Nicolas Coomber discusses the importance of a rubber dam.
The effectiveness of dental dams should not be ignored for endodontic and restorative treatment. They offer many advantages to both patients and dental teams – they could be considered essential in reducing the degree of aerosol generating exposure (AGE) and contamination, as well as providing a physical barrier to prevent patients from accidentally swallowing or inhaling dental instruments. Dental dams are also extremely useful in improving visibility and making procedures easier to carry out.
Potential challenges
During root canal treatment, dental dam isolation is considered the gold standard of care because it provides the patient and practitioner with so many advantages. However, it’s still not commonly used among all dental clinicians, with less than 19 per cent placing dental dams during root canal treatment and 45 per cent reporting that they never use one. This may be due to minor issues such as inconvenience of application, increased cost and prolonged treatment time. However, it’s important to understand the wide-ranging benefits that dental dams could offer to improve clinician safety, the safety of their patients, and their treatment outcomes.
Benefits for patients and clinicians
Using a dental dam significantly reduces splatter. Reducing contamination is essential for minimising the risk to your team. When using a dental dam, bacterial contamination from AGE has been shown to reduce by 70-98.9 per cent – a particularly useful tool in managing the risk of contamination.
Alongside this, one of the most obvious reasons for using a dental dam is that it provides a physical barrier for protecting the patient’s airway from accidental aspiration or swallowing of instruments, irrigants and debris. From a legal point of view, it would be difficult to defend reasons for not using a dental dam in the instance that a patient were to ingest or inhale a dental instrument, like an endodontic bur. Over the last 10 years endodontic files, filling materials, implant screwdrivers, prostheses, and scaler tips have been amongst the most common instruments or materials to be accidently swallowed or inhaled. The Dental Defence Union recommends using a dental dam to minimise this risk. Dental dams also ensure the isolation of the tooth or teeth undergoing treatment. This is especially important in endodontics as the outcomes of treatment are reliant on preventing re-infection from the oral cavity. It’s also beneficial to achieve sterility of the exposed dentine-pulp complex prior to sealing with cement. When carried out using a dental dam, endodontic treatment resulted in higher rates of success.
The use of dental dams during treatment also help to improve workflows. When dental dams are applied, surrounding soft tissues are retracted, providing the practitioner with easier access to the treatment site. The barrier also means that saliva is unable to contaminate the treatment site and fog up the mirror, making treatments easier, more efficient, and less stressful to carry out.
Informed patients for improved acceptance
It’s important that both practitioners and patients fully understand the benefits of using a dental dam during treatment. Patient reluctance to accept the use of dental dams may also be a hindrance, with discomfort and rejection preventing dentists using the dental dam. This makes effective communication with patients vital for maximising acceptance. The use of a dental dam is extremely beneficial and can protect the health of your patients and your dental team, as well as protecting you legally should things go wrong.
The HySolate Latex Dental Dam range from Coltene is low-protein and powder-free, for a reduced risk of hypersensitivity, and provides an enhanced dental dam solution which is ideal for use in endodontic and restorative treatment. The HySolate range of dental dams is available in a wide array of scents, thicknesses and colours to meet the specific needs in each case.
Inform patients of the advantages of using a dental dam to help improve treatment acceptance. Be sure to discuss the advantage of preventing accidentally swallowing of a file, for example. Instrument inhalation is a life-threatening accident and not necessarily uncommon if a dental dam is not used; 36 per cent of instrument ingestion cases require hospitalisation. Patient safety is vital, and dental dams are an excellent tool for treating endodontic patients. They also offer the additional benefit to the dental team of acting as a barrier to spreading infection.
References available on request.