Wand and Moisture Control

Question 1

Advantgaes of the Wand for single tooth anaesthesia

Answer 1

• Immediate onset
• Virtually painless
• Increases patient comfort and compliance – below patient pain threshold
• Increased predictability with DPS technology
• No collateral numbness of surrounding cheek, tongue, lip
• Greater volume of anaesthetic under less pressure, going to surrounding bone
• Reduces the need for blocks in most cases
• Bi-lateral mandibular dentistry possible in the same visit
• Reduction of risk of complications (no risk of intravascular or trismus, tachycardia)

Question 2

Wand technique for single tooth anaethesia

Answer 2

• Bevel facing the tooth at 30-45°
• Minimal force on needle
• Enter gently, 3mm depth at most
• Insert like a periodontal probe, not with force
• Single rooted tooth, distal position only
• Multi rooted tooth, two positions, distal then mesial
• Mandibular – Lingual. Maxillary – Buccal
• Position anywhere from line angle to interproximal contact for each root

Question 3

Wand steps for multi rooted teeth

Answer 3

1. Start distal, approach the tooth at a 30-45° angle, with the bevel towards the tooth
2. Place the needle slowly into the gingival sulcus
3. Initiate control flow rate with the foot control (STA mode)
4. Move the needle down gently until you feel resistance, now stop and hold this position steady
5. The ascending tone on the unit will inform you that you are in the correct position (The PDL space) (this takes 10-15 seconds)
6. You are in the correct location if the lights slowly build up on the unit to mid Yellow-Green
7. If after 20-30 seconds the lights do not come on, you need to relocate the needle
8. 6. After you have delivered ½ cartridge
9. Push and release the foot pedal with the needle still embedded, wait 3 seconds then remove the needle (this will prevent spray back)
10. Repeat the procedure on mesial aspect
11. It is important the shaft of the needle is parallel with the surface of the root
12. If the pressure (lights) does not build up, there is either insufficient hand pressure, did not wait 10-15 seconds for it to build or incorrect needle position

Question 4

Advantages of the Wand for infiltrations

Answer 4

• Bi-rotational technique is rotating the needle back and forth 180 degrees to prevent needle deflection
• Better access, view and control of needle, lightweight pen grasp
• Improved patient comfort, virtually painless
• Anaesthetic pathway eliminates anaesthesia “burst effect”

Question 5

Steps for Wand Infiltrations

Answer 5

• Select normal mode on unit (this gives you 2 flow rates)
• Prior to needle insertion, press and hold on the foot pedal lightly until it says “Cruise”
• Holding the handpiece very lightly, insert with a bi-rotational technique, advance 2mm then stop
• Wait for 2 seconds for the anaesthetic to create a pathway
• Then advance at 2mm increments
• If an aspiration test is required then press and release the foot pedal, wait for the 6 beeps on the unit to finish
• You will have used ¼ of a cartridge
• If positive, reposition, if negative then push and hold down on the foot pedal to deliver the required amount

Question 6

Advantages of inferior alveolar nerve block with Wand

Answer 6

• Automatic aspiration
• Improved patient comfort, virtually painless
• Fewer missed blocks as target site found easier
• Multi-cartridge function, one injection can use multiple cartridges
• Bi-rotational technique is rotating the needle back and forth 180 degrees to prevent needle deflection
• Faster onset 3 to 5 minutes due to increased injection precision

Question 7

Inferior alveolar nerve block with the Wand steps

Answer 7

• Select normal mode on unit (this gives you 2 flow rates)
• Prior to needle insertion, press and hold on the footpedal lightly until it says “Cruise”
• Holding the handpiece very lightly, insert with a bi-rotational technique, advance 2mm then stop
• Wait for 2 seconds for the anaesthetic to create a pathway
• Then advance at 2mm increments
• Once bone is contacted, perform an aspiration test by pressing and releasing the foot pedal, wait for the 6 beeps on the unit to finish
• You will have used ¼ of a cartridge
• If positive, reposition, if negative then push and hold down on the foot pedal to deliver the required amount

Question 8

ways to achieve moisture control

Answer 8

• Cheek pads/dry guards
• Sublingual pads and guards.
• Cotton wool rolls can be placed buccally and lingually.
• Suction
• Salivary ejectors.
• rubber dam - gold standard

Question 9

Rubber dam for moisutre control?

Answer 9

Rubber Dam is the gold standard for moisture control

Placement may not always be possible due to eruption status of the tooth and compliance.

• Local anaesthetic may be required.
  
  • rubber dam placement may not be suitable or justified in some circumstances for a minimally invasive procedure like fissure sealant placement.

Rubber dam has been in use for over 150 years.

Less than 2% of dentists in the UK use rubber dam.

Can be indicated for composite restorations, fissure sealants, pulpotomies, pulpectomies and all other endodontic treatments.

Latex free dams have been developed for this patients with latex allergies.

Question 10

technique for rubber dam placement

Answer 10

• Consider likely need for topical anaesthetic and local anaesthetic
• Select an appropriately sized clamp
• Tie floss around the clamp, whilst ensuring the long end of the floss will exit the clamp buccally.
• Using a rubber dam template, punch holes for the required teeth.
• Place clamp in dam and place clamp onto tooth using the clamp forceps.
• Check positioning of the clamp and dam.
• Pull the dam down over the wings of the clamp. (if using a winged clamp)
• Use the frame to secure and position the dam, by stretching it over the prongs.

Question 11

use of fissure sealants

Answer 11

• Can be described as materials to obliterate the fissures and remove the sheltered environment in which caries can thrive.
• Have been shown to reduce pit and fissure caries by 45%-70% in children.

Question 12

materials for fissure sealants

Answer 12

resin or GIC based

• GIC can be used as interim sealants if factors like eruption status and cooperation make moisture control and/or effective placement difficult.
• GIC fissure sealants generally have poorer retention than the resin alternatives.
• GIC fissure sealants do release fluoride.

Can make caries detection difficult once placed.

Moisture control is essential.

A systematic review found a 70% retention rate at 4 years for resin fissure sealants.

Question 13

technique for placement of resin based fissure sealants

Answer 13

• The tooth surface should be cleaned and debris/plaque removed.
• Tooth should be isolated
• Surface to be etched for 20-30 seconds with 37% phosphoric acid.
• Surface washed and then dried.
• Resin applied to tooth surface.
• Resin light cured.
• Fissure sealant inspected.

Palatal upper 6s

Buccal lower 6s

Question 14

technique for placement of GIC based fissure sealants

Answer 14

• Tooth surface is cleaned and a conditioner such as 20% polyacrylic acid can be used.
• Tooth to be isolated.
• GIC is run into the fissures.
• Unfilled resin, petroleum jelly or fluoride varnish can be placed to protect the material.

Question 15

BSPD selection criteria

Answer 15

• Children with special needs
• Children from a disadvantaged social background
• Children with extensive caries in their primary dentition should have all of their permanent molars sealed soon after eruption.
• Children with a caries-free primary dentition do not usually require their permanent molars to be sealed.
• Sealants should be placed as soon as moisture control is feasible.
• If one first permanent molar develops occlusal caries, the other first permanent molars should be sealed.
• Occlusal caries in the first permanent molars, indicates the need to seal the second permanent molars.