Rubber Dam Isolation Flashcards
(34 cards)
What are the main goals of rubber dam isolation
- Moisture Control
- Retraction
- Harm Prevention
What is CRITICAL for a successful procedure?
ISOLATION IS CRITICAL
What are you isolating from with rubber dams?
gingival crevicular fluid (sulcular fluid)
saliva
Bleeding (injection sites, inflamed gingival tissues)
What type of operator introduced items are used that the dam helps to isolate during use?
water spray
debris
materials/instruments
What is key about retraction and access?
- Provide maximum exposure of the operating site
- helps maintain an open mouth position
- mouth props (bite blocks) are often used as an adjunct
- Depressing/retracting tissues
- gingival
- lips
- tongue
- cheeks
- helps maintain an open mouth position
What are the harm prevention measures that the rubber dam helps with?
- Excessive saliva and/or moisture pooling can startle patients
- Fluids and/or small instruments can be swallowed or aspirated
- Soft tissues can be cut or damanged
Additional advantages of an isolated operating field for rubber dams are “A CLEAN, DRY OPERATING FIELD” that affords the ability for what?
- Better visibility
- cleaner cavity preparation walls
- improved reliability of caries detection
- With clean preparation walls, improved likelihood of restoration success
- creation of an optimal environment for restorative material use
- Intimate contact of material with intended surface
What are different methods of isolation and moisture control that could be used
- Antiosialagogues in conjunction with anesthetics
- High Velocity Evacuation (HVE)
- Saliva Ejector
- Cotton Rolls/Gauze
- Iso-dry/Iso-lite
- Rubber dam
What are the type and details of the Antiosialagogues/Anesthetics that are used for isolation/moisture control
- Atropine Sulfate
- Suppresses bronchial and salivary secretions
- Rarely used
- Anesthetics
- When profound, may decrease salivary flow
- likely due to reduced oral stimulation
- NO pharmacologic basis
- When profound, may decrease salivary flow
Explain the details of the High Velocity Evacuation (HVE) for use with isolation/Moisture control
- Operated by a dental assistant
- Removes most moisture and debris
- Usually utilized from fixed prosthodontic procedures (crowns and bridges)
- Often used in conjunction with other modalities of filed isolation
- Excellent for debris removal
- Cut tooth structure, excess moisture/water, old restorative materials, amalgam vapors
- Excellent for debris removal
Explain the use of Saliva Ejector for isolation and moisture control
- May be operated by dental assistant or may be bent to hang (unattended) in the oral cavity
- If left unattended in the floor of the mouth:
- Use caution
- delicate tissues in floor of the mouth
- Use caution
- Alternative method
- Svedopter
- Connects to saliva ejector
- Svedopter
Explain the use of cotton rolls and/or Gauze for isolation and moisture control
- Acceptable for some quick procedures
- Quickly become saturated and may need to be changed
- Placed in vestibule, floor of the mouth or other salivary gland orifices
- Do not improve visibility and may easily obstruct the working area
Explain the use of Iso-Dry and Iso-Lite for moisture control and isolation
Connects to HVE
Built in “bite block”
Who first used the rubber dam for isolation? and when?
NYC dentist S.C. Barnum - 1864
Name and describe the advantages for the rubber dam use for isolation and moisture control
- Most effective and can be effective over long appointment times
- Dry, clean operating field (isolation of operating are from rest of the mouth)
- Improved visibility and access
- Maximized patient safety
- Lacerations
- Chemicals and/or oral medicaments
- Prevents swallowing and/or aspiration
- Enhances patient comfort
- Debris does not accumulate in the mouth
- Maximizes operator safety and efficiency
- Reduces aerosols from saliva or oral bacteria
- Improved properties of dental restorative materials (bonding, composite resins)
- optimal restorative outcomes
What are the disadvantages of rubber dams for isolation and moisture control?
- Time consumption
- Patient objection
- Psychological reasons (usually because of a previous experience related to operator ineptness, can often be overcome)
-
Cannot be used for all patients
- Partial eruption (unable to hold a retainer)
- Malpositioned teeth
- 3rd molars
- Patients with impaired nasal breathing
- Lesion position/location
Advantages of using a rubber dam for isolation and moisture control outweigh the disadvantages. What are the key features as to why rubber dams are the best thing to use
- Simplifies futures restorative steps, saving time (overall maximization in efficiency)
- Minimizing provider and/or patient stress/risk
- More consistent in delivering high quality, lasting restorations
Explain the Armamentarium required for dental Dam isolation
- Latex/Non-latex sheet
- Retainers (“clamps”)
- Frame
- Punch
- Forcep
- Lubricant and/or patient napkin
Explain the details of the Latex/Non-Latex sheet used for the rubber dam (size, thickness, color, new)
- Sizes
- Adults (6” x 6”), Child (5” x 5”)
- Thickness
- Thin, regular, heavy, extra heavy gauges
- Thin: easy to apply, comfortable
- Heavy: improved resistance to tearing, improved retraction
- Thin, regular, heavy, extra heavy gauges
- Color
- Provides contract for improved visibility
- New
- Improved elasticity
- Storage recommendations (cool, dry environment)
Explain the rubber dam Retainers “clamps” (function and components)
- Function: to provide a stable anchor for the system at the most distal aspect
- Components:
- Prongs (4)
- Holes (2 usually)
- Bow
- Jaw
- Wings
- Not present on all retainers
- Hold RD out of way placement and operation, but can also restrict restorative access
Explain the function of the RD frame
Functions to hold and stretch the RD material to improve visibility and help create a “space” for access
Explain the Function and variable sizes of the RD punch
- Functions to place holes in the RD material
- Punch has variable sizes
- Primary incisors
- smallest incisors
- maxillary central incisors, canines and premolars
- large premolars/small to normal molars
- large molars
- large molars and the tooth to be clamped
what are the considerations that need to be taken when using the RD punch?
Considerations:
- Should conform to patient’s arch
- Place hole considering dentition presence, size and position
- Holes too close together
- RD will be stretched and result in gaps (leaking)
- Holes too far apart
- RD will be “bunched up” and result in poor sealing (leaking)
- AVOID AUTOCLAVING….
Explain the RD forcep function
utilized to place the retainer in position on the tooth and to remove the retainer after completion
