CHAIRSIDE (DA 5002) - Lectures 4-7

What is the saliva ejector and when is it used?

WHAT

- straw-like

- controls saliva under dental dam

- helps keep area dry when doing cementation of a crown or bridge

USE

- less invasive procedures

- prophylaxis (teeth cleaning)

- fluoride treatments

- sealants

How should a saliva ejector be placed?

- bend and shape for stationary placement

- position under tongue

- position opposite side from where dentist is working

HVE

High volume evacuator

What suctions saliva and debris from the patient's mouth during restorative and surgical procedures?

high-volume evacuator

What are the HVE grasps?

1. thumb to nose grasp/ palm thumb

2. pen grasp

When should a HVE be used?

during high speed hand-piece procedures

What are the 3 indications for use of a HVE?

- keeps mouth free of saliva, blood, water, and debris

- retracts tongue and cheek

- reduces the bacterial aerosol

What are the two types of HVE?

1. operative

2. surgical

This type of HVE has a straight or slight angle, beveled working end

This type of HVE is smaller in circumference and can be made out of stainless steel

How should an HVE be positioned?

What is the air-water syringe? How is it used?

- direct tip toward tooth being worked on

- keep tip close to operative site

- indirect vision use air on mouth mirror continuously

- when handpiece stops, rinse and dry the site

- when completing a limited area or full mouth rinse, move the tip while spraying the area

What are the two types of rinsing procedures?

1. Limited area

- frequently throughout

- quick and efficient

2. Full mouth

- freshens mouth

- at end of procedure

When isolating teeth, the type used must...

- be easy to apply

- not injure soft and hard tissues

- be comfortable for patient

- provide retraction for better visualization

- prevent moisture contamination

- isolate the area of concern

What is a dry angle? What is it used for?

- triangular absorbent pad placed over the Stensen's duct

- blocks the flow of saliva/protects the tissues in the area

What are the 3 advantages of cotton roll isolation?

- easy application

- no additional equipment is required

- flexible/adapts easily in mouth

What are the 5 disadvantages of cotton roll isolation?

1. lacks complete isolation

2. does not protect from aspiration

3. may stick to oral mucosa

4. replaced frequently because of saturation

5. limited retraction

What is the 5 purposes of isolating a tooth via the dental dam?

1. better visibility

2. clean and dry

3. prevent moisture contamination of teeth

4. provide optimum visibility of operative site

5. protect patient from aspiration of dental materials

The use of ___ is universally accepted because of the color contrast in the operative field.

dark rubber dam

What is the weight range of rubber dams?

light to heavy

What is the disadvantage of using a light weight rubber dam?

easily torn

_____ can afford more stability when being held in the retainer

heavyweight rubber dam

What are the 5 advantages of rubber dam isolation?

1. prevent moisture contamination

2. retracts and controls soft tissue

3. protects from aspiration

4. provides optimal visibility and access

5. controls aerosols

What are the 5 disadvantages of rubber dam isolation?

1. discomfort if not numb

2. claustrophobic

3. patient is congested

4. patient may be allergic to latex

5. time

How can we predict latex allergies?

Those who are allergic to

- avocados

- bananas

- water chestnuts

- kiwifruit

What is the set up for a dental dam?

True or false: In order to surround the tooth with the rubber dam, a precise and even circle must be punched in the rubber to prevent tearing.

True

How many holes are punched in the rubber dam?

one per tooth

The ____ of the teeth being isolated dictates the size of holes selected.

cervical diameter

What is a retainer (rubber dam)?

- tension created between retainer and clamp used to stabilize rubber dam

What is a rubber dam napkin?

- enhances rubber dam application by protecting the tissue underneath dam

- catches saliva that spills

- keeps rubber off face

The method used to seat the clamp on the tooth

forceps

What are the parts of the clamp?

The ___ is the key to the stabilization of the rubber dam and is used to retract the gingival tissue

clamp

What allows the rubber dam to be attached to the clamp prior to placing it?

winged clamp

What clamp is used for 95% of molars?

Ivory 56T

What clamp is used for small molars?

Ivory 12A

Ivory 13A

What clamp is used for bicuspids?

Ivory 2A

Why should you ligate the clamp?

**attach a piece of floss

- prevents the patient accidentally swallowing the clamp

- prevents injury to dental team from flying debris caused by an improper seat of the clamp

What should be placed in the area of the rubber dam when saliva is coming through?

oraseal caulking

When using a rubber dam on anterior teeth, what teeth should be isolated?

canine to canine

When using a rubber dam on posterior teeth, what teeth should be isolated?

- tooth posterior to tooth being worked on

- usually for a total of 4 teeth

What are the steps of placing the dam?

1. stamp template

2. punch dam

3. stretch dam over frame

4. select clamp

5. place clamp

6. floss contacts

7. ligate clamp

8. invert dam with woodson

What are the steps of removing the dam?

1. cut rubber septum between teeth

2. use forceps to remove clamp and move dam with frame at same time

3. remove napkin

4. use explorer or floss to remove excess pieces

5. offer the patient a paper towel and rinse mouth

How are dental hand instruments referred to?

Name and number assigned by manufacturer

True or false: ortho pliers and surgical forceps are referred to often by number rather than name (ex. Howe (110) pliers)

True

What are the 3 parts of a dental instrument?

1. handle - where operator grasps

2. shank - attaches working end to handle

3. working end - can have point, blade, or nib and can be single or double ended

What are the four categories of restorative instruments?

1. examination

2. hand-cutting

3. restorative

4. accessory

Describe examination instruments.

Exam oral cavity

- mirror, explorer, college pliers, periodontal probe

Describe hand-cutting instruments

- remove decay, smooth, finish and prepare tooth manually for restoration

NOT COMMONLY USED

- excavator, chisel, hoe

What is a spoon excavator?

- most versatile on tray setup

- removes soft dentin, debris and decay

- removes cement inside of crown

What are bin-angled chisels, straight chisels, and wedelstaedt chisels?

What are restorative instruments for amalgam (carrier/condensor)?

- place, condense, carve restorations

- condenser

- carrier/placement

What are restoraive instruments for amalgam (carvers, discoid-cleoid, hollenback, burnisher)?

What are the composite instruments?

What are accessory instruments?

- used to complete a procedure

- spatula, scissors, retainer, matrix band, amalgam well

What are the 4 uses of the mouth mirror?

1. Indirect vision

- see area not visible by direct vision

2. Light reflection (indirect illumination)

- directs light into areas not directly accessible by op light

3. Retraction

- maintains clear field by keeping tongue/cheek out of the way

4. Tissue protection

- guards tongue/cheek

This item stores supplies and materials for certain procedures, for example amalgam, crown and bridge.

Storage tubs

What are the 6 different cassette/tray set ups?

1. Exam

2. Amalgam

3. Composite

4. Crown and bridge

5. Endodontic

6. Surgical

What is the basic setup for EVERY procedure?

Mirror, explorer, college pliers (L—>R in that order)

What do procedure burs look like?

What do lab burs look like?

What are the three parts of rotary instruments?

1. Shank - portion that fits into handpiece

— straight shank

— latch type shank

— friction grip shank

2. Neck - portion of the rotary instrument that connects the shank and the head

3. Head - the cutting, polishing, or finishing portion

What are the three types of shanks?

1. Straight

2. Latch

3. Friction grip

These instruments are used for cutting, polishing and finishing of the tooth structure and the restoration process.

Rotary instruments

What are the 8 uses of dental burs?

1. Tooth preparation

2. Excavation of decay

3. Finishing of cavity walls

4. Finishing restoration surfaces

5. Taking out old fillings

6. Finishing crown preparations

7. Separating crowns and bridges

8. Adjusting and correcting acrylic temporaries

Discs, stones, points, and strips are the most ____ of rotary instruments

Varied

What are the 5 steps of finishing a composite restoration?

1. Reduction of material —> white stone or finishing diamond

2. Fine finishing —> carbide finishing burs and diamond burs

3. Polish —> medium discs then superfine disks

4. Finishing strips —> assist in polising interproximal surfaces

5. Use polishers and/or paste with a rubber cup

White stone

- step 1 of composite

- reduces material

Carbide finishing burs and diamond burs

- step 2 of composite

- fine finishing

Medium discs and superfine disks

- step 3 of composite

- polishing

Finishing strips

- step 4 of composite

- polishes interproximal surfaces

Rubber cup polishers

- step 5 of composite

- polishing

What are the three classifications of impressions?

1. Preliminary

2. Final

3. Occlusal (bite registration)

Who takes preliminary impressions? What are they used for?

1. dentist or EFDA (expanded functions dental assistant)

2. - diagnostic models

- custom trays (i.e., whitening)

- provisional coverage (temporarys)

- orthodontic applicances

Who takes final impressions? What are they used for?

1. Dentisty ONLY

- most accurate reproduction of teeth and tissue

2. - provides lab tech with information on crowns, inlays, onlays

- partial or full dentures

- implants

What are impression trays and what are the two types?

- used to hold impression material when impressions taken

- stock trays

-custom trays

Provide an accurate registration of the patient's centric relationship between the maxillary and mandibular arches

Bite registration

Used with silicone impression materials

Silicone adhesive (orange-pink)

Used with rubber base impression materials

Rubber base adhesive (brown)

For polyvinyl siloxane and polyether impression materials

VPS adhesives (blue)

Hydro

Water

Colloid

Gelatin substance

What are hydrocolloid impressions? What are the two types?

1. Irreversible —> changed by chemical factors

- alginate

- most widely used

- does not give fine detail

2. Reversible —> changed by thermal factors

What 5 things are alginate composed of?

1. Potassium alginate — from seaweed

2. Calcium sulfate — reacts with above to form gel

3. Trisodium phosphate - added to slow down the reaction time for mixing

4. Zinc oxide — adds bulk to the material

5. Potassium titanium fluoride

What are the two physical phases of alginate?

1. Solution phase - semiliquid

2. Gel phase - semisolid, similar to a pudding dessert

What is the strength of alginate?

- strong

- resists tearing when removed

- strengh increases after it sets

- leaving it in mouth for full time achieves maximum strength

What is the shelf life of alginate

approximately 1 year

True or false: alginate can be purchased in containers the size of a coffee can or in premeasured, individual packets.

True

Tue or false: alginate can have flavouring as well as change colour when set

True

When should alginate be "poured up"?

Within 1 hour of taking impression

If alginate is stored in water or soaked in a paper towel, it will expand

Imbibition

If algenate is left in open air, moisture will evaporate and cause it to shrink and distort

Syneresis

What are the two types of alginate setting times?

1. Normal-set

- 2 min working time

- 4 1/2 min set time

2. Fast-set

- 1 1/4 min working time

- 1-2 min set time

The time allowed for mixing the alginante, loading the tray, and positioning the tray in the patients mouth

Working time

The time required for the chemical action to be completed, after which the impression is ready to be removed from the patient's mouth

Setting time

True or false: Cool water is best to use when mixing alginate

False - cooler water will increase setting time; warm water will decrease setting time

Best to use is room temperature

What is the water-to-powder ratio of adult mandibular impressions?

2 scoops powder

2 measures water

What is the water-to-powder ratio of adult maxillary impressions?

3 scoops powder

3 measures water

THe most common mixing technique for alginate

Rubber bowl and beavertail wide spatula