rubber dam lecture

Rubber Dams in dentistry

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

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

What is a Rubber Dam?

University of Illinois - 1900

University of Illinois - 1900

Rubber Dams

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

Recommended by ALL teaching authorities and professional societies since the 19th Century for ALLendodontic 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!”

Don’t have to deal with tongue, saliva and patient

7. Increased Efficiency

Saves significant operating time

Quick to apply – mean: 1.9 minutesGergely BDJ 1989

7. Increased Efficiency

Saves significant operating time

Quick to apply – mean: 1.9 minutesGergely BDJ 1989

BUT - they were general dentistsOnly 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 minutesGergely BDJ 1989

BUT - they were general dentistsOnly 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 & SchwartzCohen & SchwartzJoEJoE 19871987

MATERIALS

Rubber Dam

Sizeavailable: precut squares of 6 in × 6 in and 5 in × 5 in. The 6 in × 6 in is usedfor posterior applications. The5 in × 5 in squares are for anteriorapplication and primary detention.ThicknessThe dental dam’s thicknessgauge can vary from thin, medium,and heavy. Colorwide variety of colors. scented or unscented, flavored or unflavored. prefered the darker shades for contrast.

Punch

Rubber Dam Equipment

Holes are too largeHoles are too largeDifficult to position RDDifficult to position RD

Dam Punch

used to create holes , needed to expose the teeth that are to be isolated. The punch’s 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 mandibularanterior incisors.

Punch

Rubber Dam Equipment

Use the largest Use the largest hole ONLYhole ONLY

-- one size fits all !!!one size fits all !!!

Clamp Forceps

Rubber Dam Equipment

Dental forceps

used to place and remove the dental dam clamp. The beaks of the forceps fit into the holes on the clamp’s 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.

ClampsRubber Dam Equipment

Keep it Simple !!!

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

Types

Non winged winged

Clamps Anterior teeth

Clamps Premolar teeth

Clamps Molar teeth

Keep the choices simple!!

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

Dam Frames

Young’s frame (metal)

Star “visi” frame

Nygaard-Östby frame

OraSeal

Extra Items

Wedjets

Anterior teeth isolated with wedjets

RD placement techniquesSeveral methods: Single tooth isolation and multiple teeth

1. RD and clamp already set-up and placed on tooth together as a unitUsually 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

Applying Rubber DamPreferred method RD on a winged clamp

Applying Rubber DamPreferred method RD on a winged clamp

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 rubber dam material over the clamp.

Applying Rubber Dam

Applying Rubber DamAVOID Placing clamp in mouth without RD

If used Remove floss once RD placed

a) Single Tooth Isolation

RD Techniques for Endodontics

Hole Positions - Single Tooth Technique

x

Anterior Teeth

Labi

al ¼¼¼

Labi

al

Hole Positions - Single Tooth Technique

x x

Anterior Teeth Posterior Teeth

Labi

al

Mes

ial

¼¼¼ ⅓⅓⅓

Mesial

Cuff Technique: multiple teeth isolation

RD Techniques

Hole Positions - Cuff Technique

x

Anterior Teeth

Labi

al ¼¼¼

Labi

al

Hole Positions - Cuff Technique

x x

Anterior Teeth Posterior Teeth

Mes

ial

¼¼¼ ⅓⅓⅓Labi

al

Hole Positions - Cuff Technique

x

Posterior Teeth

Mes

ial

⅓⅓⅓Mesial

Cuff technique using extra Items Wedjets + OraSeal

WHATS NEW

“Non-latex” Rubber Dam

Orashield - Rubber Dam Napkins

Orashield - Rubber Dam Napkins

Some Other HintsMissing teeth

Some Other HintsOrthodontic brackets / arch wires

Some Other HintsRD not well adapted to the tooth

Record Keeping

Some Other HintsBe sure to isolate the correct tooth!!

Some Other HintsBe sure to isolate the correct tooth!!

Plastic Clamps

Some Other Hints“Opti Dam” - the “3D rubber dam”

Some Other Hints“Opti Dam”

Some Other Hints“Optra Dam”

Some Other Hints

Some Other Hints“Improvisation” - in Vietnam 2000

Rubber Glove !!Rubber Glove !!

1) Infection control2) Patient safety3) Patient comfort4) Moisture control5) Increased visibility6) Increased access7) Increased efficiency8) “Dento-legal” reasons9) Improved treatment

outcome

Reasons for Using RD

It’s “Dam” Easy !!