MOISTURE CONTROL IN
OPERATIVE DENTISTRY
Definition

Refers to the exclusion of sulcular fluid,
saliva and gingival bleeding from the
operating field

Additionally, also prevents handpiece spray
and restorative debris being swallowed or
aspirated by the patient
ADVANTAGES





Dry, clean operating field
Access & visibility
Preserving properties of dental materials
Protection of patient & operator
Better operation efficiency & productivity
AIDS IN MOISTURE CONTROL:
INDIRECT METHODS



Comfortable position of patient & relaxed
surroundings
Local Anesthesia
Drugs–
–
–
Antisialogogues
Anti-anxiety drugs
Muscle relaxants
AIDS IN MOISTURE CONTROL:
DIRECT METHODS






Rubber Dam
Cotton Rolls & Cotton Roll Holder
Gauze Pieces
Absorbent Wafers
Suction Devices
Gingival Retraction Cord
LOCAL ANESTHESIA

Reduces salivation
–
–
–

Patient is more comfortable, less anxious
Less sensitive to oral stimulation
↓ salivary flow
Controls Hemorrhage
–
Presence of vasoconstrictor ↓ blood flow
DRUGS


Rarely used
Atropine Sulfate
–
–
–

Methantheline bromide (Banthine)
–

0.25-1mg orally, 1-2 hrs before procedure
Contraindicated in Nursing Mothers, Patients with Glaucoma
Adverse effects- Dilatation of Pupils, Tachycardia, Urinary
Retention
50mg 30 mins before procedure
Propantheline Bromide
–
15-30mg 30 mins before procedure
RUBBER DAM ISOLATION

Introduced- NY city dentist- Dr. Sanford
Christie Barnum, March 1864

Purpose: Isolate tooth/teeth from oral
environment
RUBBER DAM: PURPOSE





Define the operating field by ISOLATING one
or more teeth from the oral environment
ELIMINATES SALIVA from the operating site
RETRACTS soft tissue
Prevention of CLOSED MOUTH SWALLOW
MINIMIZES PULPAL CONTAMINATION
from oral fluids when excavating a deep
carious lesion
RUBBER DAM: ADVANTAGES
SAFETY




Surgically clean area without residue from
saliva
Protects patient from ASPIRATION /
SWALLOWING of foreign body, root canal
instruments
Oral Injuries from mechanical instrumentation
and injurious chemicals (NaOCl)
Protects dentist from infection from diseased
mouths: PHYSICAL BARRIER
RUBBER DAM: ADVANTAGES
PATIENT MANAGEMENT




Avoid need to rinse mouth
Improves access, vision
Gingival retraction
Reduction of Operating time
RUBBER DAM: DISADVANTAGES

MINIMAL
–
–
–
–

Damage to marginal gingiva and cervical
cementum (Select proper clamps)
Metal crown margins-microscopic defects
Ceramic crowns-fracture of porcelain at cervical
margin
Contact allergy
TIME CONSUMING? Myth…
RUBBER DAM: INDICATIONS


ALL OPERATIVE PROCEDURES
Mandatory
–
–
–
–

Root Canal Treatment
Pulp capping/ Deep carious lesions
Composite Restorations
Cohesive Gold Restorations
Additonally:
–
Isolation for Electric/Thermal Pulp tests
RUBBER DAM: DIFFICULT
SCENARIOS FOR PLACEMENT








Partially erupted teeth
Natural crowns with poor retentive shape
Extensive loss of coronal tissue
Fixed Partial Dentures/Orthodontic Appliances
Saliva Leakage
Extremely malposed teeth
Asthmatic patients & mouth breathers
Third molars
RUBBER DAM KIT: COMPONENTS








Rubber Dam Sheet
Rubber Dam Frame/Holder
Rubber Dam Punch
Rubber Dam Clamp/Retainer
Rubber Dam Forceps
Rubber Dam Napkin
Template
Others
RUBBER DAM MATERIAL


Continuous rolls in two widths (125mm or
150 mm)
Precut from these rolls into squares
–
–

6” X 6”
5” X 5”
Usually made from natural latex rubber
RUBBER DAM MATERIAL: COLOR


Traditionally Black.
Now in 4 colors
–
–
–
–
Light: Preferred in Endodontics
Dark: Good Color Contrast
Green: Pleasant. Mint scented, good patient
acceptance
Fiesta: 3 colored assortment (Pink, Blue, Purple)
in fruit scent
RUBBER DAM MATERIAL: GAUGE
S.
NO.
GAUGE
THICKNESS
PURPOSE
1.
THIN
.005-.007”
Endodontic Applicn. Tears
2.
MEDIUM
.007-.009”
Often used. Easy
3.
HEAVY
.009-.0115”
Retracn of soft tissues.
Harder to tear
4.
EXTRA
HEAVY
.0115-.0135”
Excellent tissue retraction
5.
SPECIAL
HEAVY
.0135-.0155”
Heaviest weight, dark
color only, when tissue
protection imperative
RUBBER DAM MATERIAL: SURFACES

SHINY
–
–

Reflective, tiring to the eyes (strain)
Should face the tooth side
DULL
–
Less reflective and should face the operator
RUBBER DAM FRAME/HOLDER


Positions and holds the borders of the rubber
dam sheet
Examples:
–
–
–
–
–
Fernald’s frame
Strap Holders or Harness Type- Woodbury holder
Young’s frame
Nygard Ostby Frame
Le Articulaire Frame
RUBBER DAM FRAME/HOLDER

Most widely used: YOUNG’s FRAME
–
–
–
–

U shaped metal/plastic
Small projections from sides to secure borders of
sheet
Optional Necktsrap- Snugs dam & frame to face
If metallic- applied over the sheet; if plastic- either
way
NYGARD OSTBY
–
Holds sheet away from face-ease for patients
breathing
RUBBER DAM FRAME/HOLDER

LE ARTICULAIRE FRAME: HINGED in the
middle
–

Used in endodontics
PRE ATTACHED FRAMES:
–
–
–
Quick Dam (Ivoclar Vivadent)-flexible plastic rim
attached to a sheet. Effective anteriorly
Handidam (Aseptico)
Dry Dam- Rubber sheet set in center of absorbent
paper sheet with elastics on either side to pass over
the ears
RUBBER DAM PUNCH


Produce clear cut holes in rubber dam sheet
through which teeth can be isolated
TYPES
–
–
–
SINGLE HOLE- 2 sizes
MULTIPLE HOLE- Size ranges 0.5-2.5mm by
rotation of the anvil
2 designs of the Multihole punch
ASH / AINSWORTH
IVORY PATTERN
RUBBER DAM PUNCH

Multi Hole Punch:
–
–
–
–
–
–
1st hole: Mandibular Incisors
2nd hole: Maxillary Incisors
3rd hole: Canines & Premolars
4th hole: Large premolars/small molars
5th hole: Molars
6th hole: Large Molars/Macrodonts
RUBBER DAM CLAMPS/RETAINERS



Anchors Dam sheet to the tooth
Rubber dam sheet usually anchored onto the
tooth using at least 1 clamp (Usually
posterior most tooth)
Other means of anchoring sheet onto teeth
–
–
–
Wedgets
Dental Tape
Small Piece of rubber Dam
RUBBER DAM CLAMPS: PARTS





Bow
Clamp Forcep Locating Holes
Jaws
Prongs
Wings (or their absence)
BOW
HOLE
JAWS
PRONGS
WINGS
RUBBER DAM
CLAMPS:CLASSIFICATION

BLAND
–
–

Winged
Wingless
RETENTIVE
–
–
Winged
Wingless
RETENTIVE
BLAND
RUBBER DAM CLAMPS

BLAND CLAMPS
–
–
–
–
Grasp tooth at or above gingival margin
Minimal Gingival Damage
Provide circumferential contact
Indicated when axial angles are lost or don’t coincide
RUBBER DAM CLAMPS

WINGS:
Small flanges on outer edges of the clamp
jaws, directed anteriorly or laterally, and can
engage the dam sheet during placement.
Provides additional gingival tissue retraction
Interferes with placing matrix bands/retainers
RUBBER DAM CLAMPS:CONTACTS

4 POINT CONTACT
–
–

JAWS not to extend beyond M & D line
angles of tooth
–
–
–

Retainer contacts only in 4 areas- 2 lingual & 2
labial
Prevents rocking or tilting of the clamp
Interferes in wedge placement
Precludes complete seal around tooth
Gingival trauma more likely
FLOSS
RUBBER DAM FORCEPS


Placement & Removal of Clamp from the
tooth: Stretch the jaws of the clamp
3 WIDELY USED DESIGNS:
–
–
–


Ash or Stokes
Ivory Pattern
University of Washington Pattern
Differ in tip design
Presence of sliding ring
RUBBER DAM NAPKIN


Precut sheet of absorbent placed between
the skin and the rubber dam sheet
USES
–
–
–
–
Reduces skin contact of sheet
Absorbs saliva at corners of mouth
Acts as cushion
Wiping patient lip on dam removal
RUBBER DAM TEMPLATE



Aids in positioning of Rubber Dam
Available as a stamp bearing the pattern of
the maxillary and mandibular dentitions
Both deciduous and permanent dentitions
RUBBER DAM LUBRICANT



Preferable water soluble
Applied onto the tissue surface of rubber
dam sheet
Facilitates passage of dam through contact
areas
ABSORBENTS



Cotton Roll Isolation & Cellulose Wafers
Acceptable moisture control
Devices for holding cotton rolls available
–

Advantage: Slight tissue retraction
Cotton Rolls:
–
–
Rolled
Prefabricated
THROAT SHIELDS



Gauze sponge (2” X 2”) unfolded and spread
over tongue & posterior parts of the mouth
Protects from objects being swallowed
aspirated
Indicated for use during
CROWN/INLAY/ONLAY try in procedures
EVACUATION SYSTEMS



Removes saliva collected at floor of
mouth/vestibules
In conjuntion with rubber dam, cotton rolls
TYPES:
–
–

HIGH VOLUME
LOW VOLUME- Saliva Ejectors
Tips:
–
–
Plastic (Disposable)
Metal
EVACUATION SYSTEMS

HIGH VOLUME SUCTION
–
–

150ml/second
Tip Diameter= 10mm
LOW VOLUME SUCTION
–
–
–
Tip Diameter= 4mm
Doesn’t remove solid debris
Evacuation is not rapid
SVEDOPTER



TONGUE RETRACTION DEVICE +
SALIVA EVACUATION
Vaccum evacuator tube passes anterior to
the chin & mandibular anterior teeth and then
down to the floor of the mouth
Mirror like vertical block is attached to this
tube and holds the tongue away
WASHED FIELD TECHNIQUE


Combined use of air water spray, high volume
evacuator and rubber dam during high speed cutting
procedures
Advantages:
–
–
–
–
–
Improved access & visibility
No dehydration of oral tissues
Unnecessary stoppages/pause during treatment are
eliminated
Quadrant dentistry is facilitated
Tooth debris & restorative materials are carried away
immediately