MDA Chapter 36 - Moisture Control

What procedures is the saliva ejector most commonly used for?

Prophy, sealants, fluoride, under dental dam, crown cementation, ortho band application

Where do most materials accumulate?

Under the tongue

What is the HVE used for?

To remove blood, saliva, and debris from the oral cavity

Purposes of the HVE

Keep mouth free of saliva, blood, debris
Retract tongue and cheek
Reduce bacterial aerosol caused by HS HP

Operative suction tips are __________ in circumference and made from either durable plastic or stainless steel

larger

Surgical tips are ___________ in circumference which is critical to placement during surgery

smaller

What is the concern during a surgical procedure?

Removal of blood, tissue, and debris

How is the HVE held?

In a thumb-to-nose grasp or pen grasp

What is critical that a dental assistant must know for efficient and effective performance during a dental procedure?

Timing; when to use it
Where to position it
When to remove from the mouth

When should the HVE be placed?

Prior to the placement of the placement of the HP and mirror

Where should the HVE be placed?

On the surface of the operative tooth closest to you

How should the Bevel of the HVE be placed?

Parallel to the tooth surface with the edge of the tip even with or slightly beyond occlusal or incisal surface

What is the daily maintenance for the evacuation system?

Flush hoses at the end of the day with an antimicrobial solution

What is the weekly maintenance for the evacuation system?

Check traps weekly and replace if needed

When should saliva ejector hoses/screens be cleaned/replaced?

As needed

What are the two basic types of rinsing?

Limited area
Full mouth rinse

When is a limited area rinse performed?

Throughout the procedure to remove debris

What is imperative when performing a limited area rinse during a procedure?

It must be quick and efficient to not hold up the procedure

When is a limited area rinse often performed?

When the Dr exits the mouth or pauses for inspection

What is the purpose of a Full Mouth Rinse?

To refresh the entire mouth

When might a Full Mouth Rinse be performed?

Following a long restorative procedure, after prophy, or before patient dismissal

When performing a Full Mouth Rinse alone, the RDA may use the __________ ____________

Saliva Ejector

Why is it important to keep a close distance between the AW Syringe and the operative tooth?

To minimize aerosol; Being too far causes aerosol splatter

When Dr is using indirect vision, what should the AW Syringe be used for?

To keep the mirror clear/clean

When the HP stops,

Rinse and dry the site

Characteristics of Isolation

Easy to apply
Protective of soft and hard tissues
Pt comfort
Retraction makes for better visualization
Prevention of moisture contamination

Three most common methods of isolation

Cotton Roll
Dry Angles
Dental Dam

How is the type of isolation selected?

Depending on the procedure to be performed

Where are cotton rolls commonly placed?

Close to salivary ducts

What is the most common type of isolation for short procedures?

Cotton Roll Isolation

Advantages of using cotton roll isolation

Easy to apply
No additional equipment/hardware needed
Flexible and varies in size depending on needs

Disadvantages of using cotton roll isolation

Doesn't give full isolation
No pt protection from aspiration
Can damage soft tissues
Must be replaced when saturated with saliva
Offers only limited retraction

Where are cotton roll holders used?

On the mandible

When are cotton roll holders most important?

When the operator is working alone

Where are dry angles placed?

On the buccal mucosa over Stensen's duct

Stensen's Duct is connected to the

Parotid Gland

Where is Stensen's Duct located?

On the maxillary opposite the 2nd molar

Dry angles are used for

Blocking saliva and protecting cheek tissues

What is the benefit of the dental dam?

Only selected teeth are exposed/isolated

What are indications for use of a dental dam?

Infection control
Pt protection; Tissues and from aspiration
Protects operative tooth from contamination
Protects oral cavity from infection within operative tooth; Endo
Moisture control during placement of restorative materials
Improves access; Cheek and

What are rubber dams made of?

Latex rubber or silicone latex-free material

What size of dam is used for posterior teeth in the permanent dentition?

6x6

What size of dam is used for anterior teeth in the permanent dentition and for the primary dentition?

5x5

Darker dam colours create better ___________ to tooth structure and reduces ________

contrast
glare

What thickness of dam is commonly used for Endodontic procedures?

Thin; less stretch is required (operative tooth hole(s) only

What thickness of dam is often used for operative procedures?

Medium thickness; ease of handling and isolating ability

When would a heavy thickness dam be utilized?

When tissue retraction and extra resistance to tearing are Important; Crown, fixed bridge, teeth with tight contacts

Dental frames can be

Plastic or metal

Where are plastic U-shaped frames placed?

Under the Dam

What is a benefit of using the plastic u-shaped frame?

It is radiolucent; does not block radiographs so it is able to be left on during exposures

What frame is made of stainless steel and is placed on the outside of the dam?

Young Frame

What frame is round, plastic, and placed on the outside of the dam?

Ostby Frame

What is the primary means of anchoring and stabilizing the dental dam?

Dental Dam Clamps

What are clamps most often made from?

Nickelplated steel or chrome

How is the end of the dam opposite the clamp most often stabilized?

Another clamp, stabilizing cord, dental floss or tape,

What is the Bow on the clamp?

Rounded portion that extends through the dental dam

How is the Bow positioned?

So the bow is at the distal aspect of the anchor tooth

What part of the clamp are the jaws?

The portion that encircles the cervical third of the tooth below the height of contour/below CEJ; shaped into 4 prongs

Winged clamps ...

Have extra projections that old the dam in place

Example of a wingless clamp

W7

Example of a winged clamp

7

What is the height of contour?

The widest point on the facial/lingual aspect of the tooth

Benefit of using a universal clamp?

Can be used on same type of tooth in the opposite quadrant

Clamps 7 and W7

Universal Mandibular molar clamps

Clamps 8 and W8

Universal Maxillary molar clamps

Clamps 9 and W9

Used for anterior teeth
Shape allows retraction of facial gingiva and improves visibility for Class V restoration

Clamps 00, W00, & 2

Used on primary teeth
Accommodate smaller size/shape of both primary teeth and partially erupted permanent teeth

What MUST be done to the clamp before try in or placement

A ligature must be attached to the bow

Purpose of tying ligature on bow of clamp

Allows for fast/easy retrieval if it comes dislodged to avoid aspiration/swallowing by pt

Dental Dam Stabilizing cord is also known as

Wedjets

What are factors to consider when planning placement of hole punches

Arch involved
Shape of arch
Teeth to be isolated
Dentition irregularities
Keyhole punch location
Sizing/spacing of other holes to be punch

Anchor tooth

Holds the dental clamp and is covered by the keyhole punch

The Max anteriors should be punched

1 inch down; allowing slightly more than 1 inch if pt has mustache

The Mand arch should be punched

2 inch margin from the edge
Anterior holes closer together than posterior

What should be applied to the underside of the dam if crowding or tight contacts are present?

Water soluble lubricant

What causes folding and stretching?

Too much or too little curve

How far are holes generally spaced between EDGES of holes; Not the center of the holes?

3.0mm-3.5mm

Correct hole size =

better isolation and fit around cervical third of tooth

What may happen if the hole is punched too large?

Saliva leakage

What may happen is the hole is punched too small?

dam may stretch and tear

Holes too close can cause

The dam to stretch and tear apart

Holes too far apart can cause

Excess material between teeth that may impede vision of Dr

When restoring anterior teeth, what teeth are often isolated?

Canine to Canine

If gingival third of anterior is being restored, use

A cervical clamp or anterior clamp that sits just below the carious lesion

The bevel must be

As close as possible to operative tooth
Parallel to the buccal/lingual surface

The upper edge of the bevel should extend

Slightly beyond the occlusal/incisal surface