ABSTRACT: Due to close face to face contact with patients and frequent utilisation of sharp devices, dental personnel are repeatedly exposed to respiratory...
ABSTRACT: Due to close face to face contact with patients and frequent utilisation of sharp devices, dental personnel are repeatedly exposed to respiratory tract secretions, blood, saliva and other contaminated body fluids and are always at risk for 2019-nCoV infection. This article addresses importance of using rubber dam in dental practice and how a simple rubber sheet is helpful in prevention of cross infections among operator, dental staff and patients. This article also covers use of rubber dam in various difficult clinical situations.
Introduction
The disease caused by the 2019 novel coronavirus (2019-nCov ) was called COVID-19 by the World Health Organisation in February 2020. COVID-19 transmission in dental sittings occur through four major routes:-
Direct exposure to respiratory secretions containing droplets, blood, saliva.
Indirect contact with contaminated surfaces and instruments
Inhalation of suspended airborne viruses
Mucosal (nasal,oral and conjuctival) contact with infection containing droplets and aerosols that are propelled by coughing and talking withot a mask.
Basics of Rubber Dam
Rubber dam is a thin square sheet of latex or non latex which is used to isolate the operating site from the rest of the mouth. Importance of using rubber dam -
Isolation
Retraction of tissues
Access & visibility
Improved properties of dental materials
Protection of patient & operator
Increased operating efficiency
Reduced operator time
Rubber Dam Isolation
Due to the creation of a barrier in the oral cavity, rubber dams effectively reduce the generated droplets and aerosols mixed with patient saliva and /or blood. Following the placement of the dam, extra high volume suction is also required for maximum prevention of aerosol and splatter from spreading. Rubber dam isolation
Use of Rubber Dam in Various Difficult Clinical Situations
During endodontics, difficult clinical situations may arise like -
Partially erupted teeth or teeth with short clinical crown
Severely broken down teeth
Clamps with serrated jaws are available called as ‘tiger clamps’. These serrations help in stabilization of the clamp. Apart from tiger clamps, other clamps available are Silker Glickman clamp for severely broken down teeth. It has an anterior extension that allows retraction of the rubber dam around the tooth in question with the clamp placed on the adjacent tooth. Specializedclamps
Some Clinical Snapshots
Single Tooth IsolationQuadrant IsolationClamp-less multiple teeth isolation in anterior regionFull Arch Isolation Besides rubber dam, there are many other methods used for isolation.
Isolation of the treatment area provides the ability to create an aseptic and dry environment and improves efficiency. Whichever colour, thickness or application technique is used, the rubber dam improves both the patient’s experience and comfort and practitioner’s performance and is a mandatory requirement in post COVID dentistry.
Rubber-dam isolation remains valuable for moisture control, visibility, adhesive procedures, endodontic asepsis and protection against aspiration or ingestion of instruments and irrigants. It can reduce contamination from the treated field, but it is only one part of infection prevention and does not replace PPE, evacuation, ventilation, hand hygiene or environmental cleaning.
Safe clinical sequence
Assess indication, tooth anatomy, contact tightness, eruption, periodontal tissues, airway and material sensitivities.
Select and inspect the sheet, frame, clamp or ligature; secure components where aspiration is possible.
Confirm clamp stability and avoid soft-tissue trauma or excessive force.
Maintain high-volume evacuation where indicated and monitor patient comfort and breathing.
Before removal, account for all components and inspect the operating field.
When conventional placement is not feasible, choose an alternative isolation method based on the procedure and risk. An alternative that controls saliva for a simple restoration may still be inadequate for endodontic treatment involving small instruments and irrigants.
Frequently asked questions
Does a rubber dam eliminate dental aerosols?
No. It can reduce contamination from the oral field but does not remove all aerosol or replace other controls.
Is rubber dam required for endodontic treatment?
It is a core safety and asepsis measure; clinicians should follow current professional standards and document exceptional limitations.
Can latex allergy be managed?
Use an appropriate non-latex system and follow the patient’s allergy assessment.
What if a clamp is unstable?
Do not proceed until isolation is safely redesigned or another appropriate approach is chosen.
Are isolation alternatives equivalent?
No. Their ability to control moisture, protect the airway and support asepsis differs by procedure.
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[1]Young DA, Nový BB, Zeller GG, et al.. The American Dental Association Caries Classification System for Clinical Practice Journal of the American Dental Association. 2015. DOI: 10.1016/j.adaj.2014.11.018. Available at: source
[2]Miao C, Yang X, Wong MCM, et al.. Rubber dam isolation for restorative treatment in dental patients Cochrane Database of Systematic Reviews. 2021. DOI: 10.1002/14651858.CD009858.pub3. Available at: source
Dr. Rockson Samuel is a dental surgeon, healthcare content strategist, and Founder and Chief Dentist of Indira Dental Clinic in Vellore, Tamil Nadu. He provides comprehensive general and family dental care with professional interests in endodontics, implant dentistry, clear aligner therapy, digital dentistry, preventive care and patient education. A graduate of K.G.F. College of Dental Sciences and Hospital under Rajiv Gandhi University of Health Sciences, he also has formal training in management and digital marketing. As Community Leader at DentalReach, he contributes to dental publishing, professional education, international media partnerships and the development of evidence-informed resources for dentists.
