Reading Flashcards
Goals of operating field isloation
- Moisture control
- Rectraction
- Harm prevention
-Excluding sucular fluid, Saliva, and gingival bleeding from the operating field
Moisture Control
Recommended technique for moisture control
Rubber Dam
Provides maximal exposure of the operating site
Retraction and access
Advantages of Rubber dam isolation
- Dry, clean operating field
- Improved access and visibility
- Improved properties of dental materials
- Protection of patient and operator
- Operating efficiency
Disadvantages of rubber dam isolation
- Time consumption- even though less than 5 minutes
- Patient objection
- Teeth haven’t erupted enough
- Tooth is very malpositioned
- Latex allergy
- Some 3rd molars
- Patient struggles with breathing through nose
Why you can’t use a rubber dam
Play a role in eliminating the discomfort of dental treatment and controlling moisture by reducing salivary flow
Local Anesthesia
When is use of a rubber dam strongly recommended?
When excavating deep caries lesion and risking pulpal exposure to prevent pulpal contamination
Rubber dam protects
The patient and the operator
- Low tear strength
- 5x5 or 6x6 in size; thin, medium, heavy, and extra heavy
- Darker colors preferred for contrast (dull side facing occlusal)
- Thicker dam used for class V lesions with cervical retainer
- Thinner used when contacts are tight
Material of dental dam
Maintains border of dam in position
Frame
U-shaped metal frame with small metal projections for securing borders
Young holder
4 prongs and 2 jaws connected by a bow
Retainer
Where does the retainer anchor the dam?
The most posterior tooth to be isolated
Retracts gingival tissue
Retainer
Where should the retainer contact the tooth
In it’s 4 line angles (to prevent rocking and tilting)
The jaws of the retainer should not extend beyond
The mesial and distal line angles
Has anterior and lateral wings
Winged retain
- Interfere with matrix and wedge placement
- More likely to have gingival trauma
- Harder to get complete seal around anchor tooth
If jaw extends beyond mesial and distal line angles
Most molar anchor teeth
W56
Mandibular molar anchor teeth
W7
Maxillary molar anchor teeth
W8e
Most premolar anchor teeth
W4
Small premolar anchor teeth
W2
Terminal mandibular molar anchor teeth requiring preparation involving the distal surface
W27
Provide extra retraction of rubber dam from operating field and allow attachment to retainer before conveying retainer to anchor tooth1
Winged retainer
Can be cut away on retainer if not wanted
Anterior wings
How many inches of dental floss should the bow be tied with?
12 inches
When is a retainer required for treatment of anterior teeth?
Cervical retainers for class V restorations
Precision instrument with rotating metal table with holes of varying sizes and tapered, sharp plunger
Punch
Used for placement and removal of retainer from the tooth
Retainer Forceps
- Improves patient comfort by reducing direct contract of the rubber material with the skin
- Absorbs any saliva seeping at the corners of the mouth
- Acts as a cushion
Rubber Dam napkin benefits
Placed between the rubber dam and the patients skin
Rubber dam napkin
Water-soluble applied in area of punched holes helps pass dam septa through proximal contacts;
Lubricant
Where should Lubricant be applied?
Both sides of the dam
What is sometimes used as a lubricant?
Shaving cream
Waxed dental tape (floss) or small piece of rubber dam material or rubber Wedjet
Anchors (other than retainers)
When are other anchors used?
When the proximal contact is sufficient to anchor the dam to the tooth
How many holes do rubber dams having in cutting table?
5 or 6
Where should incisors and the mesial side of canines be isolated from?
1st premolar to 1st premolar
- Not retainer required
Where should canines be isolated from?
1st molar of opposite lateral incisor
Should include the lateral incisor on the opposite side of the arch
Posterior teeth
1 or 2 teeth distally and anteriorly to opposite lateral incisor
Premolars
As far distal as possible to oppsite lateral incisor
Molars
How many teeth should be isolated?
Minimum of 3
How many teeth do you isolate with endodontics
1
Distance from center of 1 tooth to center of other (level of gingival tissue)
Distance between holes
1st holes for central incisors
Maxillary teeth
1st hole is posterior anchor tooth
Mandibular teeth
What is the appropriate placement for the dam and the retainer?
Should be done at the same time
Where should the rubber dam be inverted to seal?
Gingival direction
What helps to get the interproximal?
Floss
Air dry these surfaces and use a blunt instrument
Facial and Lingual
- Test and lubricate proximal contacts
- Punch the holes
- Lubricate the dam (2 sides)
- Select the retainer
- Test retainer’s stability and retention- lift occlusally with fingertip under the bow
- Position dam over retainer
- Apply the napkin/ position the napkin
- Attach the frame
- Apply anchor anteriorly (if needed)
- Pass septa through contact without and then with dental tape/floss
- Invert the dam interproximally
- Invert dam faciolingually
- Confirm proper application of dam
- Check for access and visibility
- Insert wedges
Application of rubber dam
- Cut the septa
- Remove the retainer
- Remove the dam
- Wipe the lips
- Rinse the mouth and massage the tissue
- Examine the dam
Removal of rubber dam
Cervical retainer placement
Use No.212 for Class V
Restoration of adjacent proximal surface and cervical restoration of an abutment tooth
Fixed bridge Isolation
Can be used to substitute for a retainer; lacks jaw and bow so dam slips sometimes
Matrix band
Dictates changes in procedures of rubber dam application
Age of a patient
Isolation is usually from the most posterior tooth to the canine on the same side
Isolation for primary teeth
How is jaw position different in younger patients?
It should be directed more gingivally
Retainer recommended for primary teeth
SS white No. 27
Retainer recommended for young permanent teeth
Ivory no. W14
- Off-center arch form shredded or torn dam -Inappropriate hole distance sharp tips on No. 212 retainer
- Incorrect hole arch form incorrect technique for cutting septa
- Inappropriate retainer
- Retainer-pinched tissue
Errors in application and removal
Isolation alternatives when rubber dam isolation is impractical or impossible
Absorbents
Cotton roll and Cellulose Wafers
Absorbents
When rubber dam is not being used, these are indicated when the risk of aspirating or swallowing small objects is present
Throat shield
Preferred for suctioning water and debris from the mouth
High Volume evacuators
- Cuttings of tooth and restorative material and other debris are removed from the operating site
- A clean operating field improves access and visibility
- Dehydration of oral tissues does not occur
- Precious metals can be more readily salvaged if desired
Combined use of water spray or air-water and a high- volume evacuator during cutting procedures advantages
Can often be used in direct procedures involving accessible subgingival areas and in indirect procedures involving gingival margins
Retraction cord
Usually moistened with a noncaustic hemostatic agent, may be placed in the gingival sulcus to control sulcular seepage, hemmorage, or both
Retraction cord
Establish and maintain suitable mouth opening, relieving the patient’s muscles of this task, which also produces fatigue and sometimes pain
Mouth props
