Dental Rubber Dam Guide: Improve Isolation, Safety, and Visibility

Saliva pooling is a common challenge for dentists, often complicating procedures and prolonging treatment time. While various isolation methods such as cotton rolls, saliva ejectors, and mouth props are available, none surpass the efficiency of rubber dam isolation. Rubber dams not only ensure a dry field but also significantly reduce cross-contamination.  

In this comprehensive guide, we’ll explore everything about rubber dams and help you choose the best options for your practice from DentalKart. 

What is Dental Rubber Dam Isolation? 

Rubber Dam Isolation is a method of defining an operative field by isolating one or more teeth from the oral environment. The dam helps in eliminating saliva from the operative site, retracts the soft tissue and ensures patient safety.  

Why use a Dental Rubber Dam? 

The application of a rubber dam is often considered cumbersome, and many dentists dread the thought of placing one—sometimes even more than a patient fears the procedure itself. However, it offers numerous advantages. Let’s discuss these and perhaps even convince you to use one. 

1. Dry, clean operating field: A dental procedure without a pool of saliva interfering — what a privilege that is, right? The operator can efficiently perform procedures such as tooth preparation, caries removal, and the insertion of restorative materials in a clean and dry field. The time saved by working in a clear, uncontaminated environment with good visibility always compensates for the time spent applying the rubber dam. Additionally, a dentist should always use a rubber dam when excavating deep carious lesions where there is a risk of pulp exposure, as it prevents contamination from bacteria in oral fluids. Acting as a surgical drape, the rubber dam effectively isolates the field, minimizing microbial contamination. 

2. Improved access and visibility: A rubber dam provides maximum access and visibility for the operator. Moisture is controlled, soft tissues are retracted, and even the gingival tissue is mildly displaced to enhance access to and visibility of the gingival aspects of the tooth preparation. The lips, cheeks, and tongue are all simultaneously retracted with the help of a rubber dam. Additionally, the colored rubber dam offers a non-reflective background, creating contrast with the operating site, thereby enhancing visibility. This visual contrast improves the operator’s efficiency and, in turn, increases productivity. 

3. Optimized usage of the dental material properties: Adequate moisture control provided by a rubber dam prevents the compromise of the properties of dental materials used in a procedure. Restorative materials do not achieve their optimal physical properties if used in a wet field. Bonding to enamel and dentin is severely compromised or nonexistent if the tooth substrate is contaminated with saliva, blood, or other oral fluids. The rubber dam allows the operator the freedom to focus on the details of the restorative procedure, which is especially advantageous for technique-sensitive procedures. 

4. Protection of the patient: A properly applied rubber dam protects soft tissues from irritating or distasteful solutions and medicaments (e.g., etchants, sodium hypochlorite, etc.) used during treatment. It also safeguards soft tissues from high-speed burs. Thus, the rubber dam not only provides infection control, but it also acts as a physical barrier to protect other parts of the oral cavity during a procedure. 

5. Safety and Medico-Legal Considerations: The rubber dam prevents accidental ingestion or aspiration of endodontic instruments, materials, and associated dentinal debris. Performing endodontic procedures without a rubber dam poses a risk to the patient and, in some countries, is considered legally indefensible if an accident occurs. 

6. Reduction of Aerosol Contamination: Airotors are effective atomizers of blood, saliva, crevicular fluid, and exhaled products from the alimentary and respiratory tracts. If a rubber dam is not used, these can contribute to the contamination of the working environment, leading to cross-contamination for both the dental team and patients. Studies have shown that the use of a rubber dam can lead to a 70% to 98.8% reduction in the microbial content of airotor aerosols produced during dental treatment. Thus, the risk of aerosol contamination is significantly reduced by using rubber dams. 

7. Patient Comfort: Dentists often have a preconceived notion that patients won’t accept a rubber dam during a procedure. However, patients today are well aware of its benefits and are generally receptive to its use in their treatment. Their first experience may feel daunting, but once they get the hang of it and understand how the suction and operative field remain clear for their best treatment, they are more than happy with it. 

Disadvantages of Dental Rubber Dam: 

Since everything has its pros and cons, so does the rubber dam. The following are some disadvantages of rubber dam isolation: 

1. Cannot be used for unerupted teeth as the retainer cannot be supported. 

2. Limited use for some third molars. 

3. Difficult to apply on extremely malpositioned teeth. 

4. Technique-sensitive and thus considered time-consuming. 

5. Some patients object to the use of a rubber dam. 

6. Latex allergy can often pose a hindrance to its usage. 

7. The frame may cause pressure marks on the patient’s face. 

8. Not suitable for patients with severe gingival diseases or respiratory problems. 

Armamentarium for Dental Rubber Dam:  

Rubber dam application requires a number of materials and instruments, including rubber dam sheets, templates, retainers, punches, etc. All of these are supplied in a kit, but they can also be purchased individually depending on the need.

1. Rubber Dam Sheets:  

• These are available in 12.5 X 12.5 cm or 15 X 15 cm sheets.   

• Other than the size, they are also available in the following thickness: 
  • Thin – 0.15 mm 
  • Medium – 0.2 mm 
  • Heavy – 0.25 mm 
  • Extra heavy – 0.30 mm 
  • Special Heavy – 0.35 mm 

• Available in different colors – light and dark, with dark ones often preferred for contrast. 

• Available in different flavors like mint, banana and strawberry.  

• Material is often latex but can also be artificial latex (Isodam non-latex) or latex-free (Flexidam non-latex).  

• These sheets have a dark side and a shiny side. The shiny side should always be towards the tissue so that the dam can easily pass over them with minimal irritation, whereas the dull side should be towards the occlusal aspect so that no light reflects to cause obstruction in the vision.  

• A thicker dam material is more effective in retracting the tissue and is more resistant to tearing and is thus recommended for isolating Class V lesions with a cervical retainer. Whereas, the thinner material passes through the interproximal contacts easily, hence it is useful when the contacts are broad and tight. 

2.  Rubber Dam Frame: 

• The rubber dam frame or holder suspends the borders of the rubber dam sheet. The sheet is pulled over the frame and secured by the retaining spikes. It maintains tension in the dam so that the lips and cheeks remain retracted. 

• There are two types of rubber dam frames available:  
  • Metallic – Young’s Frame, which is a U-shaped metal frame with small metal projections for securing the borders of the rubber dam. 
  • Plastic – Nygaard- Ostby, Starlite Visi, LeCadre Articule frames are some of its types depending on the shape. 

• The plastic frames are lighter and more comfortable for the patients. Also, they are not radiopaque, so they can be left in place when taking radiographs. 

3. Rubber Dam Retainers: 

• A rubber dam retainer consists of four prongs and two jaws connected by a bow.  

• Various sizes and types are available for each tooth.  

• These are used to anchor the dam to the most posterior tooth to be isolated and also retract the gingival tissue.  

• These can further be classified into winged and wingless types.  

• The winged retainers are designed to provide extra retraction of the rubber dam from the operating field.  

• The bow of the retainer can be tied with dental floss before it is placed in the mouth to prevent accidental aspiration or swallowing of the retainer.  

• These retainers can be skipped for anterior teeth, except for the cervical retainer used for Class V restorations. 

4. Rubber Dam Punch:  

• It is a precision instrument with a metal table that has holes of varying sizes and a tapered, sharp, pointed plunger.  

• These can be of two types depending on the size of the hole punched.  

• The first is a single-hole punch, which cuts a standardized hole, and the other is a punch with a rotating table for cutting different-sized holes. The larger-sized hole is for molars, and the smaller hole is for mandibular incisors. E.g.- Ivory rubber dam punch, Ainsworth rubber dam punch, etc. 

• For single-tooth isolation, a hole is punched approximately 2 cm from the center of the rubber dam sheet, in a position corresponding to the tooth’s location in the quadrant. If multiple teeth are to be isolated, it may be helpful—but not essential—to use a rubber dam stamp, depending on one’s expertise, to facilitate correct positioning of the holes. 

• Irrespective of the type of punch used, it is important that the cutting part of the punch is sharp so that clean holes are obtained. 

5. Rubber Dam Forceps:  

• These forceps are used for the placement and removal of the retainers from the tooth.  

• These can be Brewer, IV-Type, or University of Washington rubber dam clamp forceps.  

• The dentist can choose the one as per their requirement. Their main purpose is to help the dentist apply pressure toward the gingiva, which is necessary to position the clamp securely below the bulge of the tooth crown. 

6. Other Rubber Dam Accessories: 

• Lubricant: These are applied in the area of the punched holes to facilitate smooth passing of the dam through posterior contacts and also help the dam pass over clamps. It is also applied at the corners of the patient’s mouth to prevent irritation. Commonly used lubricants include cocoa butter, petroleum jelly, etc. Additionally, the use of waxed floss enables initial lubrication of contact areas of the teeth to be isolated.  

• Rubber Dam Napkin: These napkins are placed between the rubber dam and the patient’s skin. They help in preventing allergies, act as a cushion, prevent pressure marks on the patient’s cheeks, and serve as a convenient method for wiping the patient’s lips upon dam removal.  

• Template: Helps in the correct placement of the dam and punching the holes at the correct position for each tooth. 

How to apply a Dental Rubber Dam?

Recent Modifications in Dental Rubber Dams:

1. Quick Dam or Insta-Dam- These are new types of rubber dams that have pre-attached frames. They are easy to apply and take minimal time for placement. Additionally, they are not radiopaque and do not need to be removed when taking a radiograph. They can be either rectangular or circular in pattern.  

2. OptraDam- It is a modification of Quick Dam for the anterior segment, where it can be fixed directly without the use of any retainer clamps and is quite simple to apply. Example: Ivoclar OptraDam Plus. 

Top 3 Dental Rubber Dam Kits available on DentalKart: 

1. GDC Dental Rubber Dam Kit – Adult (DDK) 

Key Features: 

• Comprehensive Isolation: Includes essential instruments for efficient rubber dam placement. 

• High-Quality Materials: Made from rust-resistant, autoclavable components for durability. 

• Ergonomic Design: Each tool is designed for ease of use and operator comfort. 

• Versatile Clamps: Multiple winged clamps to accommodate different clinical needs. 

Kit Contents: 

• 36 medium-thickness rubber dam sheets (6”x6”) 

• Plastic frame and template for accurate placement 

• Rubber dam punch and forceps for secure handling 

• 11-piece winged clamp set (Sizes: 2A, 3, 4, 12A, 13A, 14A, 201, 202, 205, 210, 211)

2. Waldent Stainless Steel Rubber Dam Instrument Kit 

Key Features: 

• High-Quality Construction: Made from corrosion-resistant stainless steel for long-term use. 

• Precision Isolation: Adjustable punch with six hole sizes for accurate tooth isolation. 

• Winged and Wingless Clamps: Versatile options for different clinical scenarios. 

• Autoclavable and Reusable: Designed for multiple sterilization cycles. 

Kit Contents: 

• 12 clamps (winged and wingless) 

• Medium and large metal dental dam frames 

• Adjustable dental dam punch and clamp forceps 

• Rubber dam template for precise hole placement 

• Sterilization container for safe storage 

3. Coltene Rubber Dam Kit Hygenic 

Key Features: 

• Single-Use System: Powder-free latex sheets for optimal hygiene. 

• Effective Isolation: Prevents contamination from saliva and blood. 

• Color-Coded Clamps: Simplifies selection for various applications. 

• Lightweight and Flexible: Ensures patient comfort and easy handling. 

Kit Contents: 

• 36 latex medium rubber dam sheets (6”x6”) 

• Plastic frame and template for proper positioning 

• Stainless steel dental dam punch (Ainsworth-Styled) 

• Clamp forceps for secure placement 

• Color-coded winged clamp pack (Fiesta series) 

• Small yellow Wedgets (7 Ft./2m) 

Conclusion: 

Incorporating a rubber dam into daily practice not only enhances treatment efficiency but also minimizes contamination, improves visibility, and leads to better clinical outcomes. Studies have consistently shown that procedures performed with a rubber dam yield superior prognoses compared to those without it. Every dentist should consider using a rubber dam whenever possible to elevate their practice and ensure optimal patient care. 

At DentalKart, we offer a wide range of high-quality rubber dams to help you integrate this essential aid into your workflow. Explore our collection today and take your dental treatments to the next level! 

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