Restorative - Week 4 PP Flashcards
What is a Dental Dam?
Dental Dam is a thin, stretchable material that becomes a carrier when it is appropriately applied to selected teeth.
* When in place only selected teeth are visible
through the dam
* Routinely placed after local anesthetic has been placed
* Can usually be placed in about 2 minutes
Indications for Dental Dam - why need it/use it?
- Serves as an infection control barrier - protection from bacteria
- Safeguards the patients mouth against contact with debris, dental materials or other liquids
- Protects patient from aspirating or swallowing debris
- Protects the tooth from contamination by saliva or debris if pulpal exposure accidentally occurs (ex. root canal - where bacteria could get into pulp and cause an infection)
- Protects the oral cavity from exposure to an
infected tooth opened during endo treatment - Provides moisture control essential for restorative material placement
- Improves access by retracting lips, tongue and gingiva from the field of operation
- Provides better visibility because of contrasting colors between the dam and tooth
- Increases efficiency by discouraging patient
conversation and reducing the time required for treatment
Dental Dam Contraindications
- Patient concerns such as claustrophobia - sometimes still must use it depending on the procedures, this is when an anti-anxiety agent could be used instead
- Physical conditions, asthma, nasal congestions or lesions around the area of treatment
- Conditions in the mouth such as mobile teeth, partially erupted teeth or severe misalignment - can’t place a clamp on a loose tooth
Characteristics of Dental Dam
- Made of either latex or latex free material
- Available in continuous roll or in two precut sizes (6x6 or 5x5)
- Available in a wide range of colors from light to dark
- Available in scented or flavors
- Dam thickness (gauges) are thin (light), medium and heavy
Dental Dam Punch
Creates the holes in the dental dam that are needed to expose the teeth to be isolated
- there are different sizes of holes on the punch:
5 - larges hole
4 - large hole - for molars
3 - medium hole - premolars
2 - small hole (max anterior)
1 - smallest hole (mand anterior)
Looks like a hole punch
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.
Types of Dental Dam Frames
Plastic U-Shaped – frame is placed under the dam (next to the patients face). The frame is radiolucent (does not block x-rays), it is not necessary to remove it when radiographs are required during treatment.
Young Frame – stainless steel U-shaped holder. It is placed on the outside of the dam. This increases patient comfort by holding the dam away from the patients face.
Ostby Frame- round plastic frame with sharp
projections on its outer margin. The dam is also stretched over the outside of the frame.
Dental Dam Forceps
Dental Dam forceps are used in the placement and removal of the dental dam clamp
- The beaks of the forceps fit into holes on the
jaws of the clamp - A sliding bar keeps the handles of the forceps in a fixed position
- The handles are squeezed to release the clamp
- The beaks of the forceps are turned toward the arch being isolated
Dental Dam Clamp
The dental dam clamp is the primary means of
anchoring and stabilizing the dental dam. The clamps are made of chrome or nickel-plated steel and are designed to hold the dental dam securely at the end nearest the tooth that is being treated.
- comes in a large variety of shapes/sizes - even subgingival
- Keeps the rubber secure in the patient’s mouth
** KNOW THE CLAMPS NAMES/#s FOR BOARD EXAM **
Types of Dental Dam Clamps
Anterior - 9 & W9
Premolar - 00, W00, 2, W2
Molar - 7, W7, 8, W8, 14A, W14A
Components of the Dental Dam Clamp
- Bow- rounded portion of the clamp
- Jaws – seat around the tooth, creates the
extension and balance necessary to stabilize the clamp - Holes – Where the forcep prongs enter and
retract the jaw - Prongs – prongs of the clamp that make contact with the tooth
- Winged clamps – extra extensions to help retain the dental dam (projections on left/right side of clamp)
Dental Dam Ligature
The ligature is a piece of floss tied to the clamp, to allow the clamp to be retrieved should it accidentally become dislodged, and or inhaled by the patient
Dam is held on tooth by friction, if for some reason it pops off or breaks, it is tied to floss so we can grab it and the patient doesn’t inhale it or swallow it
Dental Dam Napkin
The disposable dental dam napkin can be used and is placed between the patients face and the dam. The primary purpose of the napkin is to increase patient comfort by absorbing moisture. The napkin also
protects the patients face from direct contact with the dam, reducing the risk that they patient may develop a latex sensitivity (if using latex dam)
-mostly for comfortability of patient*
Dental Dam Preparation
Each application of the dental dam is preplanned to accommodate the dentist’s preferences, the tooth or teeth involved, and the procedure to be performed.
Things to consider when punching a dam:
* Maxillary or Mandibular arch
* Shape of the arch
* Any irregularities, missing teeth fixed prosthesis, or mal-positioned teeth
* Size and spacing of the other holes to be punched
* not a one size fits all situation*
Maxillary Arch Application (exam question)
Punch the dental dam 1 inch down from the upper edge of the dam
If the patient has a mustache or a very thick upper lip it is necessary to allow slightly more than a 1 inch margin from the edge
Mandibular Arch Application (exam question)
Punch the dental dam leaving a 2 inch margin from the edge. Due to the smaller size of mandibular anterior teeth, the holes are punched closer together than for posterior teeth.
Anterior Application
The isolation of anterior teeth typically occurs from canine to canine. When the isolation is complete, a dental dam clamp is not required. The dam is secured using a piece of dental dam or floss.
Troubleshooting Hole Sizing and Spacing
Holes are too large – dental dam will not fit tightly around the tooth. This may allow saliva to leak through
Holes are too small – the dam will not slip easily over the tooth, this may cause the dam to stretch or tear and may leave the gingiva exposed.
Holes are too close – the dam may tear or stretch, this may cause leakage
Holes are too far apart – excess material will be present between the teeth and this may block the dentist’s vision or catch instrumentation
Fixed bridge- is a prosthetic device that is cemented in place that replaces one or more missing teeth. Because the units of the bridge are joined together it is not possible to place the dental dam septum between each tooth.
When punching the dam punch a hole for each crowned tooth, do not punch holes for the teeth that are “missing”
Why can we not always use the standard template for Dental Dam?
Each patient’s dentition is different
-Crowding
* Loose teeth
* Missing teeth
* Misaligned teeth
* Crowding
* Narrow or wider arch
Patient Education - Pre-Op instructions for Dental Dam
- Like a rubber “raincoat” that fits over your tooth
- Prevents water and debris from getting in your mouth
- Helps keep the working area dry
- A small “ring” fits around your tooth to hold the rubber in place
Patient Education - Post Op Instruction for Dental Dam
Warm salt water rinses will help any gingiva tenderness in the area worked on today
* How long local anesthetic will last (if used)
* Any other post op relating to the treatment performed that appointment (ie. Occlusion)
Other types of isolation
- Cotton Roll
- Dry Angle
- Isolite
Cotton Roll Isolation
Is tightly formed absorbent cotton that is pre-shaped to be positioned close to the salivary gland ducts to absorb the flow of saliva, and close to the working
field to absorb excess water
Advantages:
* Easy application
* Come in a variety of sizes
Disadvantages:
* Does not provide complete isolation
* Does not protect against patient aspiration
* If removed improperly it may stick to the oral mucosa
Cotton Roll Holders (Garmers)
Are designed to hold multiple cotton rolls in a more secure manner for the mandibular quadrant. Holders are especially important when the operator is working alone, without an extra pair of hands to maintain isolation
Only used on the mandibular
Dry Angle Isolation
Dry angles are triangular absorbent pads. The pad helps isolate posterior areas in the maxillary and mandibular arches. The pad is placed on the buccal mucosa over the Stensen’s duct.
Isolite
Isolite Intraoral suction and retraction
Bite block that has suction to remove moisture
Bite Block
Bite block can be used with separate suction device
