24 Ways to Retract the Tongue, Cheek and Lips

Large cheeks and wild muscular tongues can definitely make your life hard as a dentist in many ways, not to mention hindering your flow and efficiency. Retraction of the oral soft tissue has been an active area of development in the dental field for a couple of decades. A lot of commercial products and some tricks have been developed for this purpose.

In this post, I list for you the products and tricks that have had the most success over the years. I try to be as thorough as possible. If you know of or have tried other products that I missed, do tell me in the comments.

I will put a link for each item that you can check for more info, pictures or reviews.

1. Dental Mirror

Dental mouth mirror

• Most obvious and widely known method
• Pros:
• Controllable amount of retraction
• Less instruments in the patient’s mouth if you’re not using any other systems or mouth props
• Cons
• Limited retraction, meaning you can only retract either the tongue, the lip or the cheek (unless your assistant holds another mirror in which case the mouth becomes crowded with instruments which cancels the pro)
• Multiple uses of the mouth mirror will have you alternating between using it for retraction, light reflection and indirect vision
• The stainless steel mouth mirror can be uncomfortable for the patient during retraction
• Active placement (retracting the soft tissue with the mirror in your hand and holding it for extended periods) by the operator or the assistant will result in fatigue of either one of them

2. Saliva Ejector (SE) Tips

Saliva ejector tips

• Traditional SE tips
• There are a lot of commercial products and I don’t see much difference between them
• The two products you might want to know about here is the Comfort Plus saliva ejector from Crosstex and the Total-Comfort saliva ejector from Indigreen
• According to their manufacturers, they provide more comfort to the patient and substantially less tissue suction than traditional designs

• Svedopter SE - link
• Bulky and completely metal, it can be very uncomfortable for the patient
• Provides retraction of the tongue only and single-point suction (in the lingual sulcus)
• I'm not 100% sure but I am going to say that this is probably historical. I don't think anyone uses this anymore

• LM Multiseptor SE - link
• I haven’t found any info or detailed reviews about this SE. I have also never seen anyone use it. In fact, the only reason I know about this SE is because one of my coursebooks mentioned it
• If you use or have used this SE, share your views with us in the comments

• Hygoformic SE - link (review by Mark Frias, RDH)
• Pros:
• Suction holes on the inside of the coil so no tissue suction
• Good suction power
• Guards the tongue
• Cons:
• Not stiff enough to retract wild or large tongue
• Needs adaptor to connect to standard SE valve, but can also be connected with blue boa

• SweFlex SE - link1 - link2 (review by Mark Frias, RDH)
• Not very good at retraction, not stable, sometimes it pops out
• In my opinion, in the category of saliva ejectors, there are better alternatives

3. High Volume Evacuation (HVE) tip

(The ones shown in the picture are the surgical type)

• Pros:



Surgical high volume evacuation tips

• High suction power and suction of debris
• Stiff enough for good retraction
• More comfortable to the patient due to no tissue suction
• Less instruments in the patient’s mouth as it provides suction and retraction
• Cons:
• Retraction limited to one structure at a time
• Single-point suction
• Active placement
• You can add LinguaGuard to your HVE tip for more stability and better tongue retraction
• You can also do this DIY trick with two SE tips attached to a HVE tip

4. Rubber dam

Rubber dam - Multiple tooth isolation

• Rubber dam is now considered the standard of care. It is a great asset once you get comfortable with using it
• Pros:
• Complete isolation of the operative field, which is imperative in endo treatment and deep cavities where pulp exposure is probable
• Full retraction of all soft tissue from the tongue, cheek and lips by the sheet to the free gingivae around the teeth by the clamps
• Concentrated field of view with no distractions
• No need to apply rubber dam later during filling assuming you don’t tear it during preparation
• Cons:
• Lengthy procedures with rubber dam in place might cause TMJ fatigue
• Limits breathing. You can punch a hole in the middle of the sheet to help with this, but it still might not be enough for heavy mouth breathers and asthmatic patients
• It doesn’t provide suction so you will need to apply suction both under and over the dam sheet (no pun intended)
• Conventional application of rubber dam might not be suitable for crown and bridge preparation but you can do split dam

5. Optidam / Optradam

• Same pros and cons as rubber dam. They are essentially rubber dam with built-in frames
• Optidam from Kerr / Optradam by Ivoclar Vivadent

6. Optragate

• Provides retraction of the lips and corners of the mouth
• Pros:
• Comfortable for the patient
• Easy application
• Cons:
• Little to no posterior cheek retraction
• No tongue retraction
• No isolation
• No suction
• Suitable for in-office bleaching and procedures on anterior teeth (excluding composite restorations)
• Disposable
• Optragate by Ivoclar Vivadent

7. ComfortView

• Same features as Optragate but made of soft plastic and is autoclavable
• Less suitable for bleaching because it doesn’t cover both lips completely which makes it possible for the bleaching agent to contact the lips
• ComfortView from Premier Dental

8. Tooth clamp varieties

Cotton rolls stabilized by winged clamp

• Winged clamp and cotton rolls

• Simple, fast and cost effective
• You can add teflon tape or liquidam around the clamp to provide additional isolation
• You might use it for speedy fissure sealant procedures

• Hallerklammer (Haller Clamp) from Optident

• Silker Glickman clamp

• Long guard extension clamp

• Saliva Ejector Holder from Greater Curve

• Cotton roll holders (many products like this and this)

With the exception of the Cotton roll holders and using a winged clamp with cotton rolls, I don’t feel that these would be that useful. There are simply much better alternatives.

9. Dri-Angle / NeoDrys

• These are absorbent parotid patches that you place between the cheek and the posterior teeth to cover the parotid duct
• Pros: they absorb the saliva coming out of the parotid duct and also guard the cheek
• Cons: they have to be changed periodically during treatment as they get saturated
• Dri-Angle by John W. Owen, DDS / NeoDrys from Micro Copy Dental
• Review and comparison by Mark Frias, RDH

10. Isovac

• It is basically a specialized HVE valve that is attached to a mouthpiece composed of a bite block and retractor with suction holes
• You will need to remove the standard HVE valve and connect your Isovac to the HVE tubing using a coupler purchased separately
• It provides all-around suction, retraction of the tongue and cheek and some degree of isolation
• Isovac from Isolite systems
• Review by Mark Frias, RDH

11. Isolite

• Unlike the Isovac, this system comes with it’s own tubing and is independent of the standard HVE tubing and valve
• You can either connect it to the canister port in place of the HVE tubing or along with it using a Y-adaptor
• It connects to the power and provides intra-oral illumination in addition to the features provided by the Isovac (suction, retraction and some isolation)
• Isolite from Isolite systems

12. Isodry

• It is basically the same as Isolite but without the power cord and intra-oral light
• It is designed for operators who like to work with their chair light or the LED light of their magnifying loupes
• Like Isolite, this is an independent system and you will need to connect it to the canister port separately from your standard HVE tubing
• The mouthpieces from Isolite systems can be used across all three of their products and are disposable
• Mouthpieces come in 6 sizes: pedo / extra small / small / medium / medium DV (deep vestibule) / large
• Isodry from Isolite systems

13. DryShield

• Comparable to Isovac from Isolite systems
• Unlike Isovac, DryShield connects directly to your standard HVE tubing after removing the HVE valve without the use of a coupler
• Also, unlike Isovac, DryShield mouthpieces are autoclavable
• Mouthpieces come in 4 sizes: pedo / small / medium / large
• DryShield
• Review of DryShield and comparison with Isovac by Mark Frais, RDH

14. Mr. Thirsty One-Step

• It is the same idea as the previous systems but this is not a system per se. You can consider it a specialized HVE tip or a mouth prop
• It is composed of a mouthpiece (bite block and retractor with suction holes) and a tube that connects to your standard HVE valve. The whole thing is disposable
• It requires no investment in any particular system and it comes in two sizes
• Mr. Thirsty One-Step from Zirc Dental
• Review by Mark Frias, RDH
• Comparison between DryShield, Isolite and Mr. Thirsty One-Step by Mark Frais, RDH

15. EZ DAM

• Similar idea, you can check it out here if you want: EZ DAM from Synca.

Rubber bite blocks

16. Bite block mouth prop with tongue guard

(The ones shown in the picture don't have the slots for attachable tongue guards)

• Composed of the simple and commonly known bite block mouth prop with a tongue guard attached
• Provides retraction of the tongue only (no cheek retraction, no suction)
• Link

17. eBite Plus

• This is another evacuation/retraction system. It is composed of a specialized valve, tubing and mouthpieces (bite block and tongue retractor with suction holes)
• You can connect it to the HVE canister port. It is also compatible with the standard HVE and SE valves
• The eBite Plus valve provides intraoral illumination
• If you don’t want to purchase the whole system, you can purchase the mouthpieces only and connect them to the standard HVE valve with a blue boa. In this case, you will not have the intraoral light
• Unlike the group of systems I mentioned above, the eBite Plus mouthpiece provides tongue retraction only (no cheek retraction)
• Mouthpieces are autoclavable and come in two sizes
• eBite Plus from Sota Imaging
• eBite Plus promotional video

18. eBite 2

• This is mainly an intraoral lighting system not a suction and retraction system, but you can connect mouthpieces similar to the eBite Plus mouthpieces to it and have suction and retraction
• It is a wireless, rechargeable intraoral light with two modules: ordinary light for illumination, and blue light for plaque detection
• If you want suction with the mouthpiece, you can connect an external tube that connects the mouthpiece to your suction line
• Mouthpieces come in 4 sizes: large / medium / small / extra small
• eBite 2 from Dentozone Corp.
• eBite 2 promotional video 1 / promotional video 2

19. E-Z Blok

• This is a simple mouth prop similar to the eBite Plus mouthpiece but doesn’t provide suction or illumination, just retraction of the tongue and keeping the mouth open
• E-Z Blok by Liberty Global
• E-Z Blok promotional video

20. ReLeaf

• This also is not a system per se. It is a mouthpiece that connects to your standard HVE valve with a tube
• The mouthpiece is disposable. The rest of the tubing is autoclavable
• The mouthpiece guards the cheek only (no tongue retraction) and has a large hole in the middle for evacuation of large debris
• ReLeaf from ReLeaf and Kulzer Dental
• ReLeaf video tutorial

21. HELPie

• You can consider this a fancy SE tip. It is composed of a tube that connects a mouthpiece to your standard SE valve. The mouthpiece is composed of a bite block, a tongue guard and a suction channel
• It provides single-point suction in the lingual sulcus
• The mouthpiece and adaptor tube are disposable
• HELPie from Medrian
• HELPie video tutorial

22. EZE Isolator

• This is another fancy SE tip. It connects directly to your standard SE valve or to the standard HVE valve using a coupler
• It is composed of a bite block for stability and a suction tip which provides single-point suction and tongue retraction (no cheek retraction)
• The tongue retractor/aspirator is autoclavable
• EZE Isolator video tutorial

23. Cheek retractor with tongue guard

• There are many commercial products and the basic idea is the same
• They provide retraction of the corners of the mouth and hold the tongue back
• Most commonly used for in-office bleaching
• Retraction only, no suction
• Like the one you can see being used in this bleaching procedure

24. Isolation Block

• It is composed of a bilateral bite block, tongue guard, lip retractor and suction holes
• It comes in two types: single (one arch) and double (both arches) lip retractor
• 3 sizes of each type
• A saliva ejector tube connects to the block to provide suction all throughout the anterior labial vestibule from first molar to first molar in addition to two-point suction in the lingual sulcus on both sides
• You might not need to do so but you can use it in combination with Optragate or ComfortView
• Isolation Block from Isolation Block LLC
• Isolation Block promotional video

Conclusion

There are a lot of products that offer retraction, possibly along with other things. Obviously, you will not need all of them. You will not even need “some” of them.

So have you just read a 2000-word post in vain?!

Of course not, the idea here is to choose or create your own system. You can even use this post for inspiration and invent a new trick that will help you with your practice. Plus, it's nice for you as a dentist or student to know what's out there.

You will need to decide what fits your flow and style of work within, of course, the scientific standards of practice.

Personally, I go for simplicity and efficiency.

I prefer to use rubber dam for retraction if the soft tissue is getting in my way. This way I have not only achieved retraction but also complete isolation.

For composite restorations and endodontic procedures, I will eventually have to use rubber dam anyway, so I just apply it from the beginning and benefit from the retraction.

For crown and bridge preparations, normally, I prefer using my dental mirror and suction tip. If I still struggle, I go for split dam.

Some procedures where you can’t use rubber dam include bleaching and ultrasonic scaling. Again, I would use my dental mirror and suction tip for retraction during scaling, and maybe the cheek retractor with tongue guard or Optragate and cotton rolls during bleaching.

Do you know of any other retraction products that I might have missed?


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