Rubber Dams in dentistry

Dr. Arpana. A. Devi BDS (Fj) Post grad dip Endo (Aust)

What is a Rubber Dam?

a piece of thin, stretchable latex or nonlatex material that becomes a barrier to selected teeth when applied. The isolation technique helps protect the teeth for all types of dental procedures

University of Illinois - 1900

University of Illinois - 1900

Rubber Dams
First reported use in ~ 1840
Dr. S.C. Barnum USA

Recommended by ALL teaching authorities and professional societies since the 19th Century for ALL endodontic procedures
And for many other dental procedures!!

Reasons for Using RD

Reasons for Using RD

Infection control Patient safety Patient comfort Moisture control Increased visibility

Increased access Increased efficiency Dento-legal reasons Improved treatment outcome

1. Infection Control

2. Patient Safety

Increased visibility and access

You can do it better when you can see it better!

Dont have to deal with tongue, saliva and patient

7. Increased Efficiency
Saves significant operating time Quick to apply mean: 1.9 minutes
Gergely BDJ 1989

7. Increased Efficiency
Saves significant operating time Quick to apply mean: 1.9 minutes
Gergely BDJ 1989
BUT - they were general dentists Only used RD 5% of the time Regular users likely to be much faster

7. Increased Efficiency
Saves significant operating time Quick to apply mean: 1.9 minutes
Gergely BDJ 1989
BUT - they were general dentists Only used RD 5% of the time Regular users likely to be much faster

NB: Local Anaesthesia needs 3-5 minutes to be effective

Dento-legal reasons

8. Dento- legal reasons

One of the most obvious departures from the accepted standard of care (during endodontic treatment) is the failure to use rubber dam

Cohen & Schwartz JoE 1987

MATERIALS

Rubber Dam

Size available: precut squares of 6 in 6 in and 5 in 5 in. The 6 in 6 in is used for posterior applications. The 5 in 5 in squares are for anterior application and primary detention. Thickness The dental dams thickness gauge can vary from thin, medium, and heavy. Color wide variety of colors. scented or unscented, flavored or unflavored. prefered the darker shades for contrast.

Rubber Dam Equipment

Punch

Holes are too large Difficult to position RD

Dam Punch
used to create holes , needed to expose the teeth that are to be isolated. The punchs working end is used to puncture the dam for the correct hole sizes: Size 5 is the largest size used for anterior tooth. Size 4 the next size smaller used for molars. Size 3 is for bicuspids and canines. Size 2 is for maxillary anteriors and incisiors. Size 1 is the smallest size used for mandibular anterior incisors.

Rubber Dam Equipment

Punch

Use the largest hole ONLY - one size fits all !!!

Rubber Dam Equipment

Clamp Forceps

Dental forceps
used to place and remove the dental dam clamp. The beaks of the forceps fit into the holes on the clamps jaws. The handles have a spring action that allows the forceps, when squeezed, to open up and fit over the tooth. When the handles are released, so is the clamp.

Rubber Dam Equipment

clamp is used to stabilize the dental dam. The dam clamp holds the dental dam secure on the end nearest the tooth that is being treated. Clamps can be ligated for security and safety of the patient from swallowing if the clamp becomes dislodged during treatment.

Clamps

Keep it Simple !!!

Types
Non winged winged

Clamps

Anterior teeth

Clamps

Premolar teeth

Clamps

Molar teeth

Keep the choices simple!!

Dam Frames
necessary to stabilize and stretch the dam tightly over the teeth. Frames come in plastic and metal. Both can be cold or heat sterilized.

Youngs frame (metal)

Star visi frame

Nygaard-stby frame

Extra Items
OraSeal

Wedjets

Anterior teeth isolated with wedjets

RD placement techniques
Several methods: Single tooth isolation and multiple teeth 1. RD and clamp already set-up and placed on tooth together as a unit Usually requires assistance. Stretch the dam material from side to side to secure the corners of the dam on the four projections at the corner of the frame. The rubber dam material should appear baggy on the frame rather than tight to allow easier placement in the oral cavity. Pass the dam and attached frame to the dentist for placement in the oral cavity. As the dentist stretches the rubber dam material over each tooth to be isolated, the assistant uses floss to slip the septum (rubber dam material between the holes) between the teeth without tearing the material. Always place the floss on the tooth, never directly on the rubber dam itself. Placement of the floss upon the tooth assists in bringing a single thickness of the dam through the interdental area

Preferred method

Applying Rubber Dam

RD on a winged clamp

Preferred Applying RD on a winged clamp method Rubber Dam Place on tooth together

Applying Rubber Dam

Applying Rubber Dam

Applying Rubber Dam

Applying Rubber Dam

Can set it up in a frame then place Or put clamp and dam then put frame

2.places the rubber dam clamp on the tooth first. Then slip the rubbe r dam material over the clamp.

Applying Rubber Dam

AVOID RD If used

Placing clamp in mouth without Applying Rubber Dam Remove floss once RD placed

RD Techniques for Endodontics

a)

Single Tooth Isolation

Hole Positions - Single Tooth Technique

Labial Labial

Anterior Teeth

Hole Positions - Single Tooth Technique

x
Mesial

Labial

Mesial

Anterior Teeth

Posterior Teeth

RD Techniques

Cuff Technique: multiple teeth isolation

Hole Positions - Cuff Technique

Labial

x
l bia La

Anterior Teeth

Hole Positions - Cuff Technique

Mesial

Labial

Anterior Teeth

Posterior Teeth

Hole Positions - Cuff Technique

Mesial

Mesial

Posterior Teeth

Cuff technique using extra Items Wedjets + OraSeal

WHATS NEW

Non-latex Rubber Dam

Orashield - Rubber Dam Napkins

Orashield - Rubber Dam Napkins

Missing teeth Some

Other Hints

Orthodontic brackets / arch wires

Some Other Hints

RD not well adapted to the tooth

Some Other Hints

Record Keeping

Be sure to isolate the correct tooth!!

Some Other Hints

Be sure to isolate the correct tooth!!

Some Other Hints

Plastic Clamps

Opti Dam - the 3D rubber dam

Some Other Hints

Opti Dam

Some Other Hints

Some Other Hints

Optra Dam

Some Other Hints

Improvisation - in Vietnam 2000

Some Other Hints

Rubber Glove !!

Reasons for Using RD

1) 2) 3) 4) 5) 6) 7) 8) 9)

Infection control Patient safety Patient comfort Moisture control Increased visibility Increased access Increased efficiency Dento-legal reasons Improved treatment outcome

Its Dam Easy !!