Rubberdam pdf1
Rubberdam pdf1
Rubberdam pdf1
Louis Mackenzie
Timing of the introduction of rubber dam practice of dental therapists and dental transmission of SARS-CoV-2 infection has
to dentistry is famously precise; the first nurses who have received appropriate renewed interest in research, advocating
reported use was by Dr Sanford C Barnum training. the use of rubber dam as an infection
on 15 March 1864.1 Since then, rubber Rubber dam is universally control barrier during aerosol and splatter
dam teaching has been progressively recognized as the optimal method generating procedures,4,5,6,7 and its routine
introduced at the vast majority of dental of moisture control, and its use is use has been strongly recommended
schools worldwide. In the UK, rubber dam considered to be best practice in the UK by the British Dental Association for this
placement is also within the scope of and internationally during endodontic purpose:
treatment.2 However, the majority of ‘Rubber dams are very effective
clinicians never use it or use it rarely.3 in reducing bioaerosols and so where
Louis Mackenzie, BDS, FDS
Explanations for the pervasive professional it is possible, it should be used when
RCPS(Glasg), General Dental Practitioner
reluctance to adopt the use of rubber dam carrying out AGPs’ (aerosol generating
(GDP), Birmingham, Clinical Lecturer,
are well established: procedures)8
University of Birmingham; School of
‘Probably no other technique, Rubber dam has long been
Dentistry and Head Dental Officer,
instrument or treatment in dentistry has been recognized as the optimal infection
Denplan, Winchester, Mike Waplington,
more universally accepted and advocated, control barrier during endodontic
BDS, MDentSc, GDP, Specialist in
and yet is so universally ignored by practising and restorative procedures, enabling
Endodontics; Past President, British
dentists. Many reasons can be given, but a reduction in microorganisms in the
Endodontic Society and Steve Bonsor,
in most cases the fundamental cause is operative field.5,6,7 Optimal rubber
BDS(Hons), MSc, FHEA FDS RCPS(Glasg),
inadequate explanation and training in the dam isolation in combination with
MDTFEd, GDP, The Dental Practice,
dental schools. If any operative technique is high-volume aspiration, high-quality
Aberdeen; Hon Senior Clinical Lecturer,
not clearly taught and seen to be efficiently four-handed techniques and effective
Institute of Dentistry, University of
executed by the teachers, the new members of use of appropriate personal protective
Aberdeen; Online Tutor/Clinical Lecturer,
the dental profession will not use it willingly.’4 equipment, should be capable of
University of Edinburgh, Edinburgh, UK.
Mitigation of the risk of reducing the risk of infectious disease
548 DentalUpdate July/August 2020
RestorativeDentistry
a b
a c a
b d
Figure 9. (a–d) Easy isolation of a partially erupted, malpositioned, third permanent molar enables
accurate diagnosis and minimally invasive management of an early Class I carious lesion.
a b
Accessory equipment
A wide range of accessories are available
to optimize rubber dam isolation, and
include the equipment listed in Table 4.
Matrix systems Figure 15. (a) Rubber dam isolation for a bonded amalgam restoration, dam holes spaced to
accommodate a missing tooth. (b) Retainer-less AutoMatrix® system assists isolation and does not
The use of rubber dam isolation
interfere with the rubber dam. (c) Rubber dam isolation protects patients from uncomfortable excess
optimizes adhesive procedures and,
amalgam particles during placement (and carving). (d) Anatomical carving is completed with rubber
with experience, may be confidently dam in place. (e) Minimal adjustment is necessary after rubber dam removal.
used for the vast majority of restorative
treatments. In conjunction with
rubber dam isolation, retainer-less,
circumferential matrix systems are
recommended, eg SuperMat (Kerr, restorative contacts. They also help to Summary
Bioggio, Switzerland) and AutoMatrix® retain the rubber dam and the absence of The use of rubber dam isolation optimizes
(DentsplySirona, York, Pennsylvania) a retainer reduces the risk of interference. endodontic and restorative procedures
(Figure 15 a−e). These versatile matrices may also be placed and provides a very high level of infection
These matrices are easy to use, on top of a suitable rubber dam retainer, eg control. The time taken to master rubber
promote better access and result in better when restoring the last tooth in an arch. dam materials, equipment and clinical
July/August 2020 DentalUpdate 557
RestorativeDentistry
techniques will enhance confidence, Dent Assoc 1989; 119: 141−144. 12. Stewardson D, McHugh E. Patients’ attitudes to
improve outcomes and be rewarding for 6. Ather A, Patel B, Ruparel N, Diogenes A, rubber dam. Int Endod J 2002; 35: 812−819.
patients and clinicians alike. Hargreaves K. Coronavirus Disease 19 (COVID-19): 13. Whitworth J, Seccombe G, Shoker K, Steele J. Use
implications for clinical dental care. J Endod 2020; of rubber dam and irrigant selection in UK general
46: 584−595. dental practice. Int Endod J 2000; 33: 435−441.
Compliance with Ethical Standards
7. Harrel SK. Airborne spread of disease − the 14. Hill E, Rubel B. Do dental educators need to
Conflict of Interest: The authors declare that
implications for dentistry. J Calif Dent Assoc 2004; improve their approach to teaching rubber dam
they have no conflict of interest. use? J Dent Educ 2008; 72: 1177−1181.
32: 901−906.
Informed Consent: Informed consent was 15. Bonsor S, Pearson G. A Clinical Guide to Applied
8. British Dental Association. Returning to work
obtained from all individual participants Dental Materials. London: Elsevier, 2013. ISBN 978-
toolkit. www.bda.com June 2020.
included in the article. 0-7020-3158-8.
9. Lin P-Y, Huang S-H, Chang H-J, Chi L-Y. The effect
of rubber dam usage on the survival rate of teeth
References receiving initial root canal treatment: a nationwide
1. Latimer O. Barnum's Rubber Dam. Dental Cosmos population-based study. J Endod 2014; 40:
August 1864; Vol VI. 1733−1737. CPD ANSWERS
2. Consensus Report of the European Society of 10. Wang Y, Li C, Yuan H, Wong CM et al. Rubber May 2020
Endodontology. Quality guidelines for endodontic dam isolation for restorative treatment in dental
treatment. Int Endod J 2006; 39: 921–930. patients. Cochrane Database Syst Rev 2016; 9(9):
3. Ahmad I. Rubber dam usage for endodontic CD009858.
1. A 6. C
treatment: a review. Int Endod J 2009; 42: 963−972. 11. Ammann P, Kolb A, Lussi A, Seemann R. Influence 2. C 7. B
4. Ireland L. The rubber dam – its advantages and of rubber dam on objective and subjective
application. Tex Dent J 1962; 80: 6–15. parameters of stress during dental treatment
3. C 8. A
5. Cochran MA, Miller CH, Sheldrake MA. The efficacy of children and adolescents − a randomized 4. B 9. C
of the rubber dam as a barrier to the spread of controlled clinical pilot study. Int J Paediatr Dent
microorganisms during dental treatment. J Am 2013; 23: 110−115.
5. B 10. B
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