Everything You Ever Wanted to Know about Rubber Dams
The rubber dam was introduced in 1864 for use in dentistry. Dental schools and dental assisting schools require rubber dams to be used during operative and restorative procedures, but many dentists do not use the dams in private practice. Dentists that do not use dams often use cotton rolls instead, saying that the dams take too long to place. However, if proper placement procedures are used, the dams take only minutes to place.
Why Should Dentists Use Rubber Dams?
Rubber dams can prevent bacteria in the saliva from getting onto the tooth or teeth being focused on, helping to prevent infections. Rubber dams can help to protect the tongue, lips, and cheeks from any surgical instruments or materials being used during the procedure. Dams can also keep materials such as bits of tooth, ceramic, composite, and amalygam out of the mouth and throat.
Many materials require dry, clean environment for proper bonding. Rubber dams help to create that environment, which can increase procedural efficiency and reduce the time required for treatment. Since most rubber dams come in bright colors, the dams also create a high level of visual contrast, making it easier for dentists to see.
Preparing for Rubber Dam Placement
Before placing rubber dams, it is often necessary to explain to patients what the dams are and why they are used. Patients’ teeth should be flossed and cleaned as necessary before placing the dam. A saliva ejector may be placed for comfort if the patient desires. Holes can be punched in the dam based on the patient’s specific tooth placement to achieve the best results, although templates are available. A water soluble lubricant can be placed between the holes on the dam to facilitate movement of the dam between the contacts of the teeth.
Selecting the Clamps
Clamps, also called retainers, are used to hold rubber dams in place. Clamps should be placed one or two teeth distal to the tooth or teeth being worked on so that the professional has room to work. For best results, the clamp should have four-point contact on the tooth and remain stable when tested before placement of the dam. Different types of clamps work better with different types of teeth, such as double bowed clamps on anterior teeth and curved jaw clamps on maxillary molars.
Placement of Rubber Dams
After all materials are prepared, holes are punched in the dam, and clamps have been selected, it is time to place the dam. When placing the clamps over the tooth, the lingual jaws should go first, followed by the facial jaws. The rubber dam should then be stretched over the anchor tooth. Ligature, or floss, should be exposed and easy to grasp if needed. The dam should be tucked under the jaws of the retainer to keep it in place.
After the dam is secured by the retainer, it can be stretched over the lips and a plastic frame can be placed. Using finger pressure, the dam can be snapped through the contacts and the most anterior contacts can be flossed to improve stability. Finally, the dam can be inverted using an explorer tip and air from a syringe.