Ch. 36 - Moisture Control

Moisture ControlMoisture Control

Chapter 36Chapter 36

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


Lesson 36.1Lesson 36.1


Learning ObjectivesLearning Objectives

Define and spell the Key Terms.Define and spell the Key Terms. List isolation techniques used to decrease List isolation techniques used to decrease

moisture during a dental procedure.moisture during a dental procedure. Describe the two types of oral evacuation Describe the two types of oral evacuation

systems used in dentistry.systems used in dentistry. Describe the grasp and positioning of the tip Describe the grasp and positioning of the tip

of the high-volume evacuator (HVE).of the high-volume evacuator (HVE).(Cont’d)(Cont’d)



(Cont’d)(Cont’d)

Demonstrate the grasp and positioning of the Demonstrate the grasp and positioning of the HVE during a procedure.HVE during a procedure.

Discuss the use of the air-water syringe.Discuss the use of the air-water syringe. Perform limited and full-mouth rinses.Perform limited and full-mouth rinses. Place cotton rolls for isolation.Place cotton rolls for isolation.


Moisture ControlMoisture Control

The objective is to maintain an intraoral The objective is to maintain an intraoral

environment that keeps the operating field environment that keeps the operating field

free of excess water, saliva, blood, tooth free of excess water, saliva, blood, tooth

fragments, and excess dental materials. fragments, and excess dental materials.


Saliva EjectorSaliva Ejector

Small strawlike oral evacuator used for less Small strawlike oral evacuator used for less invasive dental proceduresinvasive dental procedures

Indications for use:Indications for use: Preventive procedures such as prophylaxis, Preventive procedures such as prophylaxis,

fluoride treatments, and sealant placement fluoride treatments, and sealant placement Helps control saliva and moisture accumulation Helps control saliva and moisture accumulation

under the dental dam under the dental dam For the cementation of a crown or bridge For the cementation of a crown or bridge During an orthodontic bonding procedureDuring an orthodontic bonding procedure


Placement of Saliva EjectorPlacement of Saliva Ejector

Bend and shape the saliva ejector for Bend and shape the saliva ejector for stationary placement.stationary placement.

Position the ejector under the tongue.Position the ejector under the tongue. Position the ejector opposite the side on Position the ejector opposite the side on

which the dentist is working. which the dentist is working.


Fig. 36-1 Saliva ejector.Fig. 36-1 Saliva ejector.


High-Volume EvacuatorHigh-Volume Evacuator

Used for most dental procedures, especially Used for most dental procedures, especially when the dental handpiece is in use when the dental handpiece is in use

Indications for useIndications for use Keeps the mouth free of saliva, blood, water, and Keeps the mouth free of saliva, blood, water, and

debrisdebris Retracts the tongue and cheek from the field of Retracts the tongue and cheek from the field of

operation operation Reduces bacterial aerosol caused by the high-Reduces bacterial aerosol caused by the high-

speed handpiece speed handpiece


Types of HVE Tips Types of HVE Tips

Operative-suction tipsOperative-suction tips Designed with a straight or slight angle in the Designed with a straight or slight angle in the

middle middle Beveled working end Beveled working end Made of durable plastic or stainless steelMade of durable plastic or stainless steel

Surgical-suction tipsSurgical-suction tips Much smaller in circumference Much smaller in circumference Made of stainless steel Made of stainless steel


Fig. 36-4 Grasps used for operating the HVE. Fig. 36-4 Grasps used for operating the HVE. Top, thumb-to-nose grasp; bottom, pen grasp.Top, thumb-to-nose grasp; bottom, pen grasp.


Guidelines for Positioning the HVEGuidelines for Positioning the HVE

Place the evacuator before the dentist Place the evacuator before the dentist positions the handpiece and mouth mirror.positions the handpiece and mouth mirror.

Position the HVE on the surface of the tooth Position the HVE on the surface of the tooth closest to you.closest to you.

Position the tip as close as possible to the Position the tip as close as possible to the tooth being worked on.tooth being worked on.

Position the bevel of the tip so that it is parallel Position the bevel of the tip so that it is parallel to the tooth surface.to the tooth surface.

Keep the edge of the tip even or slightly Keep the edge of the tip even or slightly beyond the occlusal or incisal edge. beyond the occlusal or incisal edge.


Fig. 36-5 Operator and assistant positions in Fig. 36-5 Operator and assistant positions in high-volume evacuation.high-volume evacuation.


The Air-Water SyringeThe Air-Water Syringe

Used for convenience and accuracy to complete Used for convenience and accuracy to complete the rinsing processthe rinsing process

Guidelines for useGuidelines for use Direct the tip toward the tooth being worked on. Direct the tip toward the tooth being worked on. Keep a close distance between the operative site and Keep a close distance between the operative site and

the syringe tip. the syringe tip. Use air on the mouth mirror continuously when indirect Use air on the mouth mirror continuously when indirect

vision is involved. vision is involved. When you hear the handpiece stop, it’s time to rinse and When you hear the handpiece stop, it’s time to rinse and

dry the site. dry the site. When completing a limited area or full-mouth rinse, When completing a limited area or full-mouth rinse,

move the tip while spraying the area. move the tip while spraying the area.


Rinsing the Oral CavityRinsing the Oral Cavity

Maintains a clear operating field for the Maintains a clear operating field for the dentist and keeps the patient comfortabledentist and keeps the patient comfortable

Two types of rinsing proceduresTwo types of rinsing procedures Limited-area rinsingLimited-area rinsing

• Performed frequently throughout a procedurePerformed frequently throughout a procedure

• Accomplished quickly and efficientlyAccomplished quickly and efficiently

Full-mouth rinseFull-mouth rinse• Freshens the patient's entire mouthFreshens the patient's entire mouth

• Completed at the end of a procedure Completed at the end of a procedure


Isolation of TeethIsolation of Teeth

Criteria for Isolation TechniquesCriteria for Isolation Techniques Easy to apply Easy to apply Safe for soft and hard tissues Safe for soft and hard tissues Comfortable for the patient Comfortable for the patient Provides retraction for better visualization for the Provides retraction for better visualization for the

operator operator Prevents moisture contaminationPrevents moisture contamination Isolates the area of concern Isolates the area of concern


Cotton-Roll IsolationCotton-Roll Isolation

AdvantagesAdvantages Easy applicationEasy application No additional equipment required No additional equipment required Flexible, permitting adaptation to different areas of the Flexible, permitting adaptation to different areas of the

mouthmouth DisadvantagesDisadvantages

Does not provide complete isolationDoes not provide complete isolation Does not protect the patient from aspiration Does not protect the patient from aspiration May stick to the oral mucosa May stick to the oral mucosa Must be replaced frequently because Must be replaced frequently because

of saturation of saturation Limited retraction Limited retraction


Fig. 36-6 Cotton-roll isolation in the mandibular quadrant.Fig. 36-6 Cotton-roll isolation in the mandibular quadrant.


Dry-Angle IsolationDry-Angle Isolation

A triangular absorbent pad placed over the A triangular absorbent pad placed over the

Stensen duct blocks the flow of saliva Stensen duct blocks the flow of saliva

and protects the tissues in this area. and protects the tissues in this area.


Fig. 36-8 Dry-angle placement in the buccal mucosa.Fig. 36-8 Dry-angle placement in the buccal mucosa.



Lesson 36.2Lesson 36.2



Describe the dental dam and its role in Describe the dental dam and its role in moisture control.moisture control.

List the equipment and supplies for dental List the equipment and supplies for dental dam application.dam application.

Identify the equipment and supplies used for Identify the equipment and supplies used for dental dam application.dental dam application.





Describe the special preparation and Describe the special preparation and placement of the dental dam.placement of the dental dam.

Have the dental dam prepared correctly for a Have the dental dam prepared correctly for a procedure.procedure.

Place the dental dam as an expanded Place the dental dam as an expanded function.function.

Remove the dental dam as an expanded Remove the dental dam as an expanded function.function.


The Dental DamThe Dental Dam

A thin stretchable latex material that acts A thin stretchable latex material that acts

as a barrier when appropriatelyas a barrier when appropriately

applied to selected teeth.applied to selected teeth.

(Cont’d)


The Dental DamThe Dental Dam


Indications for useIndications for use Infection-control barrier Infection-control barrier Safeguard for the patient's mouth Safeguard for the patient's mouth Protection from accidental inhalation or swallowing Protection from accidental inhalation or swallowing

of debris of debris Protection from contamination for the toothProtection from contamination for the tooth Moisture-control deviceMoisture-control device Tool with which to improve accessTool with which to improve access Tool with which to improve visibility Tool with which to improve visibility Tool with which to increase dental-team efficiency Tool with which to increase dental-team efficiency


Dental Dam MaterialDental Dam Material

Dental dam materialsDental dam materials Latex or latex-free material Latex or latex-free material Available in a continuous roll or in two precut Available in a continuous roll or in two precut

sizes (6 × 6 inches for adults and 5 × 5 inches for sizes (6 × 6 inches for adults and 5 × 5 inches for children) children)

Available in a wide range of colors, from light to Available in a wide range of colors, from light to dark (dark is preferred because of the contrast)dark (dark is preferred because of the contrast)

Available in various scents and flavorsAvailable in various scents and flavors Three thicknesses (gauges): thin (light), medium, Three thicknesses (gauges): thin (light), medium,

and heavy and heavy


Fig. 36-9 Fig. 36-9 Dental dam material.Dental dam material.(From Boyd L: (From Boyd L: Dental instruments: a pocket guideDental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.), ed 3, St Louis, 2009, Saunders.)


Dental Dam FrameDental Dam Frame

Stabilizes and stretches the dam so it fits Stabilizes and stretches the dam so it fits tightly around the teeth and out of the tightly around the teeth and out of the operator's wayoperator's way

Available in various plastic and metal framesAvailable in various plastic and metal frames U-shaped frameU-shaped frame Young frameYoung frame Otsby frameOtsby frame


Fig. 36-10 Dental dam frames.Fig. 36-10 Dental dam frames.(From Boyd L: (From Boyd L: Dental instruments: a pocket guideDental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.), ed 3, St Louis, 2009, Saunders.)


Additional Dental Dam EquipmentAdditional Dental Dam Equipment

Dental dam napkin Dental dam napkin Increases patient comfort by absorbing moisture Increases patient comfort by absorbing moisture

between the patient's face and between the patient's face and the damthe dam

Lubricant Lubricant Water-soluble lubricant placed on the underside of Water-soluble lubricant placed on the underside of

the dam to help the dam material slide over the the dam to help the dam material slide over the teeth and through the interproximal spaces. teeth and through the interproximal spaces.


Dental Dam PunchDental Dam Punch

Creates the holes in the dental Creates the holes in the dental

dam that are needed to expose dam that are needed to expose

the teeth to be isolatedthe teeth to be isolated


Fig. 36-11 Dental dam punch.Fig. 36-11 Dental dam punch.


Fig. 36-12 Size of holes for punching the dental dam and the coordinating Fig. 36-12 Size of holes for punching the dental dam and the coordinating teeth for the size of punched holes. teeth for the size of punched holes.

(Adapted from Baum L, Phillips RW, Lund MR: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)(Adapted from Baum L, Phillips RW, Lund MR: Textbook of operative dentistry, ed 3, Philadelphia, 1995, Saunders.)


Fig. 36-13 Dental dam stamp.Fig. 36-13 Dental dam stamp.(From Boyd L: (From Boyd L: Dental instruments: a pocket guideDental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.), ed 3, St Louis, 2009, Saunders.)


Dental Dam ForcepsDental Dam Forceps

Used in the placement and removal of the Used in the placement and removal of the dental dam clampdental dam clamp The beaks of the forceps fit into holes on the jaws The beaks of the forceps fit into holes on the jaws

of the clamp. of the clamp. A sliding bar keeps the handles of the forceps A sliding bar keeps the handles of the forceps

in a fixed position. in a fixed position. The handles are squeezed to release the clamp. The handles are squeezed to release the clamp. The beaks of the forceps are turned toward the The beaks of the forceps are turned toward the

arch being isolated. arch being isolated.


Fig. 36-14 Dental dam forceps.Fig. 36-14 Dental dam forceps.


Dental Dam ClampsDental Dam Clamps

The primary means of anchoring and The primary means of anchoring and stabilizing the dental damstabilizing the dental dam

Parts of the clampParts of the clamp Bow: rounded portion of the clamp Bow: rounded portion of the clamp Jaws: prongs that seat around the tooth create the Jaws: prongs that seat around the tooth create the

extension and balance necessary to stabilize the extension and balance necessary to stabilize the clamp clamp



Fig. 36-17 Types of dental dam clamps.Fig. 36-17 Types of dental dam clamps.


Dental Dam ClampsDental Dam Clamps


The clamp is designed to fit on the cervical The clamp is designed to fit on the cervical area of the tooth below the height of contour area of the tooth below the height of contour at, or slightly below, the cementoenamel at, or slightly below, the cementoenamel junction.junction. Winged clamps have extensions to help retain Winged clamps have extensions to help retain

the dental dam. the dental dam. Posterior clamps are for the maxillary and Posterior clamps are for the maxillary and

mandibular posterior teeth. mandibular posterior teeth. Anterior clamps retract the gingiva on the facial Anterior clamps retract the gingiva on the facial

surface, and improve visibility.surface, and improve visibility.


Dental LigatureDental Ligature

An important safety measure that makes it An important safety measure that makes it

possible to retrieve a clamp should it possible to retrieve a clamp should it

accidentally become dislodged and then inhaled accidentally become dislodged and then inhaled

or swallowed by the patientor swallowed by the patient


Fig. 36-19 Ligature placed on the bow of the clamp Fig. 36-19 Ligature placed on the bow of the clamp for protective purposes.for protective purposes.


Dental Dam ApplicationDental Dam Application

Steps in preparation and placementSteps in preparation and placement Dental dam equipment and supplies readiedDental dam equipment and supplies readied Area of mouth examined for placementArea of mouth examined for placement Dam punched Dam punched Clamp selected, ligated, and positioned Clamp selected, ligated, and positioned

on forcepson forceps Clamp placedClamp placed Dam placedDam placed Frame placedFrame placed Dam secured and invertedDam secured and inverted


Dental Dam RemovalDental Dam Removal

Steps in removalSteps in removal Remove any ligatures that are stabilizing the dam. Remove any ligatures that are stabilizing the dam. Using crown-and-bridge scissors, cut each hole, Using crown-and-bridge scissors, cut each hole,

creating one slit.creating one slit. Position the forceps in the clamp. Position the forceps in the clamp. Remove the dam and frame as a unit.Remove the dam and frame as a unit. Evaluate the patient.Evaluate the patient. Evaluate the dam. Evaluate the dam.


Ch. 36 - Moisture Control

Documents

Transcript of Ch. 36 - Moisture Control