Moisture Control Revision PDF

Moisture control Why do we need moisture control Sources of moisture: Moisture interferes with placement of ALL restorative materials leading to restoration failure. Saliva...

Moisture control Why do we need moisture control Sources of moisture: Moisture interferes with placement of ALL restorative materials leading to restoration failure. Saliva Improves visibility when working intra-oral Blood Infection prevention (air-born viruses) Gingival crevicular fluid Instruments Dental materials Compressed air Aspiration Blows excess moisture away from teeth. High volume - use with hand pieces and Can be used to keep water off mirror to ultrasonic. improve visibility. (Best for preventing aerosol transmission) Use with high volume suction to prevent Low volume - saliva ejector used for aerosol transmission. small volumes of moisture. Retraction cord · Used for crown preparations. Rubber dam Methods used for Can be helpful if cavity is near Gold standard of moisture control - moisture control gingival margin. have to justify if you do not use. Often used with haemostatic Thin barrier sheet to isolate teeth. gel. Only selected teeth are accessible. Stops gingival bleeding and Protects patients airways. crevicular fluid. Patient comfort. Improved visibility due to retraction Absorbent materials of soft tissues. Do not leave in patients mouth unattended. Prevents aerosol transmission. Soak when removing to avoid damage to mucosa. Cotton wool rolls: Placed in buccal and lingual sulcus to absorb saliva. Used for retraction of lips or tongue. Dry guards: (adult and peads size) Place inside cheek over parotid duct to absorb saliva. Used for fissure sealants. DryDent sublingual: Similar to dry guard but for floor of mouth.  Co-operative/ Clear nasal airway After local anaesthetic informed patient can been administered Root canal Rubber dam Danger of patient therapy indications for use inhaling instruments/ materials Pulp capping/ pulpotomy Fissure When using saliva- Complex/adhesive sealants sensitive materials restorations Advantages of rubber dam Disadvantages of rubber dam Complete isolation. Difficult communication for patient. Better visibility. Patient tolerance. Prevents inhalation. Jaw stiffness - ask patient to rest when not working. Protection for staff. Excessive drying - distort colour match, take shade Physical and psychological barrier. prior to placing rubber dam. Reduces time in restoration Latex allergy - most nitrile BUT always check. preparation and placement. Time and skill required by clinician. Reduces mouth breathing. Local anaesthetic required - can be difficult to administer more anaesthetic if required. Suitability for clamp - rotated or P/E’d teeth. Equipment required Gingival trauma. Rubber dam sheet Checking occlusion - need to remove rubber dam to Stamp/template complete this. W8A - Upper & lower Frame small molar root - Punch (sharp) wingless Applicator/forceps Clamps (metal/plastic) Most common clamps 212 - Upper & lower Scissors used = W8A, 212, 00 anterior clamp Wedjets Gauze 00 - Upper & lower Dental floss canine and pre-molar Caulking agenct (Oraseal, LC resin) clamp  Bow — placed distally Keep simple, use the clamp that fits the tooth! Contact points Clamp holes — help position clamp with forceps — point of contact on the tooth Central arm — helps engage rubber dam sheet Anterior arm — helps engage rubber dam sheet Discard clamp if has been stretched — increased risk of # Beaks — grip the tooth Using floss on clamps: Safety Necessary unless rubber dam placed first Prevents accidental inhalation Clamp first them dam Dam and clamp together Methods of placing rubber dam MUST use floss on clamp (One stop) Use forceps to place clamp Useful when placing clamp on on tooth distally of the posterior tooth. Dam first, then clamp tooth you want to work on. Put bow of clamp through hole, Useful when working on anterior Put rubber dam over top, invert and place on tooth. 3-3. clamp first, stretch over Pull dam over the clamped Start one side, 1-3, then other side. bow. tooth, then adjacent teeth. Floss through & try wedjets to see if Minimum 4 teeth, secure Clamp at least 4 teeth holds on last tooth in line. with wedjet and floss minimum, use wedjet to secure If not, place 00 clamp over dam on through. Floss contacts through and last tooth in line. Place napkins and frame. place napkin and frame.  Important points when using rubber dam: Floss through contact points. Inversion of dam: Inverted edges of the dam. Folding round edges so the Check seal (may need Oraseal) dam is sitting under gingival Check patient can breathe. margin. Saliva ejector for patient. (Prevents gingival crevicular fluid seeping) Removal of rubber dam: Remove any wedjets. Pull dam buccally. Cut interdentally with scissors. Remove clamp, dam and frame ALL IN ONE with forceps. Have nurse ready to offer patient a tissue. Check no rubber dam left in patients mouth. Problems with saliva Positioning errors Reassure patient they can swallow Usually due to holes not being punched in correct place. without closing mouth. Must protect airway. Saliva ejector optional to remove Patient must be able to breathe. (Can cut R.dam around saliva excess. nose) Use Oraseal to seal leaks. Breathing difficulties Difficult contact points Cut small hole in dam in palate Check for clear contact prior to Problems with region or away from treatment. punching holes with floss. rubber dam Ensure dam is cut away from nose. Consider trough technique. (Paeds) Defer treatment. Use other forms of isolation — must justify why! Patient safety Use of latex-free rubber dam. (Nitrile) Problems with clamp Patient unable to breathe, have scissors ready Gingival trauma before start. (Can cut mouth hole away from Tooth/restoration damage treatment) Clamp # due to stretched/weakened clamp Ensure frame doesn’t injure eyes. Swallowing/inhalation. (Use floss) Stop signal in place - consent. Anterior teeth = Posterior teeth = Usually 6 teeth exposed. Isolate one tooth posterior to tooth working on. 3-3 or pre-molar to pre-molar. Extend to central incisor at least. 00 clamp or 212. 8 teeth for optimum stability. Single tooth endodontics, cervical cavities, class III and 3-4 teeth minimum required. IV, trauma. Clamps not always necessary. (Wedjets or floss) Buccal restorations = Use Optragate. Rubber dam can get in the way near gingival margin. Avoid trapping rubber dam Doesn’t stop gingival crevicular fluid. (Require between matrix band and tooth other forms of isolation also) (Either remove clamp first or try sectional matrix) Paediatrics = Minimal isolation. Normally 1, 2 or 3 teeth. Trough technique. DW clamps useful. Good communication with patient and carer. (Safety, relaxing, quality of result) Must be able to breathe through nose. Tell-show-do. (Show on model) Child friendly language. (Raincoat for the teeth) Trough technique Teach patient how to communicate with stop signals. Explain can breathe through nose and swallow. Could try DryDam for ease on anterior teeth.