Civitali Dental and Prosthetic Center srl

The Dental Dam: is it really useful?

 

The dental dam is of paramount importance to provide a high quality treatment.

Many dental treatments call for the isolation of the teeth from the remainder of the mouth, in order to provide a high-quality treatment. This is particularly true for endodontic and conservative therapies. Conservative dentistry is the branch that deals with the restoration of the single tooth by applying different techniques and materials as, for example, composite resins. As the word says, conservative dentistry aims to preserve the tooth and to reconstruct it at the best to maintain it over time. Endodontics, instead, is the branch of dentistry dealing with endodontic treatments, such as tooth devitalization.

In both fields, that keep a general dentist busy for more than 2/3 of his/her time,  isolation of the tooth to be treated is not only necessary but essential.

Reasons are many


To allow therapies to be performed under correct conditions, with no teeth contamination by saliva, blood, organic residuals and bacteria


Many restoration materials, as composite resins or glass ionomer cements, call for an absolute absence of humidity for their correct usage


The patient’s comfort during the clinical procedures, since the dam prevents all liquids (water coming from drills, disinfectants…) and materials to get in touch with the patient’s mouth 


The high degree of protection of the patient’s mouth, both concerning its hygiene and the prevention of any accidental ingestion of instruments or materials debris. Instruments for tooth devitalization, for example, are thin and sharp and ingesting one would expose the patient to a high risk. The same happens when an old filling in silver amalgam is removed: even with aspirators, the risk of ingesting silver powder or mercury debris, both toxic for the human body, is high.


Hydrophilic cotton rolls, which are able to absorb large amounts of saliva, are widely used in all branches of dentistry. In particular, many operators still use them to isolate the operating field. They may show a certain effectiveness, especially if they are replaced often. Though, their use is not sufficient to guarantee a sufficient degree of isolation of the operative field.


This is clearly stated in all the international literature on the subject. All authors agree about the fact that cotton rolls cannot provide – in conservative and endodontic treatment – the correct isolation of the teeth and the applied materials from saliva and blood. Moreover, the need of managing the soft tissues and the patient’s tongue – which often disturb operations – and the risk of device or materials ingestions make the use of cotton rolls highly inadvisable if safety for the patient and comfort of the operator are set as a standard in performing correctly all the operative procedures.


The importance of using the Rubber Dam.

The rubber dam is a 15x15 cm sheet made of natural rubber. It’s among the most effective isolation techniques described in clinical literature. Therefore it must be regarded as a fundamental aid in endodontics and conservative dentistry. The quality of the seal with respect to the fluids in the oral cavity is significantly high. It prevents the contamination of the tooth undergoing treatment and, moreover, significantly reduces the production of aerosol spreading in the operating room. This lowers the environment contamination, increasing safety both for operators and patients. This is quite a relevant issue, especially considering the attention to be paid to cross-infections in dentistry due to the wide spreading of AIDS and hepatitis B and C. Many studies have addressed this subject. Beyond usual precautions (single-use materials and gloves, mask, glasses to protect the operator, effective sterilization and disinfection techniques, chlorhexidin rinses by the patient before beginning any treatment etc…) some studies have assessed the effectiveness of the rubber dam also to reduce contamination of the operating environment by the secondary aerosol generated by rotating instruments, finding it quite effective.


The patient, moreover, likes it. Liquids produced during operations cannot reach his/her mouth and the dam makes accidental ingestion of restoration materials or endodontic devices impossible. It also prevents accidental lesions to the mucosa that can always occur during normal dentist’s maneuvers.

Still many dentists don’t use it in their clinical practice, saying too time is needed for its setting, or the patient doesn’t like it or, again, that they don’t need it since they are able to perform a high quality treatment anyway.  Such statement, according to recent surveys, usually hide the own dentist’s inability to assembly it properly (leading, of course, to the increase in operative time they complain).

Advantages of such technique are never sufficiently stressed, and the simple and fast operations needed to set the dam properly in the mouth are not taught. It is worth noticing that such technique has not been introduced recently: pictures taken at the beginning of the past century show American students performing tooth restoration with its help. Its use is described already in manuals of the end of the last century. Despite this, its use is still not spread. Surveys show that only 50% among dentists use it, even in fields – as conservative and endodontic dentistry – where it is absolutely necessary. We do hope that this will change as the new generation of dentists is rising and that the dam will become – for them and for their patient, the essential aid it really is.

positioning dental dam