The use of rubber dams in dentistry is often a topic of debate. Dental schools teach us that rubber dams are the standard of care for all restorative procedures. In the profession, they are considered the standard of care in endodontics. Instead of a dam, many restorative dentists use cotton rolls or other isolation systems. However, studies have shown that dental restorations have more predictable results as well as better durability and longevity with the use of rubber dams. A 2006 systematic review shows that the retention of pit and fissure sealants increased with the use of rubber dams. A 2012 meta-analysis found that the longevity of composites placed with enamel etching and a rubber dam was similar to amalgam restorations.
Yet many dental professionals, including private student dentists, forgo the use of rubber dams, giving reasons such as they take too much time to place, they’re uncomfortable for patients, or they believe that cotton roll isolation with a high-volume evacuator provides adequate isolation. Many do not realize that mouth breathing is a source of contamination and moisture. We observe this firsthand whenever our intraoral mouth mirrors fog up while we are working.
For me, rubber dams are a vital component of providing optimal care for patients. There are many benefits of using rubber dams.
- Isolation: Properly placed rubber dams prevent contamination of the working field from saliva, blood and sulcular fluids. Moisture contamination from mouth breathing can be a contaminant altering the results of some dental restorations. Rubber dams allow dentists to deliver restorations that have predictable results.
- Visibility: Rubber dams can be effective in retracting the tongue, cheek and lips while working intraorally. Often, dentists have to deal with a tongue that has a mind of its own. Rubber dams effectively eliminate these obstacles.
- Protection: Rubber dams can also prevent aspiration of dental instruments. Additionally, by retracting the lips, tongue and cheeks, accidental lacerations from rotary instruments are prevented. Furthermore, rubber dams act to reduce aerosols of bacteria and blood due to high-speed rotary instruments.
- Time: Properly isolated working fields means freedom to decide how fast or slow to perform a procedure due to the control of contamination. It allows dentists to have time for intraoral photographs to document cases for each step of a procedure without having to worry about contamination within the next few seconds. It also gives dentists the time to sculpt tooth anatomy into restorations to provide for occlusion and guidance during tooth movement. Furthermore, because the working field is well-isolated, I find procedures to be much faster.
- Patient acceptance: I haven’t had a patient who refused to have a rubber dam placed after I explained all the benefits associated with its use.
Rubber dams can be a lifesaver and change the quality of dentistry given to patients. It is up to you to decide whether or not to use it.
~Bright Chang, Alabama ’19, Chapter Historian and Photographer