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Ch. 36 - Moisture Control

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Ch. 36 - Moisture Control

  1. 1. Moisture Control Chapter 36 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  2. 2. Chapter 36 Lesson 36.1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  3. 3. Learning Objectives <ul><li>Define and spell the Key Terms. </li></ul><ul><li>List isolation techniques used to decrease moisture during a dental procedure. </li></ul><ul><li>Describe the two types of oral evacuation systems used in dentistry. </li></ul><ul><li>Describe the grasp and positioning of the tip of the high-volume evacuator (HVE). </li></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  4. 4. Learning Objectives <ul><li>(Cont’d) </li></ul><ul><li>Demonstrate the grasp and positioning of the HVE during a procedure. </li></ul><ul><li>Discuss the use of the air-water syringe. </li></ul><ul><li>Perform limited and full-mouth rinses. </li></ul><ul><li>Place cotton rolls for isolation. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  5. 5. Moisture Control <ul><li>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. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  6. 6. Saliva Ejector <ul><li>Small strawlike oral evacuator used for less invasive dental procedures </li></ul><ul><li>Indications for use: </li></ul><ul><ul><li>Preventive procedures such as prophylaxis, fluoride treatments, and sealant placement </li></ul></ul><ul><ul><li>Helps control saliva and moisture accumulation under the dental dam </li></ul></ul><ul><ul><li>For the cementation of a crown or bridge </li></ul></ul><ul><ul><li>During an orthodontic bonding procedure </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  7. 7. Placement of Saliva Ejector <ul><li>Bend and shape the saliva ejector for stationary placement. </li></ul><ul><li>Position the ejector under the tongue. </li></ul><ul><li>Position the ejector opposite the side on which the dentist is working. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  8. 8. Fig. 36-1 Saliva ejector. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  9. 9. High-Volume Evacuator <ul><li>Used for most dental procedures, especially when the dental handpiece is in use </li></ul><ul><li>Indications for use </li></ul><ul><ul><li>Keeps the mouth free of saliva, blood, water, and debris </li></ul></ul><ul><ul><li>Retracts the tongue and cheek from the field of operation </li></ul></ul><ul><ul><li>Reduces bacterial aerosol caused by the high-speed handpiece </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  10. 10. Types of HVE Tips <ul><li>Operative-suction tips </li></ul><ul><ul><li>Designed with a straight or slight angle in the middle </li></ul></ul><ul><ul><li>Beveled working end </li></ul></ul><ul><ul><li>Made of durable plastic or stainless steel </li></ul></ul><ul><li>Surgical-suction tips </li></ul><ul><ul><li>Much smaller in circumference </li></ul></ul><ul><ul><li>Made of stainless steel </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  11. 11. Fig. 36-4 Grasps used for operating the HVE. Top, thumb-to-nose grasp; bottom, pen grasp. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  12. 12. Guidelines for Positioning the HVE <ul><li>Place the evacuator before the dentist positions the handpiece and mouth mirror. </li></ul><ul><li>Position the HVE on the surface of the tooth closest to you. </li></ul><ul><li>Position the tip as close as possible to the tooth being worked on. </li></ul><ul><li>Position the bevel of the tip so that it is parallel to the tooth surface. </li></ul><ul><li>Keep the edge of the tip even or slightly beyond the occlusal or incisal edge. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  13. 13. Fig. 36-5 Operator and assistant positions in high-volume evacuation. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  14. 14. The Air-Water Syringe <ul><li>Used for convenience and accuracy to complete the rinsing process </li></ul><ul><li>Guidelines for use </li></ul><ul><ul><li>Direct the tip toward the tooth being worked on. </li></ul></ul><ul><ul><li>Keep a close distance between the operative site and the syringe tip. </li></ul></ul><ul><ul><li>Use air on the mouth mirror continuously when indirect vision is involved. </li></ul></ul><ul><ul><li>When you hear the handpiece stop, it’s time to rinse and dry the site. </li></ul></ul><ul><ul><li>When completing a limited area or full-mouth rinse, move the tip while spraying the area. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  15. 15. Rinsing the Oral Cavity <ul><li>Maintains a clear operating field for the dentist and keeps the patient comfortable </li></ul><ul><li>Two types of rinsing procedures </li></ul><ul><ul><li>Limited-area rinsing </li></ul></ul><ul><ul><ul><li>Performed frequently throughout a procedure </li></ul></ul></ul><ul><ul><ul><li>Accomplished quickly and efficiently </li></ul></ul></ul><ul><ul><li>Full-mouth rinse </li></ul></ul><ul><ul><ul><li>Freshens the patient's entire mouth </li></ul></ul></ul><ul><ul><ul><li>Completed at the end of a procedure </li></ul></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  16. 16. Isolation of Teeth <ul><li>Criteria for Isolation Techniques </li></ul><ul><ul><li>Easy to apply </li></ul></ul><ul><ul><li>Safe for soft and hard tissues </li></ul></ul><ul><ul><li>Comfortable for the patient </li></ul></ul><ul><ul><li>Provides retraction for better visualization for the operator </li></ul></ul><ul><ul><li>Prevents moisture contamination </li></ul></ul><ul><ul><li>Isolates the area of concern </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  17. 17. Cotton-Roll Isolation <ul><li>Advantages </li></ul><ul><ul><li>Easy application </li></ul></ul><ul><ul><li>No additional equipment required </li></ul></ul><ul><ul><li>Flexible, permitting adaptation to different areas of the mouth </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Does not provide complete isolation </li></ul></ul><ul><ul><li>Does not protect the patient from aspiration </li></ul></ul><ul><ul><li>May stick to the oral mucosa </li></ul></ul><ul><ul><li>Must be replaced frequently because of saturation </li></ul></ul><ul><ul><li>Limited retraction </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  18. 18. Fig. 36-6 Cotton-roll isolation in the mandibular quadrant. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  19. 19. Dry-Angle Isolation <ul><li>A triangular absorbent pad placed over the Stensen duct blocks the flow of saliva and protects the tissues in this area. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  20. 20. Fig. 36-8 Dry-angle placement in the buccal mucosa. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  21. 21. Chapter 36 Lesson 36.2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  22. 22. Learning Objectives <ul><li>Describe the dental dam and its role in moisture control. </li></ul><ul><li>List the equipment and supplies for dental dam application. </li></ul><ul><li>Identify the equipment and supplies used for dental dam application. </li></ul><ul><li>(Cont’d) </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  23. 23. Learning Objectives <ul><li>(Cont’d) </li></ul><ul><li>Describe the special preparation and placement of the dental dam. </li></ul><ul><li>Have the dental dam prepared correctly for a procedure. </li></ul><ul><li>Place the dental dam as an expanded function. </li></ul><ul><li>Remove the dental dam as an expanded function. </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  24. 24. The Dental Dam <ul><li>A thin stretchable latex material that acts as a barrier when appropriately applied to selected teeth. </li></ul>(Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  25. 25. The Dental Dam <ul><li>(Cont’d) </li></ul><ul><li>Indications for use </li></ul><ul><ul><li>Infection-control barrier </li></ul></ul><ul><ul><li>Safeguard for the patient's mouth </li></ul></ul><ul><ul><li>Protection from accidental inhalation or swallowing of debris </li></ul></ul><ul><ul><li>Protection from contamination for the tooth </li></ul></ul><ul><ul><li>Moisture-control device </li></ul></ul><ul><ul><li>Tool with which to improve access </li></ul></ul><ul><ul><li>Tool with which to improve visibility </li></ul></ul><ul><ul><li>Tool with which to increase dental-team efficiency </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  26. 26. Dental Dam Material <ul><li>Dental dam materials </li></ul><ul><li>Latex or latex-free material </li></ul><ul><li>Available in a continuous roll or in two precut sizes (6 × 6 inches for adults and 5 × 5 inches for children) </li></ul><ul><li>Available in a wide range of colors, from light to dark (dark is preferred because of the contrast) </li></ul><ul><li>Available in various scents and flavors </li></ul><ul><li>Three thicknesses (gauges): thin (light), medium, and heavy </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  27. 27. Fig. 36-9 Dental dam material. (From Boyd L: Dental instruments: a pocket guide , ed 3, St Louis, 2009, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  28. 28. Dental Dam Frame <ul><li>Stabilizes and stretches the dam so it fits tightly around the teeth and out of the operator's way </li></ul><ul><li>Available in various plastic and metal frames </li></ul><ul><ul><li>U-shaped frame </li></ul></ul><ul><ul><li>Young frame </li></ul></ul><ul><ul><li>Otsby frame </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  29. 29. Fig. 36-10 Dental dam frames. (From Boyd L: Dental instruments: a pocket guide , ed 3, St Louis, 2009, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  30. 30. Additional Dental Dam Equipment <ul><li>Dental dam napkin </li></ul><ul><ul><li>Increases patient comfort by absorbing moisture between the patient's face and the dam </li></ul></ul><ul><li>Lubricant </li></ul><ul><ul><li>Water-soluble lubricant placed on the underside of the dam to help the dam material slide over the teeth and through the interproximal spaces. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  31. 31. Dental Dam Punch <ul><li>Creates the holes in the dental dam that are needed to expose the teeth to be isolated </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  32. 32. Fig. 36-11 Dental dam punch. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  33. 33. Fig. 36-12 Size of holes for punching the dental dam and the coordinating teeth for the size of punched holes. (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.
  34. 34. Fig. 36-13 Dental dam stamp. (From Boyd L: Dental instruments: a pocket guide , ed 3, St Louis, 2009, Saunders.) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  35. 35. Dental Dam Forceps <ul><li>Used in the placement and removal of the dental dam clamp </li></ul><ul><ul><li>The beaks of the forceps fit into holes on the jaws of the clamp. </li></ul></ul><ul><ul><li>A sliding bar keeps the handles of the forceps in a fixed position. </li></ul></ul><ul><ul><li>The handles are squeezed to release the clamp. </li></ul></ul><ul><ul><li>The beaks of the forceps are turned toward the arch being isolated. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  36. 36. Fig. 36-14 Dental dam forceps. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  37. 37. Dental Dam Clamps <ul><li>The primary means of anchoring and stabilizing the dental dam </li></ul><ul><li>Parts of the clamp </li></ul><ul><ul><li>Bow: rounded portion of the clamp </li></ul></ul><ul><ul><li>Jaws: prongs that seat around the tooth create the extension and balance necessary to stabilize the clamp </li></ul></ul><ul><ul><li>(Cont’d) </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  38. 38. Fig. 36-17 Types of dental dam clamps. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  39. 39. Dental Dam Clamps <ul><li>(Cont’d) </li></ul><ul><li>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. </li></ul><ul><ul><li>Winged clamps have extensions to help retain the dental dam. </li></ul></ul><ul><ul><li>Posterior clamps are for the maxillary and mandibular posterior teeth. </li></ul></ul><ul><ul><li>Anterior clamps retract the gingiva on the facial surface, and improve visibility. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  40. 40. Dental Ligature <ul><li>An important safety measure that makes it possible to retrieve a clamp should it accidentally become dislodged and then inhaled or swallowed by the patient </li></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  41. 41. Fig. 36-19 Ligature placed on the bow of the clamp for protective purposes. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  42. 42. Dental Dam Application <ul><li>Steps in preparation and placement </li></ul><ul><ul><li>Dental dam equipment and supplies readied </li></ul></ul><ul><ul><li>Area of mouth examined for placement </li></ul></ul><ul><ul><li>Dam punched </li></ul></ul><ul><ul><li>Clamp selected, ligated, and positioned on forceps </li></ul></ul><ul><ul><li>Clamp placed </li></ul></ul><ul><ul><li>Dam placed </li></ul></ul><ul><ul><li>Frame placed </li></ul></ul><ul><ul><li>Dam secured and inverted </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
  43. 43. Dental Dam Removal <ul><li>Steps in removal </li></ul><ul><ul><li>Remove any ligatures that are stabilizing the dam. </li></ul></ul><ul><ul><li>Using crown-and-bridge scissors, cut each hole, creating one slit. </li></ul></ul><ul><ul><li>Position the forceps in the clamp. </li></ul></ul><ul><ul><li>Remove the dam and frame as a unit. </li></ul></ul><ul><ul><li>Evaluate the patient. </li></ul></ul><ul><ul><li>Evaluate the dam. </li></ul></ul>Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

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