A novel field barrier method for patients with an impaired glossopalatal seal

Abstract

aLecturer, Section of Prosthetic Dentistry, School of Dentistry. bAssociate Professor, Section of Prosthetic Dentistry, School of Dentistry; Vice-Director, Department of Dentistry, National Taiwan University Hospital. (J Prosthet Dent 2013;109:206-207) The voluntary glossopalatal seal is formed when the soft palate and posterior tongue pinch together and can prevent premature spillage of fluid into the oropharynx during the preparation stage for swallowing.1,2 During routine dental procedures with water spray, patients control their glossopalatal seal to hold the water in the mouth until removed by an evacuator. However, patients whose glossopalatal seal is impaired by congenital or acquired soft palatal defects, tongue defects, or neurologic diseases affecting soft palate and tongue control often choke or cannot tolerate procedures even with the use of special high-volume evacuation. Although special evacuators such as the Svedopter (Svedia Dental-Industri AB, Enkoping, Sweden) or the Speejector (Pulpdent Corp, Watertown, Mass) are intended to retract the tongue, isolate the teeth, aid in fluid removal, and maintain a dry operation field, they cannot prevent water from reaching the back of the oral cavity and oropharynx. The application of a rubber dam or a throat pack as a barrier to the oropharynx has been suggested.3 However, a rubber dam is sometimes inapplicable or impedimental, and a throat pack does not work well during ultrasonic scaling or tooth preparation of the most distal or solitary abutment. For those situations, a technique to prevent water spilling into the oropharynx of patients with an impaired glossopalatal seal is presented. In this technique, the plastic sheet functions as a field barrier to prevent water spilling directly into the oropharynx. In procedures with profuse water irrigation, the passively seated plastic sheet in the oral cavity can act as a large reservoir to contain a large quantity of water before it is removed by the suction tube. The clinician can design and customize the rigid, frame-like plate according to the operation area and the location for finger rest.