Moisture Control

Chapter 36
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 36

Lesson 36.1
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Define and spell the Key Terms.
List isolation techniques used to decrease
moisture during a dental procedure.
Describe the two types of oral evacuation
systems used in dentistry.
Describe the grasp and positioning of the tip
of the high-volume evacuator (HVE).
(Contd)
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
(Contd)
Demonstrate the grasp and positioning of the
HVE during a procedure.
Discuss the use of the air-water syringe.
Perform limited and full-mouth rinses.
Place cotton rolls for isolation.
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Moisture Control
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.
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Saliva Ejector
Small strawlike oral evacuator used for less
invasive dental procedures
Indications for use:
Preventive procedures such as prophylaxis,
fluoride treatments, and sealant placement
Helps control saliva and moisture accumulation
under the dental dam
For the cementation of a crown or bridge
During an orthodontic bonding procedure
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Placement of Saliva Ejector
Bend and shape the saliva ejector for
stationary placement.
Position the ejector under the tongue.
Position the ejector opposite the side on
which the dentist is working.
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Fig. 36-1 Saliva ejector.
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
High-Volume Evacuator
Used for most dental procedures, especially
when the dental handpiece is in use
Indications for use
Keeps the mouth free of saliva, blood, water, and
debris
Retracts the tongue and cheek from the field of
operation
Reduces bacterial aerosol caused by the high-
speed handpiece

Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Types of HVE Tips
Operative-suction tips
Designed with a straight or slight angle in the
middle
Beveled working end
Made of durable plastic or stainless steel
Surgical-suction tips
Much smaller in circumference
Made of stainless steel

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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.
Guidelines for Positioning the HVE
Place the evacuator before the dentist
positions the handpiece and mouth mirror.
Position the HVE on the surface of the tooth
closest to you.
Position the tip as close as possible to the
tooth being worked on.
Position the bevel of the tip so that it is
parallel to the tooth surface.
Keep the edge of the tip even or slightly
beyond the occlusal or incisal edge.
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Fig. 36-5 Operator and assistant positions in
high-volume evacuation.
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The Air-Water Syringe
Used for convenience and accuracy to
complete the rinsing process
Guidelines for use
Direct the tip toward the tooth being worked on.
Keep a close distance between the operative site
and the syringe tip.
Use air on the mouth mirror continuously when
indirect vision is involved.
When you hear the handpiece stop, its time to
rinse and dry the site.
When completing a limited area or full-mouth
rinse, move the tip while spraying the area.
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Rinsing the Oral Cavity
Maintains a clear operating field for the
dentist and keeps the patient comfortable
Two types of rinsing procedures
Limited-area rinsing
Performed frequently throughout a procedure
Accomplished quickly and efficiently
Full-mouth rinse
Freshens the patient's entire mouth
Completed at the end of a procedure
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Isolation of Teeth
Criteria for Isolation Techniques
Easy to apply
Safe for soft and hard tissues
Comfortable for the patient
Provides retraction for better visualization for the
operator
Prevents moisture contamination
Isolates the area of concern
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Cotton-Roll Isolation
Advantages
Easy application
No additional equipment required
Flexible, permitting adaptation to different areas of
the mouth
Disadvantages
Does not provide complete isolation
Does not protect the patient from aspiration
May stick to the oral mucosa
Must be replaced frequently because
of saturation
Limited retraction
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Fig. 36-6 Cotton-roll isolation in the mandibular quadrant.
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Dry-Angle Isolation
A triangular absorbent pad placed over the
Stensen duct blocks the flow of saliva
and protects the tissues in this area.
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Fig. 36-8 Dry-angle placement in the buccal mucosa.
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 36

Lesson 36.2
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Describe the dental dam and its role in
moisture control.
List the equipment and supplies for dental
dam application.
Identify the equipment and supplies used for
dental dam application.
(Contd)
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
(Contd)
Describe the special preparation and
placement of the dental dam.
Have the dental dam prepared correctly for a
procedure.
Place the dental dam as an expanded
function.
Remove the dental dam as an expanded
function.
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The Dental Dam
A thin stretchable latex material that acts
as a barrier when appropriately
applied to selected teeth.
(Contd)
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The Dental Dam
(Contd)
Indications for use
Infection-control barrier
Safeguard for the patient's mouth
Protection from accidental inhalation or swallowing
of debris
Protection from contamination for the tooth
Moisture-control device
Tool with which to improve access
Tool with which to improve visibility
Tool with which to increase dental-team efficiency
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Dental Dam Material
Dental dam materials
Latex or latex-free material
Available in a continuous roll or in two precut
sizes (6 6 inches for adults and 5 5 inches
for children)
Available in a wide range of colors, from light
to dark (dark is preferred because of the
contrast)
Available in various scents and flavors
Three thicknesses (gauges): thin (light),
medium, and heavy
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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.
Dental Dam Frame
Stabilizes and stretches the dam so it fits
tightly around the teeth and out of the
operator's way
Available in various plastic and metal frames
U-shaped frame
Young frame
Otsby frame
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Fig. 36-10 Dental dam frames.
(From Boyd L: Dental instruments: a pocket guide, ed 3, St Louis, 2009, Saunders.)

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Additional Dental Dam Equipment
Dental dam napkin
Increases patient comfort by absorbing moisture
between the patient's face and
the dam
Lubricant
Water-soluble lubricant placed on the underside of
the dam to help the dam material slide over the
teeth and through the interproximal spaces.
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Dental Dam Punch
Creates the holes in the dental
dam that are needed to expose
the teeth to be isolated
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Fig. 36-11 Dental dam punch.
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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.
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.
Dental Dam Forceps
Used in the placement and removal of the
dental dam clamp
The beaks of the forceps fit into holes on the jaws
of the clamp.
A sliding bar keeps the handles of the forceps
in a fixed position.
The handles are squeezed to release the clamp.
The beaks of the forceps are turned toward the
arch being isolated.
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Fig. 36-14 Dental dam forceps.
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Dental Dam Clamps
The primary means of anchoring and
stabilizing the dental dam
Parts of the clamp
Bow: rounded portion of the clamp
Jaws: prongs that seat around the tooth create the
extension and balance necessary to stabilize the
clamp
(Contd)
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Fig. 36-17 Types of dental dam clamps.
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Dental Dam Clamps
(Contd)
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.
Winged clamps have extensions to help retain
the dental dam.
Posterior clamps are for the maxillary and
mandibular posterior teeth.
Anterior clamps retract the gingiva on the facial
surface, and improve visibility.
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Dental Ligature
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
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Fig. 36-19 Ligature placed on the bow of the clamp
for protective purposes.
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Dental Dam Application
Steps in preparation and placement
Dental dam equipment and supplies readied
Area of mouth examined for placement
Dam punched
Clamp selected, ligated, and positioned
on forceps
Clamp placed
Dam placed
Frame placed
Dam secured and inverted
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Dental Dam Removal
Steps in removal
Remove any ligatures that are stabilizing the dam.
Using crown-and-bridge scissors, cut each hole,
creating one slit.
Position the forceps in the clamp.
Remove the dam and frame as a unit.
Evaluate the patient.
Evaluate the dam.
Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.