Nothing but the Tooth: Rubber dams are essential tools for dentists

Q. I want to say thank you for all the time and effort you have put in to educate myself and my friends when it comes to dentistry and questions we patients might have. Along the way I have read a few times about something called a rubber dam. I am in my early 70’s and never recall ever having something like that placed in my mouth during dental treatment. Can you explain its importance, if any and why doesn’t my dentist use this when I have fillings done.

- L.C.

A. I appreciate your comments and am excited that you bring up a topic that I am so passionate about.

The rubber dam is a 6-by-6-inch square piece of latex (rubber) or synthetic material (nitrile) that is used to isolate the area of your mouth that the dentist is operating in. Most of you have probably seen on TV or elsewhere, medical surgeons isolating the area they are about to operate in. Usually they will drape and protect all areas not necessary to see, cleanse and use some sort of antibacterial with the idea of keeping the area to be treated as clean as possible and easy for them to see. All of this provides the medical surgeon a specific area of concentration necessary to achieve the positive result they are looking far.

In the last half of the 18th - yes, I said 18th century - dentists came up with this same idea for operating on teeth. Originally, they were all rubber but some patients exhibited latex allergies and since the dam will come in contact with the skin, others found the substance nitrile which has similar properties and is non-allergenic. Either is used today. WHEN IT IS USED.

I emphasize the use aspect since it is a very big disappointment that I have of my profession. I am not absolutely sure but if one were to poll all the dental patients in the U.S., I believe that less than 20% of them would have any knowledge of having a rubber dam used during their treatment. My guess also, is that of those 20%, most were ones who were undergoing root canal treatment. When root canal therapy is performed it is considered the standard of care for the dentist to use a rubber dam. What that means is that if something goes wrong during or after the root canal procedure and the rubber dam was not used, the dentist can be held liable in a court of law.

Simply what a rubber dam does is isolate the tooth or teeth to be treated as well as provide a barrier from bodily fluids i.e. blood and saliva. It covers you the patient’s mouth with holes punched in it for the teeth or tooth to be treated. The advantages are immense. The dentist can clearly see the area of operation with no distraction such as tongue or cheek movement. You the patient can easily swallow normal flow of saliva with no fear of swallowing any of the materials used by the dentist such as filling materials, dental cements or even dental instruments that might fracture during use. Almost all dental materials are adversely affected by moisture when they are being placed. If this contamination of moisture (saliva, water, blood) occurs during placement it will adversely affect the outcome of the procedure in almost every instance.

Moisture control and isolation of the area to be treated are primary to the success of any dental procedure.

As a former Associate Professor of restorative dentistry at Columbia University, I know that the use of rubber dam is mandatory for every dental student in the country prior to their being taught how to perform any surgical restorative procedure.

Why then might you ask (at least more than 80% of you) has a rubber dam not been used during your treatment?

Clear and simply what happens is that because it takes time and because it is difficult to learn, the majority of my restorative dental colleagues deceive themselves into thinking that there is an easier way to accomplish the same results once they are out from under the teaching umbrella.

Simply, I think they think of the rubber dam as one would of diapers and they grow out of its use when they leave the learning environment. They may choose the far easier use of cotton rolls or various other devices that have been designed to replace the difficult-to-use rubber dam. Yes, it is difficult to learn to use, but to achieve the surgical results desired it is incumbent on every dentist to become relaxed with its use.

Some will say that you the patient do not like to have a piece of material placed over your mouth. I think for many patients this is true. All it takes is an explanation from the dentist as to the reasons for the use. (Yes, a hole can be cut in the center for ease of breathing). The excellent result desired is easier to achieve and more comfortable to endure. After all, is this not what we all are trying to deliver? The best care possible.

It is possible to get a similar result without a dam but your dentist needs to clearly understand how much easier it is for you and he/she, when isolation with a rubber dam is so clear and so stable. Your dentist will see the field of operation with ease, will not be interrupted by the somewhat talkative patient, will be comfortable that moisture will not contaminate the area and they will clearly see when decay is removed, when cements or liners are placed properly and when the restoration is finished they will, again, clearly see the result.

If my colleagues have gotten out of the habit of placing a dam and are therefore embarrassed when attempting to do it, I would advise seeking continuing education in that area and in no time, they will find how much easier and more comfortable it is for them and their patient. It is a win-win for the patient and my profession.

P.S. Bring them a copy of the column and ask their comments.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.