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