9
Rubber Dam
Background
Rubber dam is usually well tolerated by children as long as they are prepared for its introduction. Once used most patients prefer to have rubber dam during their restorative treatment due to the enhanced intra-oral comfort during the treatment. Rubber dam is quick and easy to apply and with experience takes no more than 1 minute to apply.
History
Rubber dam has been used in dentistry for about 150 years and was first described by Barnum in 1865. UK surveys have shown that less than 2% of dentists routinely use rubber dam.
Indications
- Dental materials requiring moisture control, e.g. composite restorations and fissure sealants.
- Pulpotomy, pulpectomy and all endodontic procedures.
Advantages
- Moisture-free operating field.
- Isolation from salivary contamination.
- Improved access.
- Protection and retraction of soft tissues.
- Improved patient comfort.
- Minimised procedural time.
- Minimised mouth breathing (especially useful when inhalation sedation is being administered).
- Reduced risk of inhalation or ingestion of small instruments or debris (especially during endodontic procedures).
- Cross-infection control is achieved by minimisation of aerosol spread of microorganisms.
Contraindications
- Latex allergy. However, latex-free dam is available and must be used for anyone with a known latex allergy.
- rubber dam kit equipment: the rubber dam kit armamentarium (Fig. 9.1) comprises:
- rubber dam: latex and latex-free dam of different thicknesses, colours and even tastes are available;
- rubber dam punch: the Ainsworth pattern has a wheel with different sized holes whereas the Ash pattern punches a single sized hole;
- clamps: a wide range of plain and winged clamps is available but the following six clamps will cover most uses in children:
- DW – for first and second primary molars;
- BW – for first permanent molars;
- K – winged for first permanent molars;
- FW – a retentive clamp for partially erupted first permanent molars;
- L – winged for small first primary molars;
- EW – for primary canines, incisors and premolars.
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