Dental dam
The clamp will ideally fit snugly around the tooth along the margin of the gingiva, stabilising the dental dam and preventing contamination of the working area due to saliva ingress.
Dr Sanford C. Barnum was the original designer of the dental dam as a way to keep the operation site clear from saliva.
Although the use of rubber dam is considered a standard of care, studies showed that a large number of dental practitioners do not utilise it during procedures.
By doing this, the clinicians visibility of the tooth is greatly improved, due to the increase in contrast with the rubber dam around the tooth or teeth, whilst at the same time it retracts the soft tissues such as the lips, tongue, and cheeks, and reduces mirror fogging:allowing the clinician to focus solely on the restorative site, which can lead to the procedure also being more time-efficient.
[citation needed] A Cochrane review in 2021 suggests that the use of rubber dam as an isolation method provides a chance for dental restorations to last longer.
Disregarding the fact that it is low-quality evidence, there is still proof that over a two-year period, comparing restorations done using rubber dams versus cotton roll isolation, the rubber dam group had a lower risk of failure with a risk ratio of 0.80 compared to cotton roll isolation at 1.19, however, further research is needed on varying restorative treatments.
It does not eliminate the chance, but decreases the possibility of the patient accidentally swallowing or inhaling restorative instruments, tooth fragments or debris.
[10] That has happened in the past, and should this occur, the patient must always be admitted into hospital as a chest X-ray is necessary in order to discover where the inhalant may be and whether it may potentially need to be removed on the operating table or not.
[18] Not only instruments or debris, but also chemical materials used in dental procedures (such as acid etch, seals, and amalgam) can have harmful effects.
[19] Without the protection of a rubber dam, there is an increased risk of this chemical damaging the soft tissues of the mouth and being more harmful if swallowed.
The reason for this is that if an injury was to occur or possible cross-contamination and the result could have been prevented by rubber dam, this situation is regarded as medico-legally indefensible, meaning the clinician will not be able to defend themselves in court due to the duty of care falling under negligence of the patient.
The rubber dam can take extra time to apply; however, with consistent practice and use by the dental practitioner, this may not have an effect on the length of the appointment.
There is a risk of rubber dam clamps breaking during application due to the chemical effects of sodium hypochlorite, an antimicrobial solution used during root canal treatments, repeated stresses of clinical use,[25] or autoclaving,[26] all of which can potentially weaken the material.
As the dental dam clamp is placed along the gum line, this can cause some discomfort or pain (especially in a patient who does not require local anaesthesia), bleeding from the gums, damage to the periodontal ligament or abrasion of the cementum on the root of the tooth, which may cause an uneven surface on the tooth root that can retain plaque.
[27] The dental dam is placed over the mouth, effectively blocking off the airway, which means the patient must be able to comfortably breathe through their nose.
This is a problem for patients with nasal airway obstruction such as the common cold, a broken nose, adenoids, recurring sinus issues, or those who habitually breathe through their mouths.
[28] To an extent, the use of a dental dam may lead to visual distortion of tooth morphology since the other teeth and the rest of the mouth are hidden from view.
This will ensure the correct orientation prior to commencing removal of the blood vessels, nerve tissue and other cellular entities from the tooth.
[35] A 2022 NIH study found that "[d]ental dams can be an invaluable tool for safe oral sex, and it is important for patients to know how to use them properly[...]Although dental dams have been associated with a reduction in STIs, the lack of statistical significance may thus be explained in part by small sample sizes[...]From experience with patients in the STI clinic, the authors advise purchasing dental dams made specifically for oral sex because these are thinner than even the thinnest dental dams available for oral surgery[...]At this time, it is unclear if dental dams play a statistically significant role in decreasing incidence and transmission of STIs based on the current literature; this may be accounted for by factors, such as a paucity of data, infrequent use due to sparse patient education, perceived barriers to procurement and accessibility, and unfamiliarity on the part of providers.
Yet, there is a clear need for more provisional research on dental dams to ascertain their usage, perceived barriers, and efficacy in STI prevention.
