Pediatric Isolation techniques: Dr. Kordis

Question 1

Why do we need isolation?

Answer 1

• Most dental materials negatively affected by moisture

Question 2

Goals of Isolation

Answer 2

• Moisture Control
• Retraction and Access
• Safety

Question 3

Options for achieving oral Isolation

Answer 3

• Moisture tolerant materials
• High Speed Evacuation
• Isolite or other evacuation systems
• Efficient utilization of assistants
• Rubber dam

Question 4

Rubber Dams: Advantages vs Disadvantages

Answer 4

• Advantages:
  
  • Dry and clean Operating Field
  • Improved access and Visbility
  • Efficient operating
  • Improves dental materials properties
  • Protects patient and operator
• Disadvantages:
  
  • Placement consumes tiime
  • partially erupted teeth
  • malposed teeth
  • Nasal Obstruction
  • Latex allergy (non-latex)

Question 5

Why use a rubber dam?

Answer 5

• BEST FORM OF ISOLATION
• Protects patient and operator
  
  • Reduced chance of aspiration
  • isolates soft tissues from caustic agents/materials
  • reduces aerosol
• Patient management
  
  • prevents tongue from getting in the way
  • controls saliva and muscles
  • decreases operating time
  • seperating barrier
    
    • instrumentation perceived as being less invasive
• Access, visualization, moisture control
  
  • provides a clear, dry, isolate field for treatment
  • improved quality of restoration

Question 6

When to use a rubber dam?

Answer 6

AS MUCH AS POSSIBLE

• Sealants-whenever possible
• Amalgam & Composite restorations
  
  • most of the time (95%)
• Stainless steel crowns
  
  • most of the time (95%)
• Pulpal Therapies-Pulpotomies/Pulpectomies
  
  • always

Question 7

Rubber Dam Options

Answer 7

• Latex and non-latex
• Colors
• scented or non-scented
• Size
• Shape
• Gauge or thickness

Question 8

Which teeth to isolate?

Answer 8

• Isolate the number of teeth required to perform the procedure

Question 9

What is the key to oeprative dentistry?

Answer 9

Dry and clean field

Question 11

Rubber Dam Clamp

Answer 11

• Number
  
  • winged
• Number followed by “A”
  
  • prongs directed apically
• Number followed by “W”
  
  • wingless
• Number followed by “D”
  
  • distal extension of bow

Question 12

Recommended Clamp Selection for teeth

Answer 12

• Partially erupted permanent molars
  
  • 8A or 14A
• Fully erupted permanent molars
  
  • 8, 12A, 13A, 14, or 27
• Secondary Primary Molars
  
  • 3, 8, 8A, or 14
• Primary Incisord and canine
  
  • 0, 00, 209
• Permanent incisors and canines
  
  • 9 or 212

Question 13

Rubber Dam Clamp: Patient Safety

Answer 13

• ALWAYS tie dental floss to clamp before placing
• NEVER leave child with rubber dam alone
• NEVER leave anything in the mouth that is not visible at all times

Question 14

Rubber Dam Frames: Function

Answer 14

• RETRACT AND STABILIZE DAM

Question 15

Rubber Dam Prep: Hole Selection

Answer 15

• Largest Punch=5
  
  • clamp
  • permanent molars
• Medium Punch= 3 & 4
  
  • premolars
  • primary molars
• Second smallest punch-2
  
  • maxillary permanent incisors
• Smallest Punch-1
  
  • primary incisors
  • lower pemanent incisors

Question 16

How to control Leakage in rubber dam

Answer 16

• Inver margin of Rubber Dam
• Ligate with floss
• use caulking or putty to seal margin of rubber dam

Question 17

Slit Dam Technique

Answer 17

• Punch w holes 1/2 inch apart
• connect with scisors

Question 18

Slit Dam technique: Advantages vs Disadvantages

Answer 18

• Advantages:
  
  • Fast
  • Good for SSC preps
  • Posterior Sextant Dentistry
• Disadvantage
  
  • poor moisture control
    
    • especially mandible
  • Caution with resins, sealants, and pulp involvement

Question 19

Rubber Dam: how to introduce to patients and parents

Answer 19

• prevents tooth structure, decay, debris, and restoration material from being swallowed or aspirated
• Prevents moisture contamination
  
  • adversely affect properties and longevity of medicaments and restoration materials
• Elasticity of rubber dam reduces the muscle fatigue associated with maintaining mouth open
• Allows patient to breathe through both the mouth and nose.
• Only water tigher around teeth
• Muffles the patients peech, but verbal communication is still possible

Question 20

Behavior Management tips

Answer 20

Tell Show Do

• Explaining procedures in age appropriate and non-threatening way. Showing the equipment, completing procedure
• Explain: purpose of the rubber dam and procedure we plan to do
  
  • water cleans your tooth and shield keeps you from swallowing wash water
  • clamp is a “ring” or “tooth button”
  • Dam- “trampoline”, “raincoat” or “shield”
• Prepare patient for a “tight hug”, “pushing”, or “pressure”
• check for adequate anesthesia before applying rubber dam

Question 21

Alternatives for Isolation

Answer 21

• Moisture tolerant materials:
  
  • Cotton rolls
  • Dri-Angles
  • Gauze
• Zyris
  
  • Isolite
  • Isovac
  • Isodry
• DryShield
• Zirc-Mr. thirsty
• High Speed evacuation
• Efficient utilization of assistants

Question 22

Isolite: Pros and Cons

Answer 22

• Pros
  
  • better visibility
    
    • brings light to field
  • retracts tissues
  • decreases moisture
  • helps protect airway
  • limits patient conversation
• Cons:
  
  • difficult to apply properly
  • can impinge tissues or obstruct instruments
  • expensive

Question 23

Moisture Tolerant Materials: Pros vs Cons

Answer 23

• Pros
  
  • inexpensive
  • tissue retraction-minimal
  • easily changed, placed, added
  • used as throat screen (gauze)
• Cons:
  
  • Can get caught in bur
  • can become to moist to be effective
  • can damage tissue if not removed carefully
  • Can be uncomfortable if not positioned well (Dri-Angles
  • Minimal tissue retraction