Principles

The effective isolation of the teeth from the soft tissues, the tongue and fluids in the oral cavity can prove pivotal to the safe and successful practice of restorative dentistry. It is commonly accepted that the use of a dental dam can provide a complete form of isolation. The use of a dental dam is considered mandatory during the undertaking of non-surgical endodontic therapy. Other means of attaining isolation include the use of retraction devices and/or the use of high-volume suction techniques; however, the level of isolation may be considered to be only partial. An example of a commonly used retraction device is one by Ivoclar Vivadent (Schaan, Liechtenstein), OptraGate.

Dental dam isolation offers a number of key benefits:

• Protection of the patient, especially against the accidental aspiration of dental instruments and chemical agents such as irrigating solutions and etchants. The dam will also confer some level of protection against rotary and hand instruments.¹
• Effective isolation against saliva and other oral fluids. This may be required to provide the optimal environment for adhesive luting, to avoid adversely affecting the longer-term prognosis of chemically bonded dental restorations.²
• A barrier against cross-contamination, including aerosol sprays from dental handpieces and the air and water syringe.
• Enhanced visual access for the operator.
• Improved patient comfort, as patients need not fear the swallowing of chemicals, irrigants or instruments.¹
• Avoidance of fogging of dental mirrors.
• Reduced chairside time by virtue of treatment being carried out in an uninterrupted manner.

While the use of a dental dam appears to be inconsistent in the dental profession, it is important for the contemporary operator to be competent and proficient with the placement technique, as described in this chapter.

Procedures

Dental dams are commercially available in a range of different colours, consistencies and materials