PDF Version - Glidewell Dental Labs

The rubber dam has been used for dozens of reasons: to
provide a clear field; saliva and muscle control; aspiration
and infection prevention; gingival isolation from caustic
agents; and treatment time-saver. 1−9 Many clinicians and
educators have insisted that the rubber dam should be
routinely used in quality dentistry and medical-legal protection,
even though good dental care (including successful
malpractice defense) can be accomplished without
it. 9−12 Although actively promoted in dental schools and
literature, very few practitioners routinely use a rubber
dam. 3,11
Most dental literature describes the rubber dam in positive
terms, but little is mentioned about its many hazards
to the patient and staff or the many superior alternatives
to its use. Because most literature stresses only the benefits
of the rubber dam, this article will emphasize the
dangers related to its use in an effort to encourage a balanced
perspective.
Figure 1: Most dams are made from latex and tend to tear.
In the early days of dentistry, practitioners had few ways
of controlling the oral environment during restorative
work. The instruments and materials available to the
dentist of the 1860s−1930s were used for lengthy procedures
during which a completely dry and clearly visible
field was needed. The rubber dam was developed for this
purpose and numerous techniques were devised for its
use. These techniques, compromises of classical dam
technique, included the split dam, mini dam, double dam
and large hole techniques. 4,13 In earlier times, use of the
rubber dam was necessary to ensure a quality restoration
or course of treatment. Today, such necessities are rare.
Hazards
The use of the rubber dam presents hazards that can
be classified into three categories: material limitations,
improper application and inadequate design situations.
Figure 2: Damaged gingiva from a rubber dam clamp sliding apically
Material Limitations of the Rubber Dam
Most rubber dams are made from latex and tend to tear,
leak and disintegrate as they quickly age, a process accelerated
by a few days of exposure to air and its pollutants
(0 3
, NO 2
) (Fig. 1). 4,14 Latex tends to decompose or melt
near flame and under high-intensity lights (e.g., during
bleaching). It is difficult to patch in the event of rips, it
sticks to numerous restorative materials (impression putty,
adhesives), and it can lose its integrity when exposed
to certain solvents (e.g., alcohol, methacrylate). 2,19
Figure 3: Radiograph of a rubber dam clamp and amalgam swallowed
by a patient
Rubber Dam Hazards45