Isolation and Moisture Control in Dentistry

Isolation and Moisture Control

• This presentation covers isolation and moisture control in clinical dental practice.
• The GDC learning outcomes emphasize taking responsibility for best practice guidelines and advising on appropriate preventive materials and treatments.
• Objectives include explaining the necessity of moisture control, describing available methods, selecting appropriate techniques for patients, listing rubber dam indications/advantages/disadvantages, describing rubber dam placement methods, and practicing moisture control techniques on fellow students.

Why is Moisture Control Necessary?

• Saliva, blood, and crevicular fluid interfere with restorative material placement, leading to restoration failure.
• Moisture negatively impacts the quality of procedures and visibility. Maintaining a dry field enhances dental procedures.
• Modern procedures, like some involving SARS-CoV-2 prevention, are improved by a dry field.

Sources of Moisture

• Saliva
• Blood
• GCF (Gingival Crevicular Fluid)
• Dental instruments
• Dental materials

Methods Used for Moisture Control

• Aspiration (high volume suction for handpieces and ultrasonic scalers)
• Compressed air
• Absorbent materials (cotton rolls, dry guards, DryDent Sublinguals)
• Retraction cord
• Rubber dam

Aspiration

• High-volume suction is used with handpieces and ultrasonic scalers, efficient for preventing SARS-CoV-2 transmission.
• Low-volume suction (saliva ejector) is used for smaller volumes of fluid or saliva.

Compressed Air

• A 3-in-1 tip jet blows moisture from cavities and tooth surfaces.
• Can also be used to keep water off the mouth mirror.
• Use with high-volume suction during a pandemic to prevent aerosols.

Absorbent Materials

• Cotton rolls absorb saliva.
• Can be used for retraction of soft tissues like lips or tongue.
• Soak cotton in water when removing to avoid mucosa damage.
• Dry guards are flat pads of highly absorbent material over parotid ducts, useful for fissure sealants.

Retraction Cord

• Used for crown preparations, especially near gingival margins.
• Often impregnated with haemostatic medication.
• Helps stop bleeding and crevicular fluid oozing.

Rubber Dam

• A thin barrier sheet (latex or nitrile rubber) isolates teeth.
• Allows access to specific teeth and is an efficient moisture control method.
• Can be placed in 2 minutes by an efficient team.

Why Use a Rubber Dam?

• Protects the patient's airway.
• Provides patient physical and psychological comfort.
• Improves operator vision.
• Retracts soft tissues.
• Controls moisture.
• Protects the operator from SARS-CoV-2.

Indications for Use

• When the patient is cooperative and informed.
• If the patient has a clear nasal airway.
• After administering analgesia.
• When there's a risk of inhaling instruments or material fragments.
• When using saliva-sensitive materials.
• For adhesive restorations, complex restorations, root canal therapy, pulp capping, pulpotomy, and fissure sealants.

Advantages of Rubber Dam

• Complete isolation
• Visibility
• Prevents inhalation
• Protection for staff
• Reduces time
• Reduces mouth breathing
• Psychological comfort

Disadvantages of Rubber Dam

• Difficult communication
• Patient tolerance
• Jaw stiffness
• Excessive dryness
• Latex allergy
• Time and skill required
• Local anaesthetic (LA) needed
• Suitability for clamp
• Gingival trauma
• Checking occlusion

Rubber Dam Equipment

• Rubber dam sheet
• Stamp/Template
• Frame
• Punch
• Applicator
• Clamps
• Scissors
• Wedjets
• Gauze
• Dental floss
• Caulking agent (Oraseal)

Rubber Dam Hole Punch & Applicator

• Procedure details for using a hole punch and applicator.

Select Clamp

• Instructions and illustrations for selecting the correct clamp for different tooth types and situations.
• The correct clamp must have four points of contact with the tooth.

Parts of a Rubber Dam Clamp

• A detailed description of the parts of a rubber dam clamp (e.g., central arm, anterior arm, bow, beaks, contact points, notch).
• Importance of proper four-point contact.

Place Floss on Clamp

• Procedure for placing dental floss on a clamp.
• Importance of safety and preventing accidental inhalation.

Mark Up and Punch Rubber Dam Holes

• Procedure for marking and punching holes in the rubber dam.
• Use of rubber dam templates.

Three Methods of Rubber Dam Application

• Clamp first, then dam
• Dam and clamp (together)
• Dam first, then clamp

Rubber Dam Videos

• Location of videos on Moodle.

Clamp Placement for Anterior Teeth

• Procedure details specifically for placing a clamp on anterior teeth in a patient’s mouth.

Next Stage (Applies to All Methods)

• Detailed instructions for the next stages of the procedure after proper clamp placement and hole punching.
• Includes using floss and napkins.

Inversion of the Dam

• Proper use of compressed air, dental floss, and flat plastic to invert the edges of the rubber dam.

Wedjet Used for Stability

• Information about wedjet placement for further stability during procedures.

Important Points to Check

• Ensure dam edges are inverted, seal distal to clamp, consider Oraseal if necessary, ensure patient can breathe, provide a saliva ejector.

Removal

• Procedure for removing rubber dam.
• Instructions for removing a patient's rubber dam. Includes the process of removing wedjet, removing clamp, pulling back the dam, cutting interdentally, and removing everything in one motion.

Rubber Dam - Problems and Solutions

• Solutions for common rubber dam problems.

Positioning Errors

• Examples of incorrect dam placement and analysis of the problems.

Patient Safety with Rubber Dam

• Latex-free dam (nitrile)
• Ensure patient can breathe through nose.
• Ensure frame does not injure eyes.
• Obtain informed patient consent.

Problems with Clamp

• Possible issues, including tooth damage, gingival trauma, clamp fracture (correct size), and potential swallowing or inhalation hazards.
• Steps to address potential problems when using a dental clamp

Difficult Contact Points

• Instructions on identifying and addressing difficult contact points.
• Steps to address issues in difficult contact areas of patient’s mouth.

Problems with Saliva

• Tips for managing saliva buildup, and handling patient anxieties during the procedure.
• Includes using saliva ejectors and Oraseal.

Breathing Difficulties

• Advice on creating or adjusting space to help the patient breathe normally.

Rubber Dam for Specific Situations

• Rubber Dam usage with different kinds of teeth (anterior, posterior, buccal).

Anterior Teeth

• Standard procedure for anterior teeth isolation.

Posterior Teeth

• Procedure of isolating teeth in the posterior section.

Buccal Restorations

• Procedure to handle buccal restorations, and the issues with isolation.

Paedodontics

• Isolation and procedure differences for pediatric patients.

Paedodontics Continued

• Important aspects specifically for a pediatric treatment process involving a rubber dam

Matrix Bands

• Instructions for placing and avoiding conflicts with the rubber dam when dealing with matrix bands.

Summary

• A summary of all the procedures involved with a rubber dam.
• Key details, procedures, and precautions for all steps.

Further Information

• Links to additional resources on the topic.