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Rubber dam:
an overview
Frankly, Chris Emery, a specialist endodontist from
Portsmouth, does give a dam.
Fuss and bother
If you are very lucky the dentist that you
work with will use rubber dam for root canal
treatments and some restorative work, so this
article wont be a lot of use to you. However, if
you work with one of the 85% of dentists who
do not use rubber dam, consider it a waste of
time and say that patients dont like it, then
read on. Furthermore leave this magazine
open at this page on your dentists desk and
wait for the above reaction I guarantee
it! When Dr Sanford Christie Barnum first
described the use of rubber dam in the Dental
Cosmos in 1864, I dont think he had any idea
of the fuss and bother he would be causing. To
those of us who use rubber dam routinely for
many procedures and certainly all root canal
procedures, it seems a simple and natural
thing to do. However, to the majority of UK
dentists out there who do not use rubber dam,
the procedure seems difficult, unnecessary
and intrusive. The simple reply to this opinion
is that it really isnt! The main aim of this
article is to try and persuade the non-believers
that rubber dam is an easy, ordinary and
necessary treatment modality. The secondary
aim is to share a few rubber dam tips for the
experienced dam user. I realise this might
place you in an undesirable position but
blame me. I am very used to dentists sounding
off about the perils of rubber dam!
Have a go
There is no wrong way of placing rubber
dam; if it works for you and your dentist,
your way is great! The following examples are
clinical scenarios that work for me, bearing in
mind I am an endodontist. When I was first
working in my own general dental practice
over 40 years ago, I was not using rubber dam,
and my endo was probably rubbish. I attended
a lecture by Chris Stock, now retired but then
a new endodontic voice on the lecture circuit.
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2012 Macmillan Publishers Limited. All rights reserved
PRACTICE
1a
1b
1c
1d
1e
2a
2b
2c
I would not
contemplate
carrying out
root canal
therapy without
rubber dam.
CLINICAL CASE 2
Split dam isolation of upper molar
30 vital
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2012 Macmillan Publishers Limited. All rights reserved
PRACTICE
3a
3e
4a
3b
3f
4b
3c
3g
4c
3d
4d
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2012 Macmillan Publishers Limited. All rights reserved
PRACTICE
5a
7a
8a
5b
7b
8b
6a
6b
32 vital
PRACTICE
10
11
Christine Horbury,
(Dental Nurse) Clinical Skills Edu
cator
The need to work under dry con
ditions, free of saliva, has been
recognised for centuries, and the
idea of using a sheet of rubber
to isolate the tooth dates back
almost 150 years! However, due
to
the impact of costs and times,
the use of rubber dam is limited
and
patient safety is a risk. In Leeds
Dental Institute, where I currently
work
helping train dentists and dental
therapists, the placement of rubb
er
dam is taught very early on and
always used when a tooth nee
ds
isolation. Training dental nurses
to place rubber dam seems like
a plausible solution
but I dont feel dental nurses are
having the opportunity to perform
this.
Shaun Howe,
Dental Hygienist
This is relevant to all members
of the dental team. Dental hygi
enists
and therapists should be using
rubber dam especially for seal
ants,
but many newly qualified DCPs
find it too intimidating. That said
,
when I was a dental assistant in
the early 1990s I had the privilege
of working with an American end
odontologist and we used rubb
er
dam for pretty much everything
we did (including normal resto
rativ
e
work). This was before any real
legislation governing dental assis
ting
and I was trained by my dentist
to place the dam and became
very effective at it! With
practice using rubber dam bec
omes pretty much second natu
re and very, very easy!
www.nature.com/vital
2012 Macmillan Publishers Limited. All rights reserved