Rubber dam usage for endodontic treatment: a review
I. A. Ahmad
Private Dental Practice, Amman, Jordan
Ahmad IA. Rubber dam usage for endodontic treatment: a
review. International Endodontic Journal, 42, 963–972, 2009.
Rubber dam has been available to the dental profession for over 140 years. During this time, the use ofrubber dam has been perfected, universally taught and recommended by professional organizations. Unfortunately, its consistent use has been rejected by many in the profession. The literature suggests that rubber dam is not used routinely by dental practitioners for root canal treatment. Many unfounded reasons have been cited for its lack of use, including concerns over patient
acceptance, timerequired for application, cost of equipment and materials, insufﬁcient training, difﬁculty in use and low treatment fees. Failure to use rubber dam has been shown to inﬂuence the choice of root canal irrigant, has a negative impact on treatment outcome and places the patient at risk of swallowing or aspirating materials and instruments. Methods to popularize rubber dam amongst general practitioners arediscussed. Keywords: disincentives, prevalence, rubber dam, survey, treatment outcome.
Received 17 February 2009; accepted 8 July 2009
The rubber dam was introduced to the dental profession by Dr Sanford C. Barnum on 15 March 1864 (Elderton 1971). Since then, a number of publications have appeared related to its practicality and methods of application (Elderton 1971, Cragg 1972,Antrim 1983, Reuter 1983, Carrotte 2000, 2004, Ingle et al. 2002, Glickman & Pettiette 2006, Bhuva et al. 2008). The use of the rubber dam during root canal treatment confers three main advantages: control of cross-infection, protection and improving treatment efﬁciency. The use of the air turbine results in the formation of aerosols and droplets that are usually contaminated with bacteria andblood. These aerosols and droplets
Correspondence: Ibrahim Ali Ahmad, Private Dental Practice, P.O. Box 1906, Amman 11910, Jordan (Tel.: +962 7 853 09327; fax: +962 6 534 2953; e-mail: ibrahimali79@ yahoo.com).
represent a potential route for transmission of infectious diseases such as measles, tuberculosis, SARS, hepatitis and AIDS (Wong 1988, Forrest & Perez 1989, Harrel & Molinari 2004).The use of rubber dam results in a signiﬁcant reduction in the microbial content of air turbine aerosols produced during operative procedures, thereby reducing the risk of cross-infection in the dental practice (Wong 1988, Cochran et al. 1989, Forrest & Perez 1989, Samaranayake et al. 1989, Harrel & Molinari 2004). Rubber dam protects the patient’s oropharynx from the possible aspiration orswallowing of instruments, medicaments, irrigating solutions and tooth/material debris (Ingle et al. 2002, Glickman & Pettiette 2006) and subsequently the operator from legal responsibility should these accidents occur (Cohen & Schwartz 1987, Cohen 1989, Peters & Peters 2007). It also retracts and protects the soft tissues (gingival tissues, tongue, lips and cheeks) from rotary and hand instruments,medicaments and potential the trauma of repeated manual manipulation (Ingle et al. 2002, Glickman & Pettiette 2006).
ª 2009 International Endodontic Journal
International Endodontic Journal, 42, 963–972, 2009
Rubber dam review Ahmad
Furthermore, rubber dam enhances treatment efﬁciency by: • Improving the access to operating ﬁeld by retraction of soft tissues. • Improving visibilityby providing a dry ﬁeld, reducing mirror fogging and enhancing visual contrast. • Facilitating the practice of four-handed dentistry during endodontic treatment. Instead of having to be careful about protecting the patient’s airways, controlling and retracting the soft tissues, both the operator and the dental nurse can concentrate on the endodontic procedure. • Reducing ﬂooding of the oral...