Background and History of Dental Dam
- Rubber dam is used in dentistry for isolation during dental procedures.
- Different techniques can be used to apply the dental dam based on the tooth being treated.
- The dental dam is prepared by punching holes in the sheet to isolate the required teeth.
- Metal or flexible plastic clamps are used to anchor the dental dam in place.
- Topical anesthetic may be applied to the gingiva for patient comfort.
- Dr. Sanford C. Barnum designed the dental dam to prevent contamination during procedures.
- Dr. S. S. White improved the design by adjusting the hole punched into the sheet.
- Dr. Delous Palmer developed metal clamps to stabilize the dam around the tooth.
- Metal clamps come in different shapes and sizes to fit different tooth structures.
- Rubber dam usage was challenging until the development of metal clamps.
Applications and Controversy of Dental Dam Use
- Dental dam can be used in dental restorations, endodontic treatments, and fissure sealants.
- It is also used in the preparation of dental crowns, dental implants, and some veneer placements.
- There is ongoing controversy among dental practitioners regarding the use and efficacy of rubber dam.
- Studies show that many dental practitioners do not utilize rubber dam during procedures.
- The use of rubber dam is considered a standard of care supported by evidence.
Armamentarium and Rubber Dam Application
- Rubber dam setup involves specific tools and accessories.
- Tools include rubber dam sheets, clamps or hooks, frames, forceps, and dam punch.
- Dental floss can be used to secure the dam around the clamps and prevent aspiration.
- Other materials like OralSeal, wooden wedges, and Wedjets may assist in setting up the dam.
- Manufacturers offer alternative dam sheets for patients with latex allergies or for autoclaving.
- Dental dam sheets are made of rubber materials like latex or nitrile.
- Sheets are approximately 15cm by 15cm in size with varying thickness.
- Metal clamps are used to anchor the dental dam around the tooth.
- Dental floss can be secured around the clamps for additional safety and retrieval.
- Rubber dam frames keep the dam sheet taut and prevent obstruction during procedures.
Advantages and Disadvantages of Dental Dam Use in Dental Treatments
Advantages:
- Acts as an infection control barrier, reducing the risk of cross-contamination and infection
- Protects the patient's airways from swallowing or inhaling restorative instruments, tooth fragments, or debris
- Prevents harmful effects of chemical materials used in dental procedures, such as corrosive irrigants and mercury in amalgam restorations
- Offers additional protection of soft tissues from sharp instruments, acting as a barrier
- Used as part of a legal obligation in some places to prevent potential injuries and cross-contamination, ensuring the duty of care is not neglected
Disadvantages:
- Time-consuming application process, especially without sufficient training
- Costly expense for dental practices, including initial armamentarium costs
- Risk of rubber dam clamps breaking during application, requiring precautions for retrieval
- Discomfort or pain caused by gum line placement, potential bleeding or damage to periodontal ligament
- Difficulty breathing through the nose and reduced communication, leading to feelings of claustrophobia and anxiety
Use of Dental Dams in Oral Sex and Considerations/Precautions
- Suggested as a physical barrier against the exchange of body fluids during cunnilingus and anilingus
- Rarely used for this purpose and no evidence of reducing STI transmission or HIV infection risk
- After lubrication, dental dams can be held over the vulva or anus for oral stimulation without bodily fluid transmission
- Plastic cling wrap, repurposed condoms, or latex gloves can be alternative barrier methods for STI protection during oral sex
- These alternative barrier methods are more affordable and readily available than dental dams
- Potential risks and drawbacks of dental dams in oral sex
- Limited evidence of reducing STI transmission or HIV infection risk
- Lack of widespread usage for this purpose
- Uncertainty about the effectiveness of dental dams in preventing STIs
- Availability and affordability of alternative barrier methods, such as plastic cling wrap or repurposed condoms
- Consideration of individual preferences and comfort levels in using dental dams or alternative barrier methods
- Visual distortion of tooth morphology may occur, potentially leading to perforation during root canal therapy
- Apparent color alteration of teeth due to brightly colored rubber dams, affecting shade selection for restorative procedures
- Possibility of allergic reactions to latex material, ranging from uncomfortable to life-threatening
- Availability of nitrile versions for patients with latex allergies
- Importance of informing dental practitioners about latex allergies prior to treatment or adverse reactions after rubber dam application
A dental dam or rubber dam is a thin, 6-inch (150 mm) square sheet, usually latex or nitrile, used in dentistry to isolate the operative site (one or more teeth) from the rest of the mouth. Sometimes termed "Kofferdam" (from German), it was designed in the United States in 1864 by Sanford Christie Barnum. It is used mainly in endodontic, fixed prosthodontic (crowns, bridges) and general restorative treatments. Its purpose is both to prevent saliva interfering with the dental work (e.g. contamination of oral micro-organisms during root canal therapy, or to keep filling materials such as composite dry during placement and curing), and to prevent instruments and materials from being inhaled, swallowed or damaging the mouth. In dentistry, use of a rubber dam is sometimes referred to as isolation or moisture control.
Dental dams are also used for safer oral sex.
dental dam (plural dental dams)
