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Moisture ControlMoisture Control
Chapter 36Chapter 36
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 36Chapter 36
Lesson 36.1Lesson 36.1
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning ObjectivesLearning Objectives
(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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 36-1 Saliva ejector.Fig. 36-1 Saliva ejector.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 36-5 Operator and assistant positions in Fig. 36-5 Operator and assistant positions in high-volume evacuation.high-volume evacuation.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 36-6 Cotton-roll isolation in the mandibular quadrant.Fig. 36-6 Cotton-roll isolation in the mandibular quadrant.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 36-8 Dry-angle placement in the buccal mucosa.Fig. 36-8 Dry-angle placement in the buccal mucosa.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 36Chapter 36
Lesson 36.2Lesson 36.2
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning ObjectivesLearning Objectives
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.
(Cont’d)(Cont’d)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning ObjectivesLearning Objectives
(Cont’d)(Cont’d)
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
The Dental DamThe Dental Dam
(Cont’d)(Cont’d)
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 36-11 Dental dam punch.Fig. 36-11 Dental dam punch.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.)
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Fig. 36-14 Dental dam forceps.Fig. 36-14 Dental dam forceps.
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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
(Cont’d)(Cont’d)
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Fig. 36-17 Types of dental dam clamps.Fig. 36-17 Types of dental dam clamps.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Dental Dam ClampsDental Dam Clamps
(Cont’d)(Cont’d)
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.
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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
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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.
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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
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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.
Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.