantages: Easy application. No additional equipment is required. Flexible so they 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 and can injure it. It must be replaced frequently because of saturation. Limited retraction. Cotton Roll Isolation  cont’d

16. Copyright 2003, Elsevier Science (USA). All rights reserved.  A triangular absorbent pad placed over the Stensen's duct blocks the flow of saliva and protects the tissues in this area. Dry-Angles

17. Copyright 2003, Elsevier Science (USA). All rights reserved.  A thin stretchable latex material becomes a barrier when appropriately applied to select teeth. The Dental Dam

18. Copyright 2003, Elsevier Science (USA). All rights reserved.  Indications for use Infection control protective barrier. Safeguards the patient's mouth. Protects the patient from accidentally inhaling or swallowing debris. Protects the tooth from contamination. Provides the moisture control needed. Improves access. Provides better visibility. Increases dental team efficiency.  Indications for use Infection control protective barrier. Safeguards the patient's mouth. Protects the patient from accidentally inhaling or swallowing debris. Protects the tooth from contamination. Provides the moisture control needed. Improves access. Provides better visibility. Increases dental team efficiency. The Dental Dam  cont’d

19. Copyright 2003, Elsevier Science (USA). All rights reserved.  Provides complete isolation around one tooth or several teeth. Made of either latex or latex ‑ free material. Available in a continuous roll or in two precut sizes (6x6 or 5x5). Available in a wide range of colors from light to dark. Available in scented and flavors. Dam thicknesses (gauges) are thin (light), medium, and heavy.  Provides complete isolation around one tooth or several teeth. Made of either latex or latex ‑ free material. Available in a continuous roll or in two precut sizes (6x6 or 5x5). Available in a wide range of colors from light to dark. Available in scented and flavors. Dam thicknesses (gauges) are thin (light), medium, and heavy. Dental Dam Supplies and Equipment

20. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 36-15 Dental dam material.

21. Copyright 2003, Elsevier Science (USA). All rights reserved.  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.  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. Dental Dam Frame

22. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 36-16 Dental dam frame.

23. Copyright 2003, Elsevier Science (USA). All rights reserved.  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.  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. Dental Dam Supplies and Equipment  cont’d Dental Dam Supplies and Equipment  cont’d

24. Copyright 2003, Elsevier Science (USA). All rights reserved.  Dental dam punch: Creates the holes in the dental dam that are needed to expose the teeth to be isolated. Dental Dam Supplies and Equipment  cont’d Dental Dam Supplies and Equipment  cont’d

25. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 36-18 Sizes of the holes.

26. Copyright 2003, Elsevier Science (USA). All rights reserved.  Dental dam stamp: Ink pad and stamp used to mark the dental dam with predetermined markings for average adult and pediatric arches.  Dental template: Stiff plastic template with holes indicating where the teeth should be marked.  Dental dam stamp: Ink pad and stamp used to mark the dental dam with predetermined markings for average adult and pediatric arches.  Dental template: Stiff plastic template with holes indicating where the teeth should be marked. Dental Dam Supplies and Equipment  cont’d Dental Dam Supplies and Equipment  cont’d

27. Copyright 2003, Elsevier Science (USA). All rights reserved.  Dental dam forceps are 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.  Dental dam forceps are 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. Dental Dam Supplies and Equipment  cont’d Dental Dam Supplies and Equipment  cont’d

28. Copyright 2003, Elsevier Science (USA). 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.  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. Dental Dam Supplies and Equipment  cont’d Dental Dam Supplies and Equipment  cont’d

29. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 36-23 Dental dam clamps.

30. Copyright 2003, Elsevier Science (USA). All rights reserved.  Fitting the clamp: Designed to fit on the cervical area of the tooth below the height of contour and at, or slightly below, the cementoenamel junction. 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.  Fitting the clamp: Designed to fit on the cervical area of the tooth below the height of contour and at, or slightly below, the cementoenamel junction. 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. Dental Dam Clamps

31. Copyright 2003, Elsevier Science (USA). All rights reserved.  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.  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. Dental Dam Clamps  cont’d

32. Copyright 2003, Elsevier Science (USA). All rights reserved. Fig. 36-24 Ligature.

33. Copyright 2003, Elsevier Science (USA). All rights reserved.  Steps in preparation and placement Dental dam equipment and supplies readied. Dam is punched. Clamp selected, ligated, and positioned on forceps. Placement of clamp. Placement of dam. Placement of frame. Dam secure and inverted.  Steps in preparation and placement Dental dam equipment and supplies readied. Dam is punched. Clamp selected, ligated, and positioned on forceps. Placement of clamp. Placement of dam. Placement of frame. Dam secure and inverted. Dental Dam Application

34. Copyright 2003, Elsevier Science (USA). All rights reserved.  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 everything as one unit. Evaluate patient. Evaluate dam.  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 everything as one unit. Evaluate patient. Evaluate dam. Dental Dam Removal