Chapter 36 Moisture Control Saliva Ejector A small

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Chapter 36 Moisture Control

Chapter 36 Moisture Control

Saliva Ejector • A small straw-shaped oral evacuator used during less-invasive dental procedures •

Saliva Ejector • A small straw-shaped oral evacuator used during less-invasive dental procedures • Indications for use include: • Preventive procedures such as prophylaxis, fluoride treatments, and sealant placement • Control of saliva and moisture accumulation under the dental dam • Cementation of a crown or bridge • Orthodontic bonding procedures

Oral Evacuation Systems • The objective is to maintain an intraoral environment that keeps

Oral Evacuation Systems • 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

Saliva Ejector (Cont. )

Saliva Ejector (Cont. )

Placement of Saliva Ejector • Bend and shape the saliva ejector for stationary placement

Placement of Saliva Ejector • Bend and shape the saliva ejector for stationary placement • Position the ejector under the tongue where most fluids accumulate • Position the ejector opposite the side on which the dentist is working

High-Volume Evacuator (HVE) • Used for most dental procedures, especially when the dental handpiece

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 the tongue and cheek away from the field of operation • Reduces bacterial aerosol caused by the high-speed handpiece

Suction Tips • • Operative suction tips Designed with a straight or slight angle

Suction 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

Grasps Used for Operating the HVE

Grasps Used for Operating the HVE

Grasping the Evacuator The HVE may be held in a thumb-to-nose grasp or the

Grasping the Evacuator The HVE may be held in a thumb-to-nose grasp or the pen grasp Ø Either provides the dental assistant with control of the tip, which is necessary for patient comfort and safety

Positioning the Evacuator (HVE) • Place the evacuator before the dentist positions the handpiece

Positioning the Evacuator (HVE) • Place the evacuator before the dentist positions the handpiece and mouth mirror • Position the HVE on the surface of the operative 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 surface or incisal edge

HVE Tip Position

HVE Tip Position

Daily Maintenance of the Evacuation System • The HVE must undergo daily upkeep to

Daily Maintenance of the Evacuation System • The HVE must undergo daily upkeep to maintain proper working order • Specific guidelines include: • • Follow infection control policies when handling contaminated items Flush the hoses at the end of the day with an antimicrobial solution Check the disposable traps weekly, and replace if needed Open the saliva ejector hoses, and clean or replace the screens as needed

Rinsing the Oral Cavity • Maintains a clear operating field for the dentist and

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 • Accomplished quickly and efficiently • Full-mouth rinse • Freshens the patient's entire mouth • Completed at the end of a procedure

Air-Water Syringe • Used for convenience and accuracy to complete the rinsing process •

Air-Water Syringe • Used for convenience and accuracy to complete the rinsing process • Guidelines for use: • • • Direct the tip toward the tooth being treated 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, rinse and dry the site When completing a limited-area or full-mouth rinse, move the tip while spraying the area

Isolation of Teeth • • Criteria for isolation techniques: Easy to apply Protective of

Isolation of Teeth • • Criteria for isolation techniques: Easy to apply Protective of soft and hard tissues Comfortable for the patient Retraction provides better visualization for the operator Prevention of moisture contamination Isolation of the area of concern

Cotton Roll Isolation • • • Advantages: Easy application No additional equipment is required

Cotton Roll Isolation • • • Advantages: Easy application No additional equipment is 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

Cotton-Roll Isolation in the Mandibular Quadrant

Cotton-Roll Isolation in the Mandibular Quadrant

Cotton Roll Holders • Designed to hold multiple cotton rolls in a more secure

Cotton Roll Holders • Designed to hold multiple cotton rolls in a more secure manner for the mandibular quadrant • A metal or plastic prong is slid into each cotton roll • The rolls are then seated with one roll positioned on the buccal side and the other on the lingual side • A sliding bar is attached to the base of the holder • After it has been positioned under the chin, the bar is slid upward to secure the cotton roll holder in place

Dry-Angle Isolation • This pad helps to isolate posterior areas in the maxillary and

Dry-Angle Isolation • This pad helps to isolate posterior areas in the maxillary and mandibular arches • The pad is placed over Stensen’s duct, which extends from the parotid gland opposite the maxillary second molar • These pads block the flow of saliva and protect the tissues in this area • Replace pads if they become soaked before the procedure has been completed

The Dental Dam • A thin stretchable latex material that acts as a barrier

The Dental Dam • A thin stretchable latex material that acts as a barrier when appropriately applied to selected teeth • When the dam is in place, only selected teeth are visible through the dam

The Dental Dam Indications for Use • • Infection control barrier Safeguard for the

The Dental Dam 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

Dental Dam Equipment • Dental dam material: • Latex or latex-free material • Two

Dental Dam Equipment • Dental dam material: • Latex or latex-free material • 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

Dental Dam Material

Dental Dam Material

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

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

Dental Dam Frame (Cont. )

Dental Dam Frame (Cont. )

Dental Dam Napkin • Increases patient comfort by absorbing moisture between the patient's face

Dental Dam Napkin • Increases patient comfort by absorbing moisture between the patient's face and the dam • The primary purpose is to increase patient comfort by absorbing moisture • The napkin also protects the patient’s face from direct contact with the dam, reducing the risk that the patient may develop a latex sensitivity

Lubricants • Two types of lubricants may be selected when the dam is placed

Lubricants • Two types of lubricants may be selected when the dam is placed • One lubricant is placed on the patient’s lips to ensure patient comfort • Some operators use zinc oxide ointment; others use petroleum jelly • Water-soluble lubricant is placed on the underside of the dam to help the dam material slide over the teeth and through the interproximal spaces • Petroleum jelly should not be used for this purpose

Dental Dam Punch • Creates the holes in the dental dam that are needed

Dental Dam Punch • Creates the holes in the dental dam that are needed to expose the teeth to be isolated • The working end has an adjustable stylus that makes the hole as it strikes an opening in the punch plate • The punch plate is a rotary platform with five or six holes of different sizes cut into the face of the plate • The position of the punch plate is rotated to produce holes of different sizes

Dental Dam Punch (Cont. )

Dental Dam Punch (Cont. )

Size of Holes for Punching the Dental Dam

Size of Holes for Punching the Dental Dam

Dental Dam Stamp

Dental Dam Stamp

Dental Dam Stamp and Template • The dental dam stamp and inkpad are used

Dental Dam Stamp and Template • The dental dam stamp and inkpad are used to mark the dental dam with predetermined markings for the average adult and pediatric arches • Use of a dental dam template, which has holes where the teeth should be marked, provides greater flexibility when one or more teeth are out of alignment

Dental Dam Forceps • • • Used in the placement and removal of the

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

Dental Dam Forceps (Cont. )

Dental Dam Forceps (Cont. )

Dental Dam Clamps • • • The primary means of anchoring and stabilizing the

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

Types of Dental Dam Clamps

Types of Dental Dam Clamps

Parts of the Dental Dam Clamp • The bow is the rounded portion of

Parts of the Dental Dam Clamp • The bow is the rounded portion of the clamp that extends through the dental dam • The clamp is always positioned on the tooth so that the bow is located on the distal aspect • The jaws encircle the tooth and are shaped into four prongs • A hole is located on each side of the jaw of the clamp • The beaks of the dental dam forceps fit into these holes to allow placement and removal of the clamp

Fitting the Dental Dam Clamp • The clamp is designed to fit on the

Fitting the Dental Dam Clamp • 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

Ligatures on Clamps • An important safety measure • Makes it possible to retrieve

Ligatures on Clamps • An important safety measure • Makes it possible to retrieve a clamp should it accidentally become dislodged and then inhaled or swallowed by the patient

Ligature Placed on the Bow of the Clamp

Ligature Placed on the Bow of the Clamp

Dental Dam Stabilizing Cord • A disposable latex cord that is an alternative to

Dental Dam Stabilizing Cord • A disposable latex cord that is an alternative to the conventional clamp method of securing the dental dam • The cord is available in three sizes: extra small, and large • During insertion, the cord is stretched so that it becomes narrow and slips easily between the teeth • Once placed and released, the cord resumes its original shape and holds the dam tightly in place

Dental Dam Preparation • Preplanned to accommodate dentist preference, tooth or teeth involved, and

Dental Dam Preparation • Preplanned to accommodate dentist preference, tooth or teeth involved, and procedure to be performed • • Maxillary arch application Mandibular arch application Curve of the arch Malaligned teeth Teeth to be isolated Keypunch hole Hole sizing and spacing • Troubleshooting hole sizing and spacing

Dental Dam Placement and Removal • Two methods used for placement • One-step method:

Dental Dam Placement and Removal • Two methods used for placement • One-step method: The dam and the clamp are placed at the same time • Two-step method: First the clamp is placed and then the dental dam material is stretched over it • The main difference between the two is the sequencing in placement of the clamp and the dental dam • Remaining steps are the same

Special Applications for the Dental Dam • Anterior teeth • A cervical or anterior

Special Applications for the Dental Dam • Anterior teeth • A cervical or anterior clamp may be required if the gingival third of a tooth is to be restored, and if the gingival tissue must be retracted for better exposure • Stabilizing the cervical clamp • Softened stick compound may be used for this purpose • Fixed bridge • Punch a hole for each fully crowned tooth, but do not punch holes for the teeth that are replacing missing teeth