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potentially delaying immediate treatment (Fig. 5). The latex
can fragment and be driven gingivally or inhaled during
oral placement and removal. 5,7,21
The dam can also retard the full visualization of the oral
cavity (e.g., lingual fold), obstructing the view of nonisolated
teeth, blocking high-speed suction and irritating
the patient’s mucosa and skin. 6,17,18 Removal of the dam
can damage new restorations and increase the danger of
aspirations. 7,20
Alternatives
Dentistry has greatly advanced since the 1860s introduction
of the rubber dam. Long periods of painful intraoral
treatment are no longer routine. Materials are easy to apply
and relatively quick setting.
Today’s patient is well educated and cooperative when
compared with their Victorian-age relatives who required
dam use. Many alternatives to the use of the rubber dam
are now available. These include high-speed suction,
custom retraction devices, disposable cotton rolls, gauze
packs and throat screens, retraction cord systems, electrosurgery
and relatively moisture-tolerant restorative materials
(e.g., low zinc amalgam versus gold foils). 5,22
“Like the tooth key, gold foil
restoration and the 22 kt gold
shell crown (which were once
considered good dentistry),
the rubber dam should take
its place as a historical friend
and occasional adjunct to
dental treatment. It should
not be taught nor used as
a constant (and overutilized)
companion to
the modern practitioner.”
The rubber dam still affords practical uses in modern
dentistry and should not be abandoned. Unfortunately,
advocating unrestricted and arbitrary widespread use,
often under the guise of good dental practice, is abusive
to the patient and the dentist when more efficient
and comfortable alternatives exist. This antiquated technology
consumes too much valuable energy, materials,
and time of dental school faculty and licensing boards at
the expense of more significant procedures such as bonding.
Today, very few dentists (approximately 5 percent)
routinely use the dam. General application of the rubber
dam is hazardous to the patient, costly in time, effort and
money and, with few exceptions, is seldom necessary in
the contemporary dental practice.
Like the tooth key, gold foil restoration and the 22 kt gold
shell crown (which were once considered good dentistry),
the rubber dam should take its place as a historical friend
and occasional adjunct to dental treatment. It should not
be taught or used as a constant (and overutilized) companion
to the modern practitioner. CM
Figure 5: A rubber dam can be snagged by contact with a high-speed
dental handpiece.
Rubber Dam Hazards47