Lingual isolation

For a long time I struggled to get non rubber dam isolation on the lingual of lower teeth. Overactive or large tongues are a nightmare as saliva will build up and wash over the lower teeth every time the tongue moves.  The aims are to control moisture for bonding procedures and to control the tongue position for access. Rubber dam is probably the best option to gain isolation of lower molars for restorative procedures but barring this there are a few strategies you can employ:
-Place cotton rolls under tongue to block saliva from the sublingual and submandibular glands. unfortunately this raises the tongue and moves into the operating field. If you try and force the cotton roll down with the tongue at a rest position the tissue will bounce back and the cotton roll will dislodge. The best way I have found is to try the sublingual area with a saliva ejector or get the patient to swallow, retract the tongue away from the teeth with a mirror and place the cotton roll deep under the tongue in the mylohyoid concavity. The cotton roll will adhere to the tissues better and seat under the concavity in the mandible. A second cotton roll can be placed on top of this and this will generally sit at the level of the lower molars and keep the tongue out of the way. These cotton rolls will be saturated quickly and will need to be replaced regularly.
-If cotton rolls are too large and have to be forced into place, they can be cut into half  lengthways and this will make placement easier. This is especially useful in small mouths with prominent frenae.
- Moisture from the parotid glands is stimulated, serious saliva and will increase markedly and will flow due to gravity to the molar areas. Isolation of moisture in the parotid areas will assist in any restorative procedures. Placement of cotton rolls or dry tips adjacent to both upper molars will help keep stimulated saliva down.
-Controlling large and overactive tongues is extremely difficult without rubber dam isolation. Lingual caries on lower molars are the most difficult to restore in these cases. Placing a cotton roll in the sublingual area then placing a dry tip with the absorbent side towards the tongue will allow the dry tip to stick to the tongue and the non absorbent side to keep fluids off the cavity. It won't be very comfortable for the patient but will keep the tongue off your work.
-Keeping a saliva ejector running in the mouth can keep the level of pooling and air moisture low. Isolite, standard saliva ejectors and hygoformic saliva ejectors are good options
-Simply holding the tongue out of the way can keep it off the cavity prep. However the downside is that once you take the mirror away the tongue will collapse back onto the prep. The appointment has to be brief and the room has to be well set up otherwise you will find keeping the tooth dry very stressful.
-Tipping the patient's head to the side opposite to the prep will allow the saliva to flow away from the prep. Placing a saliva ejector at that side will keep the level of saliva buildup low. You will find that large tongues will collapse back in the supine position and stop saliva from the prep side shifting over so the DA will have to be vigilant and clear and saliva buildup in the posterolateral area of the tongue.
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