The Use Of Rubber Dams

A Rubber Dam, or a dental dam, is a thin square sheet of non-latex rubber used to isolate the operative site from the rest of the mouth. The teeth to be operated on are isolated through the dam’s holes.

In my Affinity Dental Care practice, I use rubber dams in all my restorative procedures, like white fillings, crowns, bridges, and root canal therapies.

Rubber dams serve as protective barriers in many ways and are one of the quintessential components of holistic and wellness dentistry.

1. They protect the patients from inhaling, aspiring or swallowing:
   • the toxic and unwanted materials like old silver-mercury amalgam fillings when I remove them,
   • the old resin-based fillings with unwanted chemicals and bacteria during the removal,
   • excessive water coming out from the handpieces during the cutting,
   • the solutions and chemicals we use for cleaning and disinfection of the teeth during root canal treatment or before placing the white fillings,
   • the loose burs or files during dental treatments.
2. They protect the patients’ tongues and cheeks from being injured by the rotating burs or chemicals.
3. They prevent contamination by the saliva and vapour from the moist mouth of the already cleaned and disinfection sites before the cavity can be filled. Our saliva contains bacteria and other substances like electrolytes, mucins, glycoproteins, and enzymes. Without the rubber-dam barrier, isolation from the contaminants, including the moisture in the air, can be challenging. A contaminated filling will not last and may also induce sensitivity afterward.
4. They provide a better view of the cavities and the teeth in question because they improve the contrast from the backgrounds.
5. They comfort the patient because the soft tissues are gently protected, and no excess liquid enters the mouth during the procedure. The patient feels more relaxed.
6. My assistant and I do not have to labour and spend excessive efforts to keep the tongue, cheek and saliva again. Instead, we can focus on cleaning, disinfecting the teeth, and properly filling the cavities with white fillings that bond to the teeth without contaminants, including moisture, trapped inside.

Multiple studies have shown that a surface free of contaminates necessary for successful long-term bonding in restorative dental treatment. The most effective way to achieve and maintain a clean restorative surface is with dental dam isolation.

What about the patients who have claustrophobia? I learned that most patients could tolerate rubber dams well because I explained the benefits before hands. Furthermore, I demonstrated to them that I would cut a large hole in the middle of the rubber dam so the mouth would not be covered. They usually fell asleep during the procedure because their mouths were “quiet” without the ever shuffling and jamming of cotton rolls, fingers, mirrors and instruments.

Rubber dams were a mandatory procedure in restoratives and endodontics when I was a dental student at the University of Toronto over 33 years ago. The American Association of Endodontists (AAE) states that tooth isolation with a dental dam is an important technique that helps maintain high standards of care during any non-surgical procedure. It is a standard of care for endodontic treatments in North America. However, it is not a standard of care for filling or replacing silver amalgam, resulting in most dentists not routinely using rubber dams when removing cavities and old fillings during the procedure. The obstacles to using rubber dams could be because dentists lack proper training in applying rubber dams, the extra costs, the additional time involved and the perceived difficulty in applying the rubber dam.

Rubber dam isolation was first introduced to dentistry in the 1800s, and its benefits — including patient protection, ensuring contaminate-free surfaces and improved clinical visibility — have been shown in many studies. Affinity Dental Care provides our patients with long-lasting results safely and holistically (see Figs 1, 2 and 3 for a silver filling I replaced with a resin-based filling utilizing a rubber dam as one of the protective features during the operation).