Moisture

control
 Moisture control

Excluding fluids from the

operating field
 Sources of Moisture in clinical
Environment
1- Saliva:

From Salivary glands as Parotid, Sub-mandibular and Sub-Lingual glands

2- Blood:

Inflamed gingiva OR Iatrogenic damage

3- Gingival crevicular fluid: due to Inflamed gingiva

4- Water during treatment: From rotary instruments, triplex syringe, using

irrigation, solutions ….
 Reasons for Moisture Control

Why ?
1. Accessibility and visibility.
2. Operating efficiency.
3. Best use of materials.
4. Asepsis.
5. Harm prevention.
1. Accessibility and visibility:
Visual diagnosis of caries in the form of cavitations,
discoloration, or incipient lesion (white spot), is best
achieved under dry conditions.
2. Operating efficiency:
Excessive moisture is unpleasant for patient
and complicates the work of the dentist,
especially when high-speed hand piece is used
with air-water coolant. Also, chair-time is
wasted
3. Improve quality of operative procedure:

Dental materials are moisture sensitive, success of adhesion and physical

properties relies on dry field

Moisture control is essential for proper marginal adaptation of

restorative materials.

Moisture contamination of zinc-containing amalgam will result in

blistering of the surface and postoperative hypersensitivity due to
delayed expansion.
Quality of Bonding to enamel and dentin is unpredictable if
tooth substrate is contaminated with saliva blood or other oral
fluids.

Moisture control is crucial in preventive measures such as

topical application of gel or solution fluoride or fissure sealant.

Moisture and blood must be

excluded during impression
taking and cementation of inlays.
4. Asepsis

Moisture control helps in infection control to protect

dentist and personnel, as splattering of saliva and oral
fluids is prevented or reduced.

Moisture control is strongly recommended when pulp

exposure during caries excavation is expected, with
subsequent pulp capping procedures.
5. Harm prevention
Isolation of the operative field is important to
provide safe treatment to the patient, preventing
aspiration of any small objects.
 Methods of moisture control
How ?
1. High – volume suction
2. Low-volume ejector (saliva ejector)
3. Absorbents
4. Rubber Dam
5. Additional Isolation aids
Compressed air
Mouth probe
Anesthetics
Gingival retraction cord
1. Low-volume ejector (saliva ejector)
Saliva ejector was used exclusively before the
development of high-volume suction.
Indication:
During cavity preparation, when
evacuating small amounts of
moisture is required.
During restorative procedures.
Advantage:
It hangs in the patient mouth and
does not need to be held by an
assistant.
Disadvantage:
It is quite unsuitable to aspirate
large volume of fluids.
 2. High-volume suction:
To control comparatively large volumes of water
used in washing and cooling during high-speed cutting.

It is usually held by the dental

assistant just posterior to tooth
operated on, so that it does not
obstruct operator’s vision or
access nor pull the coolant away
from the preparation site.
 Washed field technique
Combined water or air-water coolant and high volume
suction during high-speed cutting procedure.

Advantages:
Debris are removed from the
operating site.
No dehydration of the oral tissues.
The patient experiences less pain.
Pauses are eliminated.
Improves access and visibility.
3. Absorbents:
Absorbent materials such as: cotton rolls, gauze,
sponges, and absorbent pads, are manufactured in
different sizes and shapes.

They should be placed in

relation to salivary gland ducts
for short term control of saliva
and moisture provided that they
are replaced before they
become saturated.
For the isolation of upper posterior teeth, a cotton roll
should be placed:
Opposite to the opening the parotid duct to absorb
saliva as it emerges.
For isolation of the lower posterior teeth, a cotton roll:
In the upper buccal sulcus, and an additional roll
In the lower buccal sulcus should be used in
combination with the use of saliva ejector or
additional cotton roll
In the floor of the mouth.
For isolation of anterior teeth,
Gauze sponge twisted in the labial sulcus is
valuable, or cotton rolls might be used.

Cotton rolls should not cross the midline anteriorly,

as it might be dislodged by frenum attachment.

If the work is finished and the cotton rolls are still

dry and adherent to oral mucosa, they should be
moistened before removal.
Indication:

They are used when absolute dryness is not

required as in examination, topical fluoride
application, polishing, preparing for impression
procedures and cementing inlays.

Absorbents can be used in conjunction with other

methods, such as saliva ejectors during operative
procedures.
Cotton roll holder
A device that holds cotton rolls in position.
Advantage:
Facilitates access and visibility, as
the cheeks and tongue are slightly
retracted.
Disadvantage:
Inconvenient and time consuming,
as it is necessary to remove the
appliance from the mouth to
change the cotton rolls.
4. Rubber Dam:
The rubber dam is used to define the operating
field by isolating one or more teeth from the oral
environment.
Advantages:

1. It provides dry, clean operating field, for best

performance.

2. It provides maximum access and visibility.

3. It is a mean of protection of both patient and dentist.

It protects the patient from aspirating or swallowing
small instruments or debris associated with operative
procedures
4. Rubber dam is an effective infection control barrier
for the operator against splattering of saliva and
spread of infection.

5. Use of rubber dam allows for operating efficiency

and increased productivity.

6. It helps in providing improved properties of the

restorative materials.

7. The operator can apply medicaments without fear of

its dilution or irritation of soft tissue
Disadvantages
1. Time consumption.
Time saved by operating in a clean field with good

visibility > Time spent in applying the dam.

2. Patient objection.
After dam is applied most patients are relaxed
knowing that water spray and debris are isolated
from them during procedure. 
Conditions that may preclude the use of Rubber Dam:
1. Teeth not erupted sufficiently to support a retainer
2. Some third permanent molars.
3. Extremely malpositioned teeth.
4. Asthmatic patients.
5. Mouth breathers.
6. patients with latex allergy.

N.B: Saliva ejector and/or high volume evacuator should

be used in conjunction with the rubber dam
V. Additional Isolation aids:
1. Compressed air:
Air-water syringe (tripleway syringe) is
valuable in moisture control.
☹Excessive air drying of cavities can
cause dehydration, hypersensitivity and
pulpal damage.
Only short blasts from air syringe are used
to ensure dry but not dehydrated cavity.
 2. Mouth Prop:
It is used to establish and maintain the mouth
opening during extended procedures
Advantages:
☺A constant and adequate mouth
opening.
☺Maximum exposure of the
operating field.
☺Adding relaxation.
☺Relieving muscle pain and fatigue.
Requirements of mouth prop:
Should be adaptable to all mouths.
Should be easily positioned with no patient
discomfort.
Easily adjusted to provide proper mouth opening.
It should remain stable once applied.
Easily and readily removable by dentist or patient
in case of emergency.
Either sterilizable or disposable.
3. Local anesthetics:
It reduces salivation apparently
because the patient is more
comfortable, less anxious, and less
sensitive to oral stimuli, thus
producing a lower salivary rate.

Vasoconstrictor in local anesthesia

reduces the blood flow thus help to
control hemorrhage.
4. Retraction cord:
It is placed in the gingival sulcus to help control sulcular
seepage or hemorrhage.
It is particularly important in deep sub gingival
preparations and restorations.
Advantages:
☻Improves access and visibility.
☻Prevents trauma to gingival
tissues.
☻Used during restoration in
cervical area, absorbs gingival
crevicular fluid
It can also be soaked or impregnated in Vaso-
Constrictor, thus be useful in controlling minor
amount of gingival bleeding
 Faculty of
Dentistry