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Rubber Dam
WHY TO USE RUBBER DAM?
- Improves access and visibility of teeth
- Prevents contamination of teeth and dental materials by saliva
- Retracts soft tissues
- Prevents water, debris, or dropped instruments from entering patient’s throat
- Infection control—barrier reduces microbial contamination to staff by 70- 95%
First described by Dr Barnum, 1864 ,over 150 years ago in New york
Advantages of Rubber Dam
- A dry, clean operating field
- Improved access and visibility
- Improved properties of dental materials
- Protection of patient and operator
- Operating efficiency
| Moisture control | Soft tissue retraction | Patient safety | Tissue protection |
|---|---|---|---|
| It acts as a physical barrier between the selected operator field and the oral cavity, which prevents saliva, blood, gingival crevicular fluid, humid exhaled air, and other debris from interfering with the restorative treatment. | Successfully retracts the gingiva, thereby allowing improved access to deep interproximal carious lesions for direct restoration | The safety aspects associated with its use during root canal treatment and also when removing existing amalgam restorations are well established. It eliminates the risk for potentially harmful dental materials, chemicals (notably, sodium hypochlorite), and small instruments from being ingested into the gastro-intestinal tract, or worse, inhaled into the lungs. | Covered soft tissues are by default also offered a barrier of protection, albeit a relatively weak one, shielding from the bur's cutting action or other sharp instruments. |
Disadvantages of Rubber Dam
- Low usage among private practitioners
- Time consuming
- Patient objection
- Conditions precluding use of rubber dam
- Teeth that have not erupted sufficiently
- Some third molars
- Extremely malpositioned teeth
- Patients with asthma
Materials and Instrument
- Rubber Dam Material
- Rubber Dam Holder (frame)
- Rubber Dam Retainer (clamp)
- Rubber Dam Punch
- Rubber Dam Retainer Forceps
- Rubber Dam Napkin
- Lubricant
- Modeling Compound
- Anchors
Rubber Dam Material
- Dam material available in 5x5 inch or 6x6 inch sheets
- Thicknesses or weights thin (0.15mm), medium (0.2mm), heavy (0.3mm), super heavy (0.35mm)
- Has a shiny and a dull side
Rubber Dam Isolation Kit
Rubber Dam Holder ( Young’s frame)
- Maintains the borders of rubber dam in position
- U-shaped metal frame
- Small metal projections
- An optional Neck Strap may be placed behind the patient’s neck
Rubber Dam Retainer (clamp)
- Consists of 4 prongs and 2 jaws, connected by a bow
- Used to anchor the dam to most posterior tooth to be isolated
- Used to retract gingival tissue
- Available in different sizes and shapes
Rubber Dam Isolation Kit
Selection of clamp is very important
Rubber Dam Punch
A precision instrument having a rotating metal table (disk) with 6 holes of varying sizes, and a tapered, sharp-pointed plunger
Rubber Dam Retainer Forceps
Used for placement and removal of retainer from tooth
Lubricant
- Applied in area of punched holes to facilitate the passing of dam through proximal contacts
- Cocoa butter, petroleum jelly
- Applied to corners of mouth to prevent irritation
Modeling Compound
Sometimes used to secure retainer to tooth
Anchors
- Proximal contact may be sufficient to anchor the dam on the tooth farthest from the posterior retainer
- To secure the anchor further, a waxed dental tape (or floss), or a small piece of rubber dam material, can be passed through the proximal contact.
HOLE SIZE AND POSITION
- Holes must be punched by following arch form
- 5-6 holes in cutting table of rubber dam punch
- Smaller holes for incisors, canines & premolars
- Larger holes formolars, posterior anchor tooth
STEPS IN PLACING A RUBBER DAM
DENTAL DAM REMOVAL
The easiest and most convenient way to remove the dam is by:
- Stretching the dam buccally until the interseptal dam between each perforation is visible.
- Cutting the interseptal dam using round-end scissors Removing the retentive clamps to release the dam.
