Isolation of the Oral Cavity

Question 1

When would you use a clamp with inverted prongs?

Answer 1

On partially erupted teeth where additional retraction is necessary

Question 2

What part of the clamp is responsible for achieving 4-point contact?

Answer 2

The prongs

Question 3

When can you add winged clamps in relation to the rubber dam?

Answer 3

Winged clamps may be placed 1st, 2nd, OR at the same time as the rubber dam. Think, if you had wings you could walk OR fly.

Question 4

When can you add wingless clamps in relation to the rubber dam?

Answer 4

MUST add wingless clamps PRIOR to adding the rubber dam. Think, if you didn’t have wings you would ONLY be able to walk.

Question 5

What teeth are isolated with a rubber dam for a posterior procedure? What tooth is the clamp placed on?

Answer 5

Ideal is TWO teeth posterior and around the arch to the opposite lateral incisor. Clamp is placed on most posterior tooth.

Question 6

What teeth are isolated with a rubber dam for an anterior procedure? What tooth is the clamp placed on?

Answer 6

Ideal is 1st premolar to 1st premolar. NO clamp is placed for anterior isolations.

Question 7

What should you always do before adding a clamp to a tooth?

Answer 7

Put floss around the clamp in order to ensure that, if dropped, it will not be aspirated.

Question 8

What type of clamp and what is it used for? W56

Answer 8

Wingless clamp used on maxillary and mandibular molars.

Question 9

What type of clamp and what is it used for? 212 UNC. What additional measure must be taken when using the 212 UNC clamp?

Answer 9

Wingless clamp used for class V restorations. Placed on tooth being restored. Must use compound to secure clamp on tooth and to keep from rocking.

Question 10

What type of clamp and what is it used for? 14A. Why special conditions call for the use of the 14A clamp? What must you be careful of when using this clamp?

Answer 10

Winged clamp used for maxillary and mandibular molars. Used as a last resort replacement for the W56 clamp when additional gingival retraction is required (i.e. partially erupted teeth or tapering molars). Must be careful to not damage gingiva b/c the prongs are more flared.

Question 11

What type of clamp and what is it used for? 90N. How does the 90N differ from its non-winged counterpart? What is a downside to the 90N vs its counterpart?

Answer 11

Winged clamp usually used for endodontic procedure but we used for class V restoration. Similar to the wingless 212 UNC, but has wings, has holes for clamp forceps, and provides additional gingival retraction. However, when compared to 212 UNC, the 90N clamp provides poor access to class V’s.

Question 12

When clamping a small premolar, what clamp would you likely use? What about a larger premolar?

Answer 12

Small = W1
Large = W3

Question 13

When clamping maxillary and mandibular molars, what clamp is preferred?

Answer 13

W56

Question 14

When clamping a molar that is partially erupted or tapered, what is the optimal clamp?

Answer 14

14A

Question 15

When preparing to perform a class V restoration on anterior teeth, premolars, and some molars, what clamp is used? What additional precaution must be taken when placing this clamp?

Answer 15

212 UNC. Remember must secure with (green) compound to surrounding teeth.

Question 16

To avoid a patient aspirating or swallowing a clamp what precaution should ALWAYS be taken before adding the clamp and what additional precaution can be taken w/ winged clamps but NOT wingless clamps?

Answer 16

ALWAYS tie floss to the clamp before putting it in the mouth. With winged clamps ONLY, put on rubber damn FIRST, then add clamp (remember, with wingless clamps, the clamp MUST be added before the dam).

Question 17

A rubber dam punch has 5 holes. What is each used for?

Answer 17

1. Largest: Posterior tooth with clamp ALREADY in place
2. Clamped molars
3. All molars & clamped premolars
4. All premolars, canines & upper central incisors
5. Smallest: Lower incisors & upper lateral incisors

Question 18

What is another name for clamp forceps?

Answer 18

Rubber dam forceps

Question 19

When isolating the posterior teeth, the general rule is ‘at least one tooth distal.’ How does this change when you are working on a premolar? What do you do if there are no teeth posterior?

Answer 19

Premolar: Isolate at least TWO teeth posterior
Terminal Tooth: Add clamp to the tooth you are working on. Use a clamp that allows for the greatest working area when applied, i.e. 14A.

Question 20

When might you only isolate a single tooth?

Answer 20

During endodontic procedures when you must keep the working area as sterile as possible b/c pulp being exposed.

Question 21

Name at least 6 steps to be taken before adding a rubber damn.

Answer 21

1. Select teeth to be isolated
2. Test interproximal contacts, to determine dam thickness
3. Check MIC, can’t do this after dam is added
4. Select the shade of the tooth if a bonded restoration is being done. Remember, the color of the rubber dam affects ability to pick proper shade of isolated teeth.
5. Punch the holes using a template
6. Select the proper clamps, tie floss on bow
7. Lubricate the shiny side of the dam
8. Lubricate patient’s lips and corners of mouth

Question 22

How does the position of the holes punched on the dam differ for maxillary vs mandibular isolations? Why?

Answer 22

Maxillary isolation: punch holes 1” from the top of the rubber dam to cover lips but NOT nose
Mandibular isolation: 1.5” from the bottom of the rubber dam to cover lips

Question 23

When adding rubber dam to posterior, what are the 1st two teeth that should be isolated?

Answer 23

1st: Most posterior tooth w/ clamp
2nd: Opposing lateral incisor, ligated w/ floss

Question 24

For a #19 class I: 1) What teeth should be isolated? 2) What clamp should be added to what tooth? 3) Ligate with floss b/t what teeth?

Answer 24

1) 18-26
2) Add W56 (preferable) or 14A
3) 26 & 27

Question 25

What are the 4 steps in removing a rubber dam?

Answer 25

1. Remove retainer (retainer = clamp)
2. Pull rubber dam material occlusally & towards the buccal/facial
3. Cut rubber material w/ blunted scissors away from soft tissue (don’t just pull over teeth!)
4. Check rubber dam & soft tissue for missing material. Can’t leave material in gingiva or will cause infection.

Question 26

Give at least 4 examples of common mistakes made when placing rubber dam?

Answer 26

1. Not inverting dam into sulcus around teeth
2. Not putting floss on the clamp
3. Too much/too little material b/t teeth
4. Leaving maxillary arch exposed when isolating mandibular arch
5. Covering nasal passages when isolating maxillary arch
6. Flipping the dam frame upside-down so that the horizontal bar is placed below the nose and not on the chin