DLA 1203- Exam 3

1. Dental Dam
Quick Dam
ADVANCED CHAIRSIDE FUNCTION
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2. The Dental Dam
 Dental dam (also referred to as a rubber dam) placement is one method of
isolating teeth for restoration.
 It can be used on almost any patient.
 The dental dam is a barrier that is applied by the dentist and, in some states,
by the dental assistant and the dental hygienist.
 After the patient has received the anesthetic, the dental dam is prepared and
placed.
 The dental assistant assists the dentist with its placement, or places the dental
dam before the dentist begins to prepare the tooth.
 The dam can be placed to isolate one tooth, or one or more quadrants.

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4. Advantages of Dental Dam Use
 Greater visibility because of the contrast between the tooth and the dental dam
material
 Greater accessibility to the operating field by retracting gingiva, tongue, cheeks, and
lips
 Control of moisture, keeping the area dry for better vision and ensuring a dry tooth
when bonding agents, etchants, and restorative materials are used
 Protection of the patient from swallowing or aspirating debris during the procedure
 Protection of the gingiva during acid-etching procedures
 Improved patient management and decreased operating time due to limited patient
conversation, and the maintenance of a clear, dry field
 Decreased amount of contaminated aerosol exposure

5. Dental Dam
Contraindications:
Physical condition of patient- such as asthma, respiratory
congestion, allergies to latex, herpetic lesions or lesions of
the commissures.
Concerns of patient- such as patient is claustrophobic or
patient has had, or heard of a bad experience with the
dental dam.
Condition of oral cavity- such as partially erupted teeth or
misaligned teeth

6. Dental Dam Materials and Equipment
 Dental dam material
Latex or latex free material that
comes in a variety of sizes.
 Dental dam napkin
used for patient comfort and to
absorb saliva, water and perspiration.
 Dental floss and tape

7. Dental Dam Materials and Equipment
 Dental dam clamps- stabilizes dental
dam material and secures it in place.
 Forceps- used to place and remove the
dental dam clamp.
 Frame-(U-frame or Young frame, Ostby-
Frame)
 Punching guide
 Punch

8. Dental Dam Material
 The dental dam is a latex or latex-free material that comes in various sizes,
weights, and colors, which is selected according to an office’s preference.
 The most common sizes of the dental dam are the 5 × 5 inch or the 6 × 6 inch
precut squares.
 The 5 × 5 inch dental dam is used for endodontic procedures, anterior
applications on adults, and for children.
 The 6 × 6 inch dental dam is used for adult procedures.
 These squares usually come in a box of 50 or more, and are lightly powdered
on one side to prevent sticking.
 The dental dam is also available in a continuous roll of 5 inch and 6 inch widths.
This material is cut to the desired length by the operator.

9. Dental Dam material
 The dental dam is available in different weights (thicknesses),
including thin, medium, heavy, extra heavy, and special heavy.
 The thin or light dental dam materials are passed easily through
contacts, but tear easily and do not retract the tissues effectively.
 The medium and the heavy materials are often used because they
do not tear as easily and provide greater tissue retraction.
 The heavier the material, the more difficult it is to place
interproximal, but the retraction of the tissues is excellent

11. Dental Dam Material
 The dental dam is available in various colors (shades), from dark gray or green
to pastels.
 The darker shades provide more contrast with the teeth and are easier for the
operator.
 A scented dental dam is also available and is very pleasing to the patient (in
comparison to the latex smell).
 It may be scented with mint or fruit.
 The dental dam material has no definite shelf life but is sensitive to
temperature changes and, like other latex rubber, to age.
 For a longer shelf life, store dental dam material in the refrigerator.

12. Dental Dam Napkin
The dental dam napkin is used for patient comfort
and to absorb saliva, water, and perspiration.
Disposable napkins are made of a soft, absorbent
fabric and are precut.
They are designed to prevent the dam material from
touching the face by covering the area around the
mouth and the cheek

13. Dental Dam Napkin

14. Dental Dam Materials

15. Dental Dam Punch and Clamps

16. Dental Dam Clamp
 Bow —Arched metal joining the two jaws of the clamp
 Jaws —Part of clamp that expands to fix over the tooth, and then
releases to fit on the gingival one-third of the tooth.
 Jaws secure the clamp to the tooth.
 The jaws are different sizes for different teeth in the arch.
 Forceps holes —Located on the jaws of the clamp, the dental dam
forceps attach to the clamp to place and remove the clamp from the
tooth at these holes.
 Points —Parts of jaws that actually contact the tooth.
 The points are located at different widths and angles to fit and secure the
clamp on the tooth.

17. Dental Dam Clamps
 The jaws of the clamp are designed to be winged or wingless.
 Winged clamps have extra projections for better retraction,
and they hold the dental dam in place because the wings are
angled toward the gingiva.
 Wingless clamps have the letter W in front of the number of
the clamp and have no projections.

18. Dental Dam Clamps
Some clamps are double bowed, and they are called
cervical clamps.
These clamps are used for Class V restorations on
anterior teeth.
Occur at the cervical third of the facial or lingual surface
of the tooth
These clamps assist in gingival retraction and often
must be stabilized with stick impression compound
after the teeth have been exposed.

19. Preparation Before Placement of the
Dental Dam
 Educating patient
 Patients like to know what is going to happen during their appointments.
 Determining area to be isolated
 Before the dental dam is punched, the area to be isolated needs to be determined and then examined.
 Determine the anchor tooth, which is one to two teeth distal of the tooth being worked on.
 The number of teeth exposed is determined by the dentists preference.
 Examine area for missing teeth, teeth that are out of alignment, or fixed prosthetics.
 The area is then flossed to identify any tight contacts and open spacing.

20. Preparation Before Placement of the
Dental Dam
 Dividing dental dam:
 Select the size and weight of the dental dam that best suits the patient and
the procedure.
 Punching dental dam
 There are many places to begin actually punching the dental dam, so its
important for the operator to visualize the patients arch on the dental dam.
 The key hole punch (the largest hole that slides over the clamp and onto the anchor tooth)
is usually punched first.
 The next holes are punched moving forward, about 3-3.5mm apart.

21. Items Needed
 Dental Floss- Easy retrieval, material through tight contacts,
inverting (tucking) around teeth
 Lubricant- slipping the dam material over teeth easier
 Scissors- Cuts interceptal (in-between teeth) during removal
 Inverting or Tucking Instrument- Perio probe, spoon, flat side of T-
ball burnisher
 Ligatures- floss or cord that ties
 Stabilizing Cord- interproximally to secure/stabalize

22. Stabilizing Cord

23. Equipment

24. Dividing the Dental Dam
 Select the size and weight dental dam that best suits the patient and
the procedure.
 When preparing the dental dam material for punching, it is first
divided into sixths.
 One way to mark the divisions is to fold and then crease the dental
dam.
 This leaves a faint mark on the dam for the operator to use when
punching the dam.

25. Dental Dam Divided into 6ths

26. Punching the Dam
 There are many places to begin actually punching the dental dam, so it is
important for the operator to visualize the patient's arch on the dental dam.
 Often, the key hole punch is punched first.
 The key hole punch is the largest hole punched in the dental dam.
 It is the hole that slides over the clamp and onto the anchor tooth.
 The next holes are punched moving forward, about 3 to 3.5 mm apart.
 This is the amount of dental dam that slides between the teeth.
 It is called the septum.

27. Dental Dam Punch
The punch table is
adjusted for the size
of the teeth

28. Maxillary Arch
The maxillary arch is punched in the
upper middle sixth portion of the dental
dam

29. Maxillary Arch
 Holes punched for the anterior teeth should be 1 inch from the top edge of the
dam.
 This assists in positioning the arch.
 Variations in this 1-inch guide are for patients with full upper lips or mustaches or
patients with thin upper lips.
 The distance is increased or decreased accordingly.
 Punch the pattern to follow the patient's arch, leaving 3 to 3.5 mm between each
tooth.
 The punch includes from one to two teeth distal of the tooth to be restored and
then all teeth to the opposite cuspid.
 Punch the two centrals first.
 Then continue to punch the remaining teeth.
 This centers the punch pattern on the dam.

30. Mandibular Arch
The mandibular arch is
punched in the lower
sixth portion of the
dental dam

31. Mandibular Arch
 The first punch is the key hole punch.
 Teeth #17 and #32 are punched at the junction of the horizontal half and the vertical third.
 The more mesial the key hole punch is in the arch, the closer the punch is to the middle and
bottom of the dam.
 The holes are not punched beginning with the central incisors, 1 inch from the lower
edge of the dam.
 This would place the top part of the dam over the patient's nose.
 Instead, the central incisors are usually punched 2 inches from the lower edge of the dam.
 The rest of the punch follows the patient's arch, leaving 3 to 3.5 mm between each tooth.
 The punch includes one or two teeth distal of the tooth to be restored and all teeth to
the opposite cuspid.

32. Maxillary and Mandibular Anterior
teeth
 It is often unnecessary to use a clamp for anterior teeth
 Dental floss is doubled and a piece of dental dam or stabilizing cord
is placed in the distal interproximals of each cuspid.
 This is usually enough to hold the dam in place without the
placement of a clamp
 There is no key punch.
 The punches for the two centrals are in the middle third of the dam, 1
inch from the top edge for the maxillary and 2 inches from the
bottom edge for the mandibular.

33. Missing or Malpositioned Teeth
 Accomplished by the operator following the patterns of the teeth in the patients'
mouths as the dental dams are punched.
 When teeth are malpositioned (out of normal alignment or position), they often
are positioned either buccal or lingual of the normal curve of the arch, so the
corresponding holes must be positioned either toward the buccal or the lingual to
match the arch.
 Missing teeth or edentulous areas are accommodated by leaving a space on the
dam between holes punched for teeth present in the mouth.
 So, if tooth #5 is missing, then tooth #4 would be punched, a space would be left,
and then teeth #6, #7, and so on would be punched.

34. Bridgework Placement
Patterns for patients with bridgework require punches
similar to the punches with the missing teeth.
It is impossible to punch holes for the pontics, so the
punches are made for the abutment teeth and spaces
are left for the number of pontics.
Slits are cut between the holes with scissors to allow
the bridges to be exposed.

35. Class V Restorations
 The hole is punched facially to its normal position in the arch.
 A cervical clamp is often used with the Class V restorations,
because they retract the gingiva and the dam beyond the borders
of the cavity.
 The lower the cavity is on the facial surface of the tooth, the more
the punch hole is moved toward the facial.
 The largest hole on the punch is used for this clamp, because the
double wings allow an additional 1 to 3 mm between adjacent
teeth.

36. Common Errors
 Matching arch curve to patient
 Cleaning and properly operating punch table
 Hole spacing

37. Placement and Removal Procedures
for the Dental Dam
Many techniques for placement
Through practice, operator will find what works best
Dental assistant will either assist dentist with
placement or place it themselves
Depends on state legality

38. Checking Contacts

39. Punching Dental Dam

40. Clamp with ligature

41. Clamp Placed on Anchor Tooth
• 1-2 teeth distal to the tooth being worked on

42. Evaluate Clamp Placement

43. Placing Dental Dam

44. Dental Dam Napkin

45. Dental Dam Frame

46. Between Contacts with Floss

47. Tucking dam material

48. Correctly Placed Dental Dam
© Cengage Learning 2013

49. Dental Dam for the Child Patient
 Basic technique is same for both child and adult
 Parts of dental dam and procedure should be explained
using terminology appropriate to maturity of child

50. Dental Dam for the Child Patient
 Child should be taught how to swallow
and breathe with dental dam in place

51. Alternatives for Full Dental Dam Placement
Quickdam
Oval piece of dental dam
that has border of flexible
plastic