The rubber dam in dental practice: use and practical advice

Use of rubber dam offers many advantages in endodontic, operative and prosthetic procedures. Rubber dam protects the patient against ingestion or inhalation of instruments or chemical products, the cavity against contamination and the dental practitioner against infections. This article gives technical advice for the easy application of rubber dam.     

The attitudes of undergraduate dental students to the use of the rubber dam

ABSTRACT: The majority of dental schools teach that use of the rubber dam is mandatory for certain procedures, e.g., endodontic therapy and adhesive dentistry. Despite this, many dentists perceive use of the rubber dam as a hindrance to dental treatment in adults and children. PURPOSE: This study sought to evaluate the attitude of undergraduate students towards the use of the rubber dam and elucidate if the negativity towards its use is evident in undergraduate clinics. METHODS: A structured questionnaire was developed, which sought to establish current perceptions of the use of the rubber dam in adults and children, and circulated to the current fourth and final year clinical undergraduate class in the Dublin Dental Hospital. RESULTS: Isolation was identified as the main advantage of using a rubber dam and difficulty to place the main disadvantage. Some 98.5% of students believed they had received adequate training in rubber dam use for adults. While 72% of students were confident in placing a rubber dam for children, 38% felt that more training was necessary. The most commonly cited difficulty in placing a rubber dam was tight contacts. Most students are confident regarding which clamps to use. The majority of students (61%) believe that patients, especially children, prefer treatment without rubber dam isolation and that adequate isolation can be achieved without using a rubber dam. The average time spent placing the rubber dam was eight minutes for children and five minutes for adults. The students are more predisposed to using the rubber dam on adults than children for the same procedure. CONCLUSIONS: Undergraduate students are not convinced that the use of a rubber dam is effective and efficient except for endodontic therapy. Students already believe that patients, both adults and children, would prefer their treatment to be conducted without a rubber dam. Teaching efficient methods of placing the rubber dam may improve students' confidence and reduce placement time so that the students will be more likely to use the rubber dam after graduation.     

Extending the use of rubber dam isolation: alternative procedures. Part I.

Most dentists are well aware of the value of the rubber dam in allowing technical excellence; however, few recognize the potential for protecting the dentist and staff against the ever-growing number of carriers of the hepatitis and human immunodeficiency viruses. The effectiveness of the rubber dam as an isolation barrier is dependent on the consistency of its application. Sporadic rubber dam application is therefore a weak link in an infection control program. This paper describes additional modified utilizations of rubber dam, uses that are generally not attempted with restrictive orthodox application methods. In addition, practical hints on other means of retention are offered, with the emphasis on nuisance-free and easy application.     

A new rubber dam frame design--easier to use with a more secure fit.

The application of the rubber dam (dental dam) is indicated in endodontics and for restorative dental treatments involving the acid-etch technique. The frequency of the technique's use varies significantly according to individual circumstances, and is generally too low given its advantages. One possible reason for many dentists' reluctance to use it could be frustrating results in the past with technically difficult applications. Such conditions arise, for example, when the taut rubber dam sheet exerts too much pull on the rubber dam clamps, causing them (and the entire rubber dam) to come loose. Particularly susceptible here are clamps attached to molars. This undesired tension results from stretching the rubber dam material--a necessary step--for attaching the sheet to the traditional rubber dam frame. As an alternative, a new easy-to-use rubber dam frame (Safe-T-Frame) has been developed that offers a secure fit without stretching the rubber dam sheet. Instead, its "snap-shut" design takes advantage of the clamping effect on the sheet caused when its two mated frame members are firmly pressed together. In this way the sheet is securely attached, but without being stretched. Held in this manner, the dam sheet is under less tension, and hence, exerts less tugging on clamps--especially on those attached to molars. Even in cases where there are no distinct anatomic undercuts, this lack of tension in the sheet eases isolation procedures and permits the use of standard rubber dam clamps. As a further benefit, the frame's raised edging provides a barrier around the sheet, which prevents small amounts of fluids from escaping. This contributes to greater patient comfort.     

Use of rubber dam and irrigant selection in UK general dental practice

AIM: To evaluate factors which influence rubber dam use and irrigant selection in UK National Health Service (NHS) endodontics. METHODOLOGY: A postal survey was conducted amongst two age cohorts of dentists, representing all of the 1970-73 (older) and 1990-93 (younger) graduates of two northern English dental schools (n = 643). Key and supplementary questions were posed on levels of rubber dam use, irrigant selection, and factors influencing practice in NHS endodontics. After manual checking, validated (dual) entry of responses was made to a flat ASCII data file before analysis with SPSS software. The threshold for statistical significance was set at the 95% probability level. RESULTS: Eighty-five per cent of the valid sample responded to the questionnaire. Regardless of age and qualifying school, less than one-fifth of dentists always or frequently used rubber dam, whilst 60% never used it. Qualifying school had a significant influence on rubber dam use, whilst age had a variable influence. Major disincentives to the use of rubber dam included the perception that patients do not like it, that the NHS fee was inadequate to justify its use, that it took too long to apply, and that dentists had received inadequate training. Frequent users of rubber dam were significantly less likely to cite these disincentives than nonusers. Overall, local anaesthetic solution was the most common endodontic irrigant. Irrigant choice was strongly linked to rubber dam use, and to graduation cohort. Seventy-one per cent of rubber dam users irrigated with sodium hypochlorite, compared with only 38% of nonusers. This pattern was reversed for local anaesthetic irrigation. Younger graduates were significantly more likely to irrigate with local anaesthetic solution than their older counterparts, and the younger graduates of one school showed a highly significant increase in the use of chlorhexidine. CONCLUSIONS: 1) The majority of UK Health Service dentists never use rubber dam isolation in endodontic treatment. 2) Qualifying school has a significant impact on rubber dam use, and irrigant selection. 3) Use of rubber dam has a significant association with irrigant choice in endodontics.     

The use of myofunctional appliances in the UK: a survey of British orthodontists.

A questionnaire was sent out to members of the British Orthodontic Society in an attempt to establish how myofunctional appliances are currently used in the UK and to attempt to explain the differences between provider groups. This article reports the findings of this survey and that, of all the appliances currently available, British orthodontists prefer to use the Twin Block appliance. Furthermore, most of the sample questioned felt that the laboratory cost of many myofunctional appliances meant their provision under the General Dental Service was not practical.     

An assessment of rubber dam usage amongst specialists in paediatric dentistry practising within the UK

OBJECTIVE: Rubber dam is recommended by the British Society of Paediatric Dentistry (BSPD) for various restorative and endodontic procedures. To date, there has been no report of actual usage of rubber dam within the speciality of paediatric dentistry. The aim of this study was to assess the usage of rubber dam amongst paediatric dentistry specialists within the UK. METHODS: A postal questionnaire was distributed to all practitioners registered on the UK General Dental Council's 2004 specialist list in paediatric dentistry. RESULTS: Data were available for 162 questionnaires (a 75% response rate), and of these, 85% of respondents worked in the National Health Service (NHS), 4% were private practitioners and the remainder had a mixed NHS/private practice. Regarding the benefits of rubber dam, 65% and 52% of respondents quoted patient safety and moisture control, respectively. Perceived difficulties of dam usage were lack of patient cooperation and the non-necessity for a particular treatment, as quoted in 64% and 36% of the completed questionnaires, respectively. The most common modes of isolation for anterior and posterior teeth were Dry Dam(R) (58%), and clamp and dam (80%), respectively. CONCLUSION: Current BSPD guidelines recommend rubber dam usage for many restorative procedures; however, it would appear that there is wide variability in the application, as well as under-use, of rubber dam.     

Attitudes of final year dental students to the use of rubber dam

Aim  To investigate the attitudes of final year dental students in Wales and Ireland to the use of rubber dam.
Methods  A pre-piloted questionnaire was distributed to final year dental students in Cardiff and Cork Dental Schools in January 2008. Information sought included attitudes to, and the current and anticipated use of, rubber dam for a variety of operative and endodontic treatments.
Results  Of 93 questionnaires distributed, 87 were completed and returned (response rate = 94%; Cardiff: 89%, n  = 51; Cork: 100%, n  = 36). Rubber dam was routinely used by 98% of respondents ( n  = 85) on adult patients, but only 32% of respondents ( n  = 28) had used rubber dam on child patients ( P  < 0.05). Rubber dam was never used by 75% of respondents ( n  = 65) when placing posterior amalgam restorations, and by 21% of respondents ( n  = 18) when placing anterior composite restorations. Rubber dam was used by 98% of the respondents ( n  = 85) when performing root canal treatments. Sixty-two per cent of respondents ( n  = 54) believed their use of rubber dam would decrease once leaving the dental school.
Conclusion  Whilst dental students believe that rubber dam is relevant to clinical dentistry, there are negative perceptions associated with its use amongst dental students. More than half of those questioned predicted their use of rubber dam would decrease once in independent practice. Greater emphasis should be placed on the advantages of using rubber dam in clinical dentistry whilst at dental school.