Chapter 36

Moisture Control
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Introduction
Objective: Maintain an environment that keeps
the operating field free of excess water, saliva,
blood, tooth fragments, and excess dental
materials.

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Oral Evacuation Systems

The process of removing excess fluids and

debris from the mouth.

Two systems:
Saliva ejector
High-volume evacuator (HVE)

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Saliva Ejector
Small, strawlike oral evacuator used during

less invasive dental procedures.

Indications for use:
Preventive procedures such as a
prophylaxis or fluoride treatments.
Helps control saliva and moisture
accumulation under the dental dam.
For the cementation of crown or bridge.
During an orthodontic bonding procedure.

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Saliva Ejector contd

Placement of saliva ejector
Bend and shape saliva ejector for
placement.
Position under the tongue.
Position saliva ejector opposite the side on
which the dentist is working.

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HVE
Used for most dental procedures, especially

when the dental handpiece is in use.

Indications for use
Keep the mouth free of saliva, blood, water,
and debris.
Retracts the tongue and cheek away from the
field of operation.
Reduces the bacterial aerosol caused by the
high-speed handpiece.

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HVE contd
Oral evacuation 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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Grasping the HVE

Thumb-to-nose grasp
Pen grasp
Right hand

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Fig. 36-4 Grasping the HVE.

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Positioning the HVE

Criteria:
Place the evacuator prior to the dentist
positioning the handpiece and mouth mirror.
Position the tip on the surface of the tooth
that is closest to you.
Position the tip as close 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
higher than the occlusal or incisal edge.
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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
procedure.
Accomplished quickly and efficiently.
Full-mouth rinse
Freshens the patient's entire mouth.
Completed after a procedure.

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The Air-Water Syringe

Used for convenience and accuracy to complete the

rinsing process.
Criteria for use:
Direct the tip toward the tooth that is being worked
on.
Keep a close distance between the operative site and
the syringe tip.
Use the air on the mouth mirror continuously when
indirect vision is involved.
When you hear the handpiece stop, you know 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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Isolation of Teeth
Criteria for isolation techniques:
Be easy to apply and not injure soft and
hard tissues.
Be comfortable for the patient.
Provide retraction for better visualization
for the operator.
Prevent moisture contamination.
Isolate the area of concern.

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Cotton Roll Isolation

Formed, preshaped cotton positioned close to
the salivary gland ducts absorbs the flow of
saliva and excess water.

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Cotton Roll Isolation contd

Advantages:

Easy application.
No additional equipment is required.
Flexible so they can be adapted to fit areas of
the mouth.
Disadvantages:
Does not provide complete isolation.
Does not protect the patient from aspiration.
May stick to the oral mucosa and can injure it.
It must be replaced frequently because of
saturation.
Limited retraction.
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Dry-Angles
A triangular absorbent pad placed over the

Stensen's duct blocks the flow of saliva and

protects the tissues in this area.

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The Dental Dam

A thin stretchable latex material becomes a

barrier when appropriately applied to select

teeth.

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The Dental Dam contd

Indications for use
Infection control protective barrier.
Safeguards the patient's mouth.
Protects the patient from accidentally
inhaling or swallowing debris.
Protects the tooth from contamination.
Provides the moisture control needed.
Improves access.
Provides better visibility.
Increases dental team efficiency.
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Dental Dam Supplies and Equipment

Provides complete isolation around one tooth or
several teeth.
Made of either latex or latex-free material.
Available in a continuous roll or in two precut
sizes (6x6 or 5x5).
Available in a wide range of colors from light
to dark.
Available in scented and flavors.
Dam thicknesses (gauges) are thin (light),
medium, and heavy.

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Fig. 36-15 Dental dam material.

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Dental Dam Frame

Stabilizes and stretches the dam so it fits tightly
around the teeth and out of the operator's way.
Available in plastic and metal frames.
U-shaped frame.
Youngs frame.
Otsby frame.

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Fig. 36-16 Dental dam frame.

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Dental Dam Supplies and

Equipment contd
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 Supplies and

Equipment contd
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. 36-18 Sizes of the holes.

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Dental Dam Supplies and

Equipment contd
Dental dam stamp: Ink pad and stamp

used to mark the dental dam with

predetermined markings for average adult
and pediatric arches.
Dental template: Stiff plastic template with
holes indicating where the teeth should be
marked.

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Dental Dam Supplies and

Equipment contd
Dental dam forceps are used in the placement

and removal of the dental dam clamp.

Beaks of the forceps fit into holes on the jaws
of the clamp.
Sliding bar keeps the handles of the forceps in
a fixed position.
Handles are squeezed to release the clamp.
Beaks of the forceps are turned toward the
arch being isolated.

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Dental Dam Supplies and

Equipment contd
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.

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Fig. 36-23 Dental dam clamps.

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Dental Dam Clamps

Fitting the clamp: Designed to fit on the

cervical area of the tooth below the height of

contour and at, or slightly below, the
cementoenamel junction.
Winged clamps have extra 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 Dam Clamps contd

Ligature: An important safety step 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. 36-24 Ligature.

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Dental Dam Application

Steps in preparation and placement
Dental dam equipment and supplies readied.
Dam is punched.
Clamp selected, ligated, and positioned on
forceps.
Placement of clamp.
Placement of dam.
Placement of frame.
Dam secure 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 forceps in clamp.
Remove everything as one unit.
Evaluate patient.
Evaluate dam.

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