Moisture Control in Dentistry Dr. Asmat Jameel
B.D.S, F.C.P.S Assistant P f A i t t Professor & Head Department of Preclinical Dentistry
Objectives
• The understanding of the importance of effective moisture control in the clinical practice of dentistry • Th understanding of th diff The d t di f the different methods of t th d f moisture control in the clinical setting. • To demonstrate the safe and effective use of various moisture control methods in the clinic
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A. Sources of moisture in the clinical environment. B. Why is B Wh i moisture control i i t t l important? t t? C. Methods of moisture control.
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A. Sources of moisture in the clinical environment: • i. Saliva: - from salivary glands. (parotid, submandibular, sublingual) ( tid b dib l bli l) • ii Blood: ii. - inflamed gingival tissues. - iatrogenic damage. g g • iii. Gingival crevicular fluid: -inflamed gingival tissues.
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Cont.
• iv. Water/dental materials: - from rotary instruments. - water from triplex syringe syringe. -materials we may use during treatment [eg. etchants, [eg etchants irrigant solutions] solutions].
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B. Why is moisture control important?
i. Patient related factors • C f t Comfort. • Protects patients swallowing or aspirating foreign bodies. • Protects patient soft tissues – tongue, cheeks by retracting them from operating field.
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Example
“A small round bur detached from the slow speed handpiece and lodged in patients’ left bronchus….. The patient bronchus underwent a thoracotomy to retrieve the bur
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Cont. C t
ii. Operator related factors
• I f ti control; to minimise aerosol production. Infection t l t i i i l d ti • Increased accessibility to operative site, allowing greater convenience and efficiency of operative. • Procedures (e.g. patient’s “need to swallow”) causes fewer problems. p y g g • Improves visibility of the working field and diagnosis. • Less fogging of the dental mirror. • Prevents contamination of cavity preparation/ root canal. • Haemorrhage from gingiva does not enter operative site. site
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Cont. C t
iii. Task/technique being performed: • Dental materials are moisture sensitive, success of adhesion and physical properties relies on a dry field.
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C. C Methods of moisture control
Application: i. Aspiration ii. Air-Water-Syringe ii Ai W t S i iii. Absorbent materials iv. iv Rubber dam v. Pharmacological methods vi. Gingival retraction cord g vii. Electrosurgery viii. Tricholoroacetic acid
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i. i Aspiration:
High volume aspiration. • High volume vacuum (large diameter tip, autoclavable or disposable). • Operated from vacuum unit. Application: • Suitable to remove -large particulate matter l i l -water from high speed drills -air water sprays i t
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Cont. Cont
Saliva ejector.
• Low volume small diameter tip volume, tip, usually disposable. • Flexible plastic tubing with protective flange. fl • Routine saliva control. • Can be placed under rubber dam. p • Best used to remove small amounts of moisture. • Can be used in conjunction with other methods of moisture control.
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Cont. Cont
• Advantages: •Cheap, easy to use (can be held by patient). •Some have flanges attached which can retract tongue and floor of mouth. • Disadvantages: •Can be uncomfortable for patient if used inappropriately. inappropriately •May cause soft tissue damage; care must be taken not to suck in patients tissues into the tip. •Active tongues can make placement difficult. •Low volume aspirators don’t remove solids well. slide 13
High volume vacuum/ Low volume
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ii. Air-Water-Syringe: ii Ai W t S i
Application: • Air blast useful to dry tooth or soft tissues during examination or used during operative procedures Advantages: Ad t
• Easy to use. • Needs greater caution with use as can dehydrate dentine and cause pain and discomfort to patient g ; j • Not effective if large volumes of moisture; can just transfer moisture from one tooth to the next.
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Disadvantages:
iii. iii Absorbent materials
• Cotton rolls, pellets, gauze, cellulose wafers. Application: • Cotton rolls (placed in buccal or lingual sulcus) and cellulose wafers (placed in the buccal sulcus). Can place cotton rolls over parotid d id duct to control parotid fl l id flow • Are used to absorb saliva and other fluids for short periods of time eg; any examinations, fissure sealants, polishing
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Cont. C t
• Can be used with other methods of moisture control eg saliva ejector When removing cotton rolls or cellulose wafers make sure they are moist to prevent inadvertent removal of the epithelium
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Cont. C t
• Advantages: • Effective to control small amounts of moisture • Retract soft tissues at same time • Disadvantages: • Only provides short term moisture control • Ineffective if high volumes of fluid • Active tongues and shallow sulci may make placement and retention difficult
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iv. Rubber dam
Total T l moisture control method i l h d
Application: • Isolation of one or more teeth from the oral environment. • Rubber dam eliminates saliva from the working field d l fi ld and also retracts soft t t ft tissues
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Rubber dam set
• • • • • Rubber dam ( R bb d (green, bl and bl k)/15 blue d black)/15cm Rubber dam punch Rubber dam clamps Rubber dam clamp forceps Rubber dam frame/holder
Rubber dam stamp for marking the position of tooth t th Rubber dam lubricant Waxed dental floss Scissors
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Rubber dam clamps
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Cont. Cont
Advantages:
• Complete, long term moisture control • Maximises access and visibility • Protection for both patient and dentist • Infection control measure • Prevents accidental swallowing or aspiration of foreign bodies • R t t soft tissues Retracts ft ti • Increases operator efficiency • Improved properties of dental materials
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Cont. Cont
Disadvantages:
• Claimed that it takes time to apply • Communication with patient can be difficult • Incorrect use may damage p y g porcelain crowns/crown margins/ traumatise gingival tissues • Patient may feel incomfort or phobic with it on • Insecure clamps can be swallowed or aspirated
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v. v Pharmacological methods
• Use of local anaesthetic with a vasoconstrictor • eg Adrenaline: causes transient vasoconstriction of blood vessels in site of injection May control injection. haemorrhage in some situations
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Cont. C t
Advantages:
• Used as an adj nct to control gingi al adjunct gingival bleeding when use of retraction cord is not sufficient
Disadvantages:
•I Invasive, patient may not want LA needle i ti t t t dl • Will be numb for a while p g • Not effective if profuse bleeding
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Cont. C t
• Use of chemicals inhibit salivary secretion eg, atropine, methantheline bromide • Chemical method of. Is administered orally 1-2 hours prior to the procedure and causes temporary dry mouth (Acts on the sympathetic nervous system). Very rarely y p y ) y y used as a moisture control method
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Cont. Cont
• Advantages:
• Used to control patient with excessive salivary flow when other methods ineffective
• Disadvantages:
• Side effects; tachycardia, dilation of pupils, urinary retention, sweat gland inhibition • Long lasting effects, after treatment is completed
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vi. vi Gingival retraction cord
Application: • Special type of cord either knitted or twisted that is placed gently into the gingival sulcus and stretches the circumferential gingival fibres. • Provides isolation and retraction of the gingival tissues eg when d i restorations i cervical ti h doing t ti in i l area or when unable to apply rubber dam. • Ab b gingival crevicular fl id and can also b Absorbs i i l i l fluid d l be soaked or impregnated with vasoconstrictors and thus be useful in controlling minor amounts of gingival bleeding. bleeding
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Cont. Cont
• Advantages:
• Effective in control gingival haemorrhage or gingival crevicular fluid and at same time retracting gingival tissues • Can be used as adjunct to other methods
• Di d Disadvantages: t
• Only effective if small amounts of gingival crevicular fluid • May need local anaesthetic prior to placement placement. • Can be difficult to insert • Can cause gingival damage if not inserted correctly
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vii. vii Electrosurgery
Application: • Use of high frequency electric current to incise/coagulate tissues. • Used during crown-bridge procedures and also to access subgingival caries
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Cont. Cont
Advantages:
• Can be used to control small amount of bleeding. bleeding
Disadvantages:
• Potentially can cause tissue damage if not used properly. • Can’t use if patient has a pacemaker. • Unpleasant odour. • Can’t use with metal instruments.
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viii. viii Tricholoroacetic acid
• Chemical method of controlling haemorrhage in local areas of tissue trauma. Advantages:
• Eff ti control of bl di site. Effective t l f bleeding it • Transient.
Disadvantages:
• Caustic; need to use with care as can cause soft tissue damage if accidentally dropped on tissues.
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Examples p
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High volume evacuation- whilst using a high speed handpiece
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Cotton roll
controls small amounts of moisture and also retracts soft tissue.
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Absorbent - Dry guard
Used to control small amounts of moisture from parotid gland duct opening.
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Rubber dam isolation
Total moisture control method
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Rubber dam isolation
- during fissure sealant placement
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Gingival retraction cord.
- retracts gingival tissues and controls GCF/small amounts of bleeding.
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Trichloroacetic acid
- controls small amounts of bleeding
Hume and Mount 1999
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Intraoral examination procedure:
• Low volume suction – to remove saliva build-up. • Gauze – to dry teeth or soft tissues to visualise better. • Triplex syringe- air to dry small amounts of moisture from tooth t f i t f t th surfaces.
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Prophylaxis
• Low volume suction – to remove saliva build-up during procedure. p gp
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Topical fluoride application
• Low volume suction – to remove saliva build-up during and after p g procedure.
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Fissure sealant application
• Rubber dam – 1st choice for complete moisture control, to isolate working field. • Cotton rolls as 2nd option to isolate working field. • Triplex syringe air to dry small syringeamounts of moisture from tooth surfaces during the procedure. • Hi h volume suction – to remove water High l i used to rinse tooth etc during the p procedure.
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Simple restorative procedures
• Rubber dam – 1st choice for complete moisture control, to isolate working field. • Cotton rolls as 2nd option to isolate working field. • Triplex syringe air to dry small syringeamounts of moisture from tooth surfaces during the procedure. • Hi h volume suction – to remove water High l i used when using the handpieces and to rinse tooth etc during the procedure. g p
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Endondontic procedures
• Rubber dam – only choice for complete moisture control, to p , isolate working field. • High volume suction – to remove solutions used to rinse root canal(s) during the procedure.