Dr Wan Zaripah Wan Bakar School of Dental Sciences USM Health ...

Dr Wan Zaripah Wan Bakar
School of Dental Sciences
USM Health Campus
BDS (Malaya), Grad. Dip. (Adelaide), D.Clin.Dent
(Prosthodontics) (Adelaide), FRACDS

Outline of Lecture
• What is Rubber Dam
• Functions
• Armamentariums
• Steps of Application
• Techniques

What is Rubber Dam (RD)?
• The rubber dam is a flat thin sheet of latex/ non-latex that is held by
a clamp and frame that is perforated to allow the teeth that will be
worked on to protrude through the perforations in the sheet while all
the other teeth are covered and protected by the rubber dam.
• Moisture control
• Infection control

The Benefits
• Raincoat for your teeth
• Limits bacterial laden splash and splatter of saliva and blood.
• Restricts drowning response during rinsing the mouth in a procedure.
• Serves as a barrier, so your throat is protected from debris and tiny
instruments from being swallowed or inhaled.
• Isolates and protects the area that needs to be worked on.
Improves accessibility and visibility of the working area.
Infection control.
Helps to protect your gag reflex area from being triggered.
protects the lips and cheeks by keeping them out of the way.
Helps to keep your tongue out of the way of the work area so it is
not harmed.

• Give a dry clean environment for tooth colored fillings to be successful. The
moist air exhaled from your mouth can increase the humidity in the working
area causing weaker bonds leading to weaker fillings.
• Keeps teeth saliva free while performing a root canal so the tooth does not
get re-contaminated by the bacteria that is in saliva.
• Don't have to concentrate on staying open or positioning your tongue out of
the work area.
• Gives you peace of mind that objects will not fall into your throat.
Mandatory for endodontic treatments and deep caries lesions management

Contraindications
• If a tooth is too short to hold a clamp
• Tooth not fully erupted
• Not enough area to clamp tooth
• Patient's inability to handle their own oral secretions, e.g., a person
with Parkinson's disease (may have a diminished ability to swallow
and therefore be unable to handle saliva accumulation under the
rub)

Armamentarium
Instruments needed:
Topical LA or infiltration (optional
in patient)
Rubber dam
Punch hole
Clamps
Clamp holder
Floss
Rubber dam frame
Napkin (in patient)
Vaseline
Scissors
Triple syringe
Probe 6
Rubber Dam
Latex
Non-latex
Extra stretchable
Punch hole and Clamp holder
RD punch: eg. Aesculap DF 401; 1-5 holes size
Punch the hole following the tooth size

Clamps
Posterior
Anterior-”butterfly”
Types
Winged
Unwinged
Winged clamps provide more retraction of
tongue, cheeks, lips.
-Record the clamp no. and RD method for
future references.

• Rubber dam frame
- flipable frame
- place under the RD preferable
• Napkin
- avoids skin irritation, more comfort
• Vaseline
• Floss
• Oraseal (Ultradent)
- to seal the dam margin

Application steps
Steps:
• i) Position the rubber dam (RD) on the teeth area and marks the holes point.
• ii) Punch the correct hole size for the suitability of tooth size with the punch hole.
• iii) Apply vaseline on the inside surface of the hole on the RD.
-if tooth broken down – restore @ temporarise first @ use Cuff technique.
• iv) Choose the correct clamp and tie with the floss.
v) Apply topical or infiltration (in patients)
vi) Position the RD and clamps using one of the 3 techniques.
vii) Check the stability of clamps
viii)Position the napkin (in patient) and later apply the frame properly.
Technique I : insert clamp first
Technique 2 : Insert rubber dam first
Technique 3 : insert together; both fixed outside first
ix) Confirm the correct flip of the RD at teeth area using triple syringe and probe 6 for
proper isolation
x) Excess RD can be trimmed with scissors and tie the floss proper
xi) Check the symmetrical and uncovered the nose area.

• Single
• Multiple
• “Cuff Technique”
Rubber Dam Techniques
“Cuff Technique”
Indications:
- a very broken tooth
- more than one tooth need isolation
- avoidance of crown margin from chipping by the clamp
- bridge work
- treatment for subgingival or gum level area

References
• Endodontics and dental traumatology- An overview of modern endodontics.
Paul V. Abbott
• http://www.dentalgentlecare.com/rubber_dam.htm.
• Worksheet on rubber Dam placements manual