Dry idea

March 1, 2006
By design the mouth is a moist environment. Secretions of saliva help protect the mouth from decay as well as initiate the digestion process.

By design the mouth is a moist environment. Secretions of saliva help protect the mouth from decay as well as initiate the digestion process. However, some dental procedures - especially cosmetic bonding, seating of inlays, crowns, and bridges, or laser use - require a dry field free of saliva. Even with “moisture friendly” products, where a completely dry field is not strictly needed, many dental procedures still require a waterless zone. For example, most preventive sealant materials are better placed in the absence of moisture. When one is fortunate to have a good chairside assistant, moisture control is less of an issue because of suction services. But when an assistant is not available and one must keep the field dry alone, there are simple products, such as cotton rolls, which can help control saliva. Unlike the average disposable cotton rolls, however, improved products are now available that will not leave the patient with “cotton mouth” when the procedure is complete.

Standard cotton rolls offer absorbency. However, the anatomy of the mouth - especially when controlling salivary flow cheek side - may be better maintained with the use of cotton roll substitutes. Products that hold their shape and do not stick to mucous membranes are ideal. Many companies offer comfortable alternatives to the traditional, bulky cotton rolls to contain saliva fluids.

The parotid gland (major salivary gland) and the Stensen’s duct (drain duct for the parotid) empty serous fluid within the inside of the cheek. Containing the flow of saliva along with cheek retraction is crucial in this area when a dry environment is needed for treatment. To address this need, Microcopy introduced the ultimate parotid salivary control pad - NeoDrys. This alternative pad offers coverage of the parotid opening as well as the buccal mucosa. NeoDrys accommodate both small and large cheeks and are flexibly fit to work with cheek movement. Once placed (colored side of product to the cheek side), the pad will begin to moisten with saliva to comfortably adhere to the tissue and remain where placed until ready for removal. Amazingly absorbent, the core of NeoDrys is similar to a squishy, disposable diaper. The pad becomes jelly-like (acrylate polymer) under the poly-netted pad and leaves no cottony fibers or residue even when saturated. This product is so effective that water spray along the pad and tissues is needed to release the fully moistened NeoDrys when treatment is complete.

The risk of moisture contamination during procedures is limited with the use of a cellulose, triangular-shaped Dri-Angle. Dental Health Products offers Dri-Angles, which are contoured to fit the mouth or may be cut to size without compromising the angle. This thin product may be double layered to accommodate patients with plentiful saliva. Silver-coated Dri-Angles are available in addition to plain Dri-Angles. The silver-coated angle offers an even more complete barrier against saliva, all with a reflective backing. For mandibular arch treatment needs, have the patient extend his/her tongue and place a small Dri-Angle on the tongue to offer protection. The product will slightly adhere to the tongue’s dorsum with reasonable comfort, restricting salivary flow and absorbing any pooling saliva.

Optimizing dryness requires products that absorb saliva and are suited for the site. Choose a product that fits comfortably against the cheek to block saliva flowing from the parotid duct. Dri-Aid and Silver Dri-Aid by Young Dental and Dry Tips by Mölnlycke Health Care/Promed both provide tissue retraction with moisture control. The Silver Dri-Aid has a laminated side that reflects light and stops saliva soak-through. Whenever restoration or cementation procedures require moisture control, absorbent contoured products are best suited. When administering professional tray fluoride treatments, try first placing a saliva absorber on the cheek side. Fluids will not dilute the applied fluoride when an absorber is used. Chevron-shaped Dry Tips offer layers of saliva protection as well. Mesh protects the outside of the Dry Tips and offers less slippage when the product becomes saturated with moisture. The middle layer absorbs the fluid, and a film on the outer side offers saliva resistance and some stiffness along with the ability for tissue retraction.

The majority of saliva-absorbing substitutes are placed on the side of the cheek or along the lingual on the tongue region. Different sizes are available or can be custom fit by trimming the pad to size when applicable. For these type pads, the smaller apex end fits comfortably near the retromolar pad area, with the larger portion of the product fit along the mouth’s opening. Gagging does not seem to be a major problem for patients with these cotton roll substitutes, because they stay in place. Traditional cotton rolls tend to move about the mouth unless somehow anchored.

Some saliva absorbents borrow from the conventional cotton roll concept and then further improve on the absorbency. Tongue’n Cheek pads absorb eight times more fluid than standard cotton rolls. These pads have a core between the layers that turns to gel to hold the saliva. Tongue’n Cheek pads are not rounded, as traditional cotton rolls are; rather, they are more rectangular. The rectangular design allows for comfortable placement even under the tongue area. During restorative procedures, these super-absorbers are easily placed around all the necessary hardware and even provide retraction without worry of snagging on a handpiece bur. When a bur grazes too closely over a soggy, traditional cotton roll - with the shrill noise of the handpiece - the bur engages the cotton, saliva takes a spin, and off it goes into a twirling motion.

Another improvement on the old standby cotton roll is Absorb-Its. Shaped like a porous peanut shell, these nonstick absorbers work without being bulky. Placement under the tongue is excellent for both adults and children because of the absorber’s anatomical shape. Absorb-Its are nonirritating to the tissues and especially designed not to stick to tissues, yet they stay where they are placed. These saliva absorbers come in a flattened design made of layers of absorbing cellulose, which works well over common cotton rolls.

During certain dental procedures, saliva is unwanted. Maximizing saliva absorption may be obtained with cotton roll substitutes. Offering comfortable cheek retraction, these nontraditional pads and enhanced rolls maintain their shape, expand in a manageable fashion, and offer better oral visibility when reflective material is part of the product. Improve your treatment outcome by using saliva-absorbing technology to improve the risk of not contaminating the field. RDH

The author did not receive compensation for products mentioned. Want to absorb more information? Visit the Web at www.neodrys.com, www.dhpinc.com, www.youngdental.com, and www.alldentalprodx.com.