One of the most important responsibilities of the dental assistant is to maintain moisture control during a procedure. Why is moisture control so important? The term “oral evacuation” describes the process of removing excess fluids from the mouth. When is an oral evacuator used? ( Before, during, and after a dental procedure. ) The saliva ejector and high-volume evacuator are the two types of evacuators used in dentistry.
What is the main function of the saliva ejector? (Removes liquids from the mouth; not powerful enough to remove debris. ) The saliva ejector is made of a soft plastic tubing that can be shaped and easily placed in the oral cavity.
Hold the saliva ejector throughout the procedure, repeatedly sweeping the mouth to remove fluids, or position the suction in the mouth during a procedure. When the saliva ejector is stationary, bend it into the shape of a candy cane. This shape permits easy placement under the tongue.
Place the saliva ejector cautiously to avoid traumatizing soft tissue (e.g., floor of the mouth, frenums, mucosa). What common dental item can be used as a buffer to help avoid trauma? ( Cotton roll. ) Instruct the patient to avoid closing down on the saliva ejector and clamping off the vacuum suction. Tell the patient not to close the lips around the saliva ejector during suctioning.
The HVE, also known as the oral evacuator, works on a vacuum system. It is stronger than the saliva ejector and can remove debris because a high volume of air is moved into the vacuum hose. Two types of HVE tips are available. Each is designed for specific dental procedures.
Name an advantage and a disadvantage of a plastic operative tip. ( Advantage: disposable; disadvantage: cost. ) Why does the surgical tip have a smaller circumference? ( So it can operate within the limited space and visibility of a surgical site. ) What is the main function of the surgical tip? ( Removes blood, tissue, and debris instead of large amounts of water and fluids. ) The stainless-steel tip is part of the surgical setup tray.
Describe the two HVE grasps pictured in the slide. ( Top: thumb-to-nose grasp; bottom: pen grasp. ) Both methods enable the dental assistant to control the tip. Why is it important to control the tip? (For placement and to assure patient comfort and safety.)
Depending on how much the tissue resists retraction and on the area being treated, you may want to reduce dental-assistant fatigue by changing the position of the evacuator. In which hand does the dental assistant hold the evacuator tip when assisting a right-handed dentist? (Right hand. ) Hold the evacuator tip in the left hand when assisting a left-handed dentist.
The efficiency and effectiveness of the procedure depends on timing when suction is needed, when the HVE is positioned, and when to remove the suction tip. Notice how the suction tip is close to the working end of the handpiece. Why should the dental assistant position the HVE close to the handpiece? (To catch water spray and debris before it collects in the patient’s mouth.)
Use the air-water syringe to increase visibility of the treatment area. The air-water syringe is attached to the dental unit; it directs air, water, or both through a small, sterile metal tip or plastic disposable tip. Rinsing also removes debris from the patient’s mouth before dismissal.
Perform limited rinsing quickly and efficiently, without delaying the procedure, when the dentist exits the mouth and pauses for inspection. When the assistant is alone and rinsing the entire mouth, he or she can use the saliva ejector as an alternative to the HVE.
For best results during a dental procedure, keep the area being treated dry and isolated from its normal environment. Why is isolation so important? (The area or tooth being treated should be kept free from contaminants such as saliva, blood, and debris to help prevent infection from a failed restoration.) What are the three most common isolation techniques used in dentistry? ( Cotton-roll isolation, dry-angle isolation, and dental dam placement.)
Rolls of tightly formed absorbent cotton are preshaped to be positioned close to the salivary ducts. The cotton rolls are positioned to absorb the saliva flow and excess water. What is the best way to place or remove a cotton roll from the patient’s mouth? (With the use of cotton pliers or forceps. ) Use cotton-roll holders, which are designed to hold multiple cotton rolls more securely, in the mandibular areas. Can you think of a time when cotton-roll holders would be needed most? (When the operator is working alone. )
Knowing the location of salivary ducts is important in controlling moisture properly. Where are the salivary ducts on the maxillary arch, and what are they called? (The ducts are located in the buccal mucosa adjacent to the maxillary second molar buccal surfaces. These bilateral ducts are called the Stensen ducts.) Where is the salivary duct on the mandibular arch located, and what is it called? ( The duct is located just under the tongue lingual to the mandibular anterior teeth. This duct is called the Wharton duct . )
Instead of placing a cotton roll along the buccal mucosa as an isolation technique, place a dry angle. This pad helps isolate the posterior teeth in both the maxillary and mandibular arches. Place the dry angle on the buccal mucosa over the Stensen duct. What are the two functions of the dry angle? (Blocking the flow of saliva and protecting the tissues in this area from injury caused by the dental bur or other instruments.)
Remember to follow the manufacturer’s instructions for placement. If the dry angle becomes soaked during the procedure, it may need to be replaced several times. Soaking the pad with water lets you easily remove and separate it from the tissues (buccal mucosa). Use the cotton pliers/forceps to replace the dry angle.
When the dam is in place, only selected teeth are visible through the dam. What are these isolated teeth called? (Isolated or exposed teeth. ) The dam is placed after local anesthesia is administered and before the procedure begins. Use caution when using the dam on a patient who is allergic to latex; make sure that the dam is latex-free.
The dental dam can be placed in about 2 minutes. The dental dam keeps debris from the preparation or treatment area away from the rest of the mouth.
Thin dam materials are most used frequently in endodontic applications because only one tooth is isolated at a time and minimal stretching of the material occurs. The medium-thickness dame is used in operative procedures because it is easy to handle and can be used to isolate selected teeth. Use heavy materials when tissue retraction and extra resistance to tearing are required. Also use a heavier dam when you must isolate teeth with tight contacts.
Many dental manufacturers and dental supply companies have dental dam materials available. Consider several factors when purchasing dental dam materials: cost, quality, availability, and compatibility with dental dam napkins, lubricants, the dental dam punch, the dental dam forceps, and the dental dam frame.
The dental dam frame is a necessary component for f dental dam placement. Both plastic and metal frames can be sterilized and reused. The plastic U-shaped frame is radiolucent, so it’s not necessary to remove it before radiograph exposure. The frame is placed under the dam material. The Young frame is placed on the outside of the dam. Patients are more comfortable with this frame.
Identify the two common dental dam frames in the slide. ( Both are U-shaped frames. The first is the metal Young U-shaped frame, and the second is a plastic U-shaped frame.) The sharp projections hold the dental dam material in place.
Can you think of another advantage to using a dental dam napkin? (It keeps the patient’s face from coming into contact with the dental dam material, which could cause skin irritation. ) Two dental dam lubricants may be used. One is used on the patient’s lips to ensure patient comfort. The second is used to help the dam materials slide between the interproximal spaces without tearing or ripping.
The working end of the dental punch has an adjustable stylus. What is a stylus? (Cutting tip. )
Notice how the punch plate is a rotary plate form with five or six holes of different sizes cut into the face of the plate. These holes are approximately 1 mm deep, with sharp edges to accommodate the stylus. Use caution to make sure that the holes are cut cleanly. A hole with a ragged edge may tear easily when forced into an interproximal space during isolation of a tooth. Ragged edges on the holes may also irritate the gingiva.
The punch-plate holes, numbered 1 (the smallest) through 5 (the largest), fit around different sizes of objects as follows: 1: Fits the mandibular anterior teeth 2: Fits the emaxillary anterior teeth 3: Fits mandibular and maxillary premolars 4: Fits larger teeth such as molars 5: Used to create the hole that fits over the dental dam clamp How do you know where to punch the holes on the dental dam material? ( The dental dam stamp and template will guide the positioning of the holes to be punched.)
The dental dam stamp and inkpad are used to imprint the dental dam with predetermined markings for the average adult and pediatric arches. The template provides flexibility when one or more teeth in the arch are out of alignment.
The handles of the forceps work by way of a spring action. Why do you think the beaks of the forceps are turned toward the arch being isolated? (This permits the operator to place or remove the clamp without having to rotate the forceps to put them into position .)
Notice how the hand of the operator is stretched before squeezing the forceps. After squeezing the spring-action forceps, the operator holds the forceps in position with the sliding bar. The operator will squeeze the handles again to release the dental dam clamp. Notice the position of the beaks, which keeps the operator from having to rotate the forceps to place the clamp in position.
The clamps are made of chrome- or nickel-plated steel and can be sterilized and reused. The clamps are designed to hold the dental dam securely at both ends, along with a dental dam–stabilizing cord. Dental dam clamps are available in many sizes and designs to accommodate different needs. The jaws are designed to fit the cervical area, or collar, of the tooth.
Numerous clamps are available for various isolation needs: Clamps 7 and W7 are universal mandibular molar clamps. Clamps 8 and W8 are universal maxillary clamps. Clamps 9 and W9 are designed for anterior teeth. Clamps 00, W00, and 2 are designed for primary teeth.
Posterior and anterior clamps are available. The posterior clamp is universal and can be used on the same tooth in the opposite quadrant. Anterior clamps are designed to retract gingiva on the facial surfaces, improve visibility for class V restorations, and isolate an anterior tooth during endodontic treatment.
A dental dam stabilizing cord can be a simple piece of dental floss or dental tape.
The slide shows an example of ligation of the dental dam clamp. Always cut a piece long enough to be grabbed quickly if needed. Tie the other end of the ligature to the frame of the dental dam to ensure that you can easily find the end.
Applications Maxillary arch application: Punch the holes 1 inch down from the upper edge of the dam. Mandibular arch application: Punch the holes 2 inches from the edge. Curve of the arch: It may be necessary to make adjustments to accommodate an extremely narrow or wide arch. Use the one-step or two-step method to place the dam. The main difference in the methods is the sequencing in the placement of the clamp and dental dam.
Why is it important to evaluate the dental material after its removal? (Fragments of the dental dam left behind under the gingiva can cause gingival irritation.)