Pediatric Isolation techniques: Dr. Kordis Flashcards Preview

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Flashcards in Pediatric Isolation techniques: Dr. Kordis Deck (23)
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1

Why do we need isolation?

  • Most dental materials negatively affected by moisture

2

Goals of Isolation

  • Moisture Control
  • Retraction and Access
  • Safety

3

Options for achieving oral Isolation

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

4

Rubber Dams: Advantages vs Disadvantages

  • 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)

5

Why use a rubber dam?

  • 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

6

When to use a rubber dam?

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

7

Rubber Dam Options

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

8

Which teeth to isolate?

  • Isolate the number of teeth required to perform the procedure

9

What is the key to oeprative dentistry?

Dry and clean field

10

11

Rubber Dam Clamp

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

12

Recommended Clamp Selection for teeth

  • 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

13

Rubber Dam Clamp: Patient Safety

  • 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

14

Rubber Dam Frames: Function

  • RETRACT AND STABILIZE DAM

15

Rubber Dam Prep: Hole Selection

  • 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

16

How to control Leakage in rubber dam

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

17

Slit Dam Technique

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

18

Slit Dam technique: Advantages vs Disadvantages

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

19

Rubber Dam: how to introduce to patients and parents

  • 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

20

Behavior Management tips

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

21

Alternatives for Isolation

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

22

Isolite: Pros and Cons

  • 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

23

Moisture Tolerant Materials: Pros vs Cons

  • 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