Rubber dam
What is a rubber dam ?
A rubber dam (also known as dental dam) is a thin, rectangular sheet, usually latex rubber, used in dentistry to isolate the operative site (one or more teeth) from the rest of the mouth.
The rubber dam has two important purposes:
It prevents saliva interfering with the dental work (for example, contamination of oral micro-organisms during root canal therapy, or to keep filling materials such as composite dry during placement and curing).
It prevents instruments and materials from being inhaled, swallowed or damaging the mouth.
Dental dams come in lots of different colors. If you are allergic to latex, there are non-latex versions available.
A rubber dam is mainly used in endodontics (during root canal therapy), fixed prosthodontics (for example, when a crown or bridge is cemented) and general restorative treatments (when a filling is placed).
Placement technique
The dentist uses a hole-puncher to make a hole in the sheet for the tooth (or teeth) to be treated. The sheet is placed onto a metal frame to make it easier to place.
A tiny clamp is placed around the tooth itself to prevent the rubber dam from slipping, and then the sheet with the hole in it is slipped around the clamp.
When the operation is over, the tooth crown should stand out from the rubber dam through the individual hole made by the hole-puncher.
What are the benefits of using a rubber dam?
It stops bacteria in saliva from splashing onto the tooth. This is very important for successful root canal treatment, because the bacteria in saliva can contaminate the root canals, thus increasing the risk of endodontic failure.
It keeps the operative field clean and dry. For dentistry procedures involving bonding with adhesives or cements, the tooth must be kept perfectly dry during placement or the resin (or dental cement) will likely fail to adhere to the tooth.
It can prevent instruments, materials, endodontic irrigants or other solutions from being inhaled, swallowed or damaging the mouth. Some of these could damage the soft tissues of the mouth and be harmful if swallowed.
There is improved visibility of the operative site.
Drawbacks
It takes extra time to apply
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Since it effectively blocks of the oral airway, the patient must be able to comfortably breathe through his nose.
For this reason, many people have a fear of rubber dams, because they are worried that they won't be able to breathe and/or swallow (although, usually, there is lots of room around the sides, so patients are able to breathe through their mouth).
Some patients find the dental dam claustrophobic.
Reduced communication between patient and dentist may increase patient anxiety and make them feel more vulnerable.
Although most practitioners agree that the rubber dam has certain benefits, few private practices use the rubber dam as a standard isolating procedure.
Some dentists even argue that unrestricted and arbitrary widespread use is abusive to the patient and dentist as, in most cases, more efficient and comfortable alternatives exist (such as high speed suction, custom retraction devices, disposable cotton rolls, gauze packs and throat screens, retraction cord systems etc).
Nevertheless, at least for some dental procedures (for example root canal therapy), a properly placed rubber dam can maximize the chances for success.
Last review and update: August 2021