Moisture Control

• Reasons for using moisture control:

  • Protect operator and assistant from aerosol spread
  • Protect pt's soft tissues from materials eg etch
  • Isolate the tooth - keep soft tissues away and keep tooth dry
  • Stop saliva contaminating the tooth - etched surface and pulp
• Indications for using moisture control - pretty much all procedures:

  • Fissure sealants
  • Composite restorations
  • Applying fluoride varnish
  • Pulp treatments
  • GIC restorations
• Etching:

  • Use: 37% phosphoric acid
  • It dissolves mineral content of enamel, so microscopically roughening the surface, increasing surface area leading to micromechanical retention of sealant/bond.
  • Bond between enamel and fissure sealant is MECHANICAL. Saliva contamination allows formation of an organic adherent film to recover the etched enamel which cannot be removed by washing with water alone (needs to be re-etched).

  
• Salivary glands and their oral openings:

  • Parotid - adjacent to buccal surface of upper 6
  • Sublingual - floor of mouth
  • Submandibular - floor of mouth
  • Minor salivary glands - all over mucosal surfaces
• Saliva and water will pool in the floor of the mouth and towards the back of the mouth. This will lead to the patient wanting to or needing to swallow.
• Dry tips:

  • Come in small/large sizes
  • A smooth shiny side and a rough absorbent side
  • Absorbent side placed over the parotid duct opening against the cheek
  • Stays in for the duration of the procedure
  • Able to absorb 30x its weight
  • Don't release moisture during use
  • Nickname = sticker, sponger
  • Needs wetting to release it before removal

  
• Replace cotton wool rolls as they become saturated.

  
• Saliva ejector:

  • This is placed lingually between the teeth and tongue and will suck saliva pooling in the floor of the mouth
  • Can be bent to fit better in the mouth
  • Often given to the patient to hold in place giving them something to focus on and feel part of the procedure
  • Nickname: curly wurly, straw

  
• Order of placing moisture control items:

  1. Dry tip
  2. Cotton wool rolls
  3. Saliva ejector
  4. High volume suction as required

  Do not remove until happy procedure is completed.