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Dentistry, Operative↗
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Effect of various irrigant and autoclaving regimes on the fracture resistance of rubber dam clamps.
Rubber dam clamps are known to break during clinical use in endodontics. This in-vitro study examined some of the variables which may contribute to the fracture. Stainless steel rubber dam clamps were subjected to various cleaning and autoclaving regimes and exposure to various solutions of sodium hypochlorite (NaOCl). Each clamp was examined after four cycles of cleaning and exposure to NaOCl. During environmental exposure to NaOCl, the clamp was stressed over a perspex rod to simulate placement onto the crown of a tooth. Clamps were examined after each test cycle visually and microscopically, or immediately after breakage. Results suggested that the fractures were because of a stress corrosion cracking phenomenon. There was evidence of intergranular and transgranular cracking of the metal. Corrosion spots were seen on the surface of the clamps and fracture occurred mainly through these spots. A number of recommendations to reduce breakage of clamps have been suggested.
Corrosion↗
Hardness and stress-corrosion of rubber dam clamps.
Rubber dam clamps fracture infrequently during use. There are no American National Standards Institute or International Standards Organization standards for their manufacture. The purpose of this study was to measure the hardness of the clamps and test their resistance to a stress-corrosion test. Upper molar, lower molar, and premolar clamps were obtained from two manufacturers (A, B). The Rockwell C hardness at four sites on the bow of each clamp was then determined. Fresh clamps were placed on blocks corresponding to the average buccal-lingual dimension of the tooth on which they would be used. These blocks were then submerged in room temperature 5.25% sodium hypochlorite for 20 min and then allowed to air dry for 30 min. This was repeated 10 times. Rockwell C hardness values ranged from C30 to 38, with the clamps of manufacturer B being significantly harder. None of the clamps from manufacturer B cracked or corroded. When a third batch received from manufacturer A was tested in the same manner, none of the clamps fractured or corroded either.
Analysis of Variance↗
An innovative method of cushioning metal clamp jaws during rubber dam isolation.
Competent rubber dam use increases both operating speed and treatment quality. In many instances, however, the application of rubber dam clamps may cause immediate and/or postoperative discomfort, and some dentists continue to use this as a "justifiable" excuse for not employing rubber dam. This paper reviews the iatrogenic potential of metal rubber dam clamps, and introduces a new cushioning technique that makes use of light-cured provisional material.
Acrylic Resins↗
Endodontic procedures must never be performed without the rubber dam.
The rubber dam is an absolute essential in all endodontic procedures. In documentation of that fact, we have presented the case of a 50-year-old man who swallowed an endodontic broach during endodontic treatment; the instrument passed through the gastrointestinal tract without difficulty.
Dental Instruments↗
An investigation of possible iatrogenic damage caused by metal rubber dam clamps.
Rubber dam may be held in place over a tooth by metal clamps. It has been shown that a mismatch of contact between the clamp gripping edge and the tooth surface may be reduced to a point contact, thereby concentrating the gripping force generated by the bow of the clamp. Experiments were conducted to measure the force. Clinically realistic loading of the tooth surface by sections of the gripping edge of clamps was carried out using special apparatus. Examination by scanning electron microscopy showed that iatrogenic damage to the tooth could occur. Therefore a plea is made for clamps to be redesigned to reduce any harm.
Dental Instruments↗
Endodontics: Part 6 Rubber dam and access cavities.
Rubber dam is easy to apply once the basic components and principles are understood. An efficient and well-trained dental nurse will greatly facilitate the application procedure. Although preparation of the access cavity may be commenced before rubber dam is applied to enable anatomical landmarks to be followed, the rubber dam should be placed as soon as possible with adequate protection against contamination of the access. The access cavity reflects the shape of the pulp chamber, modified by the angle of instrument approach.
Dental Auxiliaries↗
Rubber dam--the easy way.
Rubber dam use can only enhance a dental procedure by allowing better access, visibility, and dry field isolation. The reasons offered by many dentists for not using the dam can be overcome by additional training and clinical use. Suggestions are given that have made rubber dam use routine for the author and have facilitated much improved dentistry.
Dental Restoration, Permanent↗
Polydam--polythene sheet, a practical alternative to rubber dam for patients allergic to rubber compounds.
An alternative to rubber dam is required to ensure nasopharyngeal protection during endodontic procedures on patients who are allergic to rubber compounds. The use of polythene sheeting as a practical alternative is described, illustrated and discussed.
Dentistry, Operative↗
Scientific rationale and cost effectiveness of routine use of rubber dam in clinical practice.
The rubber dam was first developed and put to use in the 19th century by S.C. Barnum. Since then, the use of the rubber dam in dentistry has become mandatory especially during root canal treatment. Various irrigation solutions which are used during root canal treatment have toxic effects on the soft tissues around the teeth. This can be prevented or minimized when rubber dam is put to use. Similarly for esthetic dentistry, optimum results are obtained if the working area is protected from contamination by saliva.
Cost-Benefit Analysis↗
Rubber dam isolation in a difficult situation.
Rubber dam retainers can be modified easily in the dental office to enable the dentist to isolate teeth with difficult restorative problems with the rubber dam. Isolation with the rubber dam enhances visibility and access and gives the dentist the opportunity to render safe, restorative care of high quality to the patient.
Dental Caries↗
Using rubber dams to boost quality, quantity of restorative services.
Rubber dam use for restorative dentistry is far too low. If practitioners realized rubber dam's advantages and increased treatment quality, its use would be irresistible. Few other dental procedures offer both an increase in operating speed and treatment quality. To save the most time, competent auxiliary staff should be taught to place rubber dams before the clinical procedure begins. (Additional information on rubber dam placement by auxiliary staff is available from Dr. Christensen.)
Dental Restoration, Permanent↗
A new rubber dam frame design--easier to use with a more secure fit.
The application of the rubber dam (dental dam) is indicated in endodontics and for restorative dental treatments involving the acid-etch technique. The frequency of the technique's use varies significantly according to individual circumstances, and is generally too low given its advantages. One possible reason for many dentists' reluctance to use it could be frustrating results in the past with technically difficult applications. Such conditions arise, for example, when the taut rubber dam sheet exerts too much pull on the rubber dam clamps, causing them (and the entire rubber dam) to come loose. Particularly susceptible here are clamps attached to molars. This undesired tension results from stretching the rubber dam material--a necessary step--for attaching the sheet to the traditional rubber dam frame. As an alternative, a new easy-to-use rubber dam frame (Safe-T-Frame) has been developed that offers a secure fit without stretching the rubber dam sheet. Instead, its "snap-shut" design takes advantage of the clamping effect on the sheet caused when its two mated frame members are firmly pressed together. In this way the sheet is securely attached, but without being stretched. Held in this manner, the dam sheet is under less tension, and hence, exerts less tugging on clamps--especially on those attached to molars. Even in cases where there are no distinct anatomic undercuts, this lack of tension in the sheet eases isolation procedures and permits the use of standard rubber dam clamps. As a further benefit, the frame's raised edging provides a barrier around the sheet, which prevents small amounts of fluids from escaping. This contributes to greater patient comfort.
Dental Stress Analysis↗
Use of rubber dam and irrigant selection in UK general dental practice.
AIM: To evaluate factors which influence rubber dam use and irrigant selection in UK National Health Service (NHS) endodontics. METHODOLOGY: A postal survey was conducted amongst two age cohorts of dentists, representing all of the 1970-73 (older) and 1990-93 (younger) graduates of two northern English dental schools (n = 643). Key and supplementary questions were posed on levels of rubber dam use, irrigant selection, and factors influencing practice in NHS endodontics. After manual checking, validated (dual) entry of responses was made to a flat ASCII data file before analysis with SPSS software. The threshold for statistical significance was set at the 95% probability level. RESULTS: Eighty-five per cent of the valid sample responded to the questionnaire. Regardless of age and qualifying school, less than one-fifth of dentists always or frequently used rubber dam, whilst 60% never used it. Qualifying school had a significant influence on rubber dam use, whilst age had a variable influence. Major disincentives to the use of rubber dam included the perception that patients do not like it, that the NHS fee was inadequate to justify its use, that it took too long to apply, and that dentists had received inadequate training. Frequent users of rubber dam were significantly less likely to cite these disincentives than nonusers. Overall, local anaesthetic solution was the most common endodontic irrigant. Irrigant choice was strongly linked to rubber dam use, and to graduation cohort. Seventy-one per cent of rubber dam users irrigated with sodium hypochlorite, compared with only 38% of nonusers. This pattern was reversed for local anaesthetic irrigation. Younger graduates were significantly more likely to irrigate with local anaesthetic solution than their older counterparts, and the younger graduates of one school showed a highly significant increase in the use of chlorhexidine. CONCLUSIONS: 1) The majority of UK Health Service dentists never use rubber dam isolation in endodontic treatment. 2) Qualifying school has a significant impact on rubber dam use, and irrigant selection. 3) Use of rubber dam has a significant association with irrigant choice in endodontics.
Age Factors↗
Use of rubber dam and its association with other endodontic procedures in New Zealand.
The use of rubber dam for endodontic treatment in New Zealand was analysed by a national survey of general dental practitioners. The response rate was 79 percent. Rubber dam was used routinely by 57 percent, its use increasing among practitioners graduating since 1969. A greater percentage of practitioners with less than 10 years experience used rubber dam than did more experienced practitioners. Use of rubber dam was associated with sodium hypochlorite and EDTA as canal irrigants. Reamers were the favoured hand instrument of non-users of rubber dam. No significant differences were found in the canal obturation techniques of users and non-users, but rubber dam users used the long-cone paralleling method of radiography significantly more than non-users. Practitioners in solo practice used rubber dam significantly less than those in group practice. Rubber dam users attended significantly more refresher courses in endodontics than non-users.
Chi-Square Distribution↗
The effect of rubber dam placement on the arterial oxygen saturation in dental patients.
This study assessed the effect of rubber dam placement on arterial blood oxygen saturation in dental patients; it also determined whether the effects are technique sensitive. The study group consisted of 28 ASA Class I patients who were randomly allocated to one of two groups: Group A--rubber dam isolation of the maxilla (from tooth #14 to #6) and Group B-rubber dam isolation of the mandible (from tooth #19 to #27). A pulse oximeter was used to detect arterial blood oxygen saturation in both groups. Each patient's oxygen saturation (Sp02) was recorded every 30 seconds for two minutes to establish a baseline. Group A subjects received local infiltration in the vestibule above tooth #14, while Group B subjects received an inferior alveolar nerve block using 1.8 ml of 2% Lidocaine with 1:100,000 epiphrine, respectively. During the subsequent five minutes, the patient's Sp02 was recorded every 30 seconds. A rubber dam was then placed, which extended to the anterior septal angle (which completely covers the nose). This rubber dam remained in place for 20 minutes, with the patient's Sp02 being recorded every 30 seconds. The rubber dam was then altered (cut) to expose the nasal passages, creating what is known as proper rubber dam isolation, and the Sp02 was recorded every 30 seconds for 20 minutes. In both groups, there was no significant change in arterial oxygen saturation before or after rubber dam isolation was performed. Also, there was no significant difference in Sp02 when comparing the rubber dam isolation technique. Although rubber dam placement has no effect on blood oxygen levels in healthy patients, its effects on unhealthy patients are unknown.
Analysis of Variance↗
Secondary retention of rubber dam: effective moisture control access considerations.
Primary rubber dam retention affects attachment of the latex sheet to the anchor teeth bordering the isolated working field. Secondary rubber dam retention is the provision of an effective seal at the dam-tooth junction, which is essential to the maintenance of adequate access and moisture control within the working field. Practical hints are offered to optimize access and moisture control through well-planned and properly executed secondary retention of classic rubber dam applications. In addition, innovative solutions to the limitations of general field isolation, which pertain mostly to secondary retention of the unrestrained buccal and lingual curtains of the slit dam, are introduced.
Dentistry, Operative↗
An assessment of rubber dam usage amongst specialists in paediatric dentistry practising within the UK.
OBJECTIVE: Rubber dam is recommended by the British Society of Paediatric Dentistry (BSPD) for various restorative and endodontic procedures. To date, there has been no report of actual usage of rubber dam within the speciality of paediatric dentistry. The aim of this study was to assess the usage of rubber dam amongst paediatric dentistry specialists within the UK. METHODS: A postal questionnaire was distributed to all practitioners registered on the UK General Dental Council's 2004 specialist list in paediatric dentistry. RESULTS: Data were available for 162 questionnaires (a 75% response rate), and of these, 85% of respondents worked in the National Health Service (NHS), 4% were private practitioners and the remainder had a mixed NHS/private practice. Regarding the benefits of rubber dam, 65% and 52% of respondents quoted patient safety and moisture control, respectively. Perceived difficulties of dam usage were lack of patient cooperation and the non-necessity for a particular treatment, as quoted in 64% and 36% of the completed questionnaires, respectively. The most common modes of isolation for anterior and posterior teeth were Dry Dam(R) (58%), and clamp and dam (80%), respectively. CONCLUSION: Current BSPD guidelines recommend rubber dam usage for many restorative procedures; however, it would appear that there is wide variability in the application, as well as under-use, of rubber dam.
Adult↗