Chapter 36 Moisture Control Copyright 2003 Elsevier Science

Introduction Objective: Maintain an environment that keeps the operating field free of excess water,

Oral Evacuation Systems § The process of removing excess fluids and § debris from

Saliva Ejector § Small, strawlike oral evacuator used during § less invasive dental procedures.

Saliva Ejector- cont’d § Placement of saliva ejector • Bend and shape saliva ejector

HVE § Used for most dental procedures, especially § when the dental handpiece is

HVE- cont’d § Oral evacuation tips § Operative suction tips • Designed with a

Grasping the HVE § Thumb-to-nose grasp § Pen grasp • Right hand Copyright 2003,

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

Positioning the HVE § Criteria: • Place the evacuator prior to the dentist positioning

Rinsing the Oral Cavity § Maintains a clear operating field for the dentist §

The Air-Water Syringe § Used for convenience and accuracy to complete the § rinsing

Isolation of Teeth § Criteria for isolation techniques: • Be easy to apply and

Cotton Roll Isolation § Formed, preshaped cotton positioned close to the salivary gland ducts

Cotton Roll Isolation- cont’d § Advantages: • Easy application. • No additional equipment is

Dry-Angles § A triangular absorbent pad placed over the Stensen's duct blocks the flow

The Dental Dam § A thin stretchable latex material becomes a barrier when appropriately

The Dental Dam- cont’d § Indications for use • Infection control protective barrier. •

Dental Dam Supplies and Equipment § Provides complete isolation around one tooth or several

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

Dental Dam Frame § Stabilizes and stretches the dam so it fits tightly around

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

Dental Dam Supplies and Equipment- cont’d § Dental dam napkin: Increases patient § comfort

Dental Dam Supplies and Equipment- cont’d § Dental dam punch: Creates the holes in

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

Dental Dam Supplies and Equipment- cont’d § Dental dam stamp: Ink pad and stamp

Dental Dam Supplies and Equipment- cont’d § Dental dam forceps are used in the

Dental Dam Supplies and Equipment- cont’d § Dental dam clamps: The primary means of

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

Dental Dam Clamps § Fitting the clamp: Designed to fit on the cervical area

Dental Dam Clamps- cont’d § Ligature: An important safety step that makes it possible

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

Dental Dam Application § Steps in preparation and placement • Dental dam equipment and

Dental Dam Removal § Steps in removal • Remove any ligatures that are stabilizing

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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. Power. Point® 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 Copyright 2003, Elsevier Science (USA). All rights reserved.

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

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

Saliva Ejector § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

Saliva Ejector- cont’d § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

HVE § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

HVE- cont’d § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

Positioning the HVE § 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. Copyright 2003, Elsevier Science (USA). 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 after a procedure. Copyright 2003, Elsevier Science (USA). 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 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

Isolation of Teeth § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

Cotton Roll Isolation- cont’d § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

The Dental Dam- cont’d § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

Dental Dam Supplies and Equipment § 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 (6 x 6 or 5 x 5). • 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. Copyright 2003, Elsevier Science (USA). 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 2003, Elsevier Science (USA). All rights reserved.

Dental Dam Supplies and Equipment- cont’d § 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 2003, Elsevier Science (USA). All rights reserved.

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

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

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

Dental Dam Supplies and Equipment- cont’d § 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 2003, Elsevier Science (USA). All rights reserved.

Dental Dam Clamps § 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

Dental Dam Clamps- cont’d § 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 2003, Elsevier Science (USA). All rights reserved.

Dental Dam Application § 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. Copyright 2003, Elsevier Science (USA). 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 everything as one unit. • Evaluate patient. • Evaluate dam. Copyright 2003, Elsevier Science (USA). All rights reserved.