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Rubber Dam Placement


When asking Dental Assistants how many uses a rubber dam in their practice, it shocking to see the show of hands. Studies show that only 15% of dental offices use rubber dam for adhesive procedures. Excuses come up such as; it takes too long to place, we just use cotton rolls, retractors get the same results. With so many new and innovative dams introduced, dam placement takes minutes. Why take chances?

What is a Rubber Dam

The dental rubber dam is a piece of thin, stretchable latex or non-latex material that becomes a barrier when applied to the selected teeth. The isolation technique helps protect the teeth for all types of dental procedures such as root canals, bleaching, and preparation and delivery on all types of restoration.

Why use a Rubber Dam

  1. Visibility is much better due to the contrast of colors of the dam and the teeth being prepared.
  2. Creates dry and non-contaminated field from saliva and other debris during all bonded procedures.
  3. Improves access during dental procedures by retracting the lip, cheek, and tongue from the field of operation.
  4. Protects the patient from swallowing any debris such as the removal of amalgam, old porcelain, and composite.
  5. Increases the efficiency, productivity and reduces the time required for treatment.
  6. Adds comfort for the patient and dentist.
  7. Infection Control.

Contraindicated

  1. Tooth may be too short to hold a clamp.
  2. Tooth may not fully erupted and there is not enough tooth to clamp to
  3. Patients that may not be able to swallow

Size

Dental Dam material is available in pre-cut squares of 6×6 and 5×5 inches. The 6×6 is used for posterior applications. The 5×5 squares are for anterior application and primary detention.

Thickness

The thickness gauge of a dental dam can vary from thin, medium, and heavy. Thin is used for endodontic, medium is the most popular for easy placement, and heavy for tight contact areas or the need for stronger support of the dam.

Color

Dental Dams come in a wide variety of colors. They come in colors of grey, blue, pink, purple, green, white, and yellow. They can also come scented or unscented, flavored or unflavored. Most dentists prefer the darker shades for contrast.

Dam Napkins

A dam napkin can be placed between the dental dam and the patients face. This helps to absorb moisture and increase comfort for the patient.

Dam Frames

A Dental Frame is necessary to stabilize and stretch the dam tightly over the teeth. Frames come in plastic and metal. Both can be cold or heat sterilized.

Lubricants

Lubricant such as topical such as Ultradents () or KY jelly can be placed on the underside of the dental dam for easier placement over the teeth and through the interproximal areas.

Dam Punch

The dental dam hole punch is used to create holes in the dental dam needed to expose the teeth that are to be isolated. The working end of the punch is used to puncture the dam for the correct hole sizes.

  • Size 5 is the largest size is an anterior tooth
  • Size 4 the next size smaller is for molars
  • Size 3 is for bicuspids and canines
  • Size 2 is for maxillary anteriors and incisiors
  • Size 1 is the smallest size is for Mandibular Anterior Incisiors

Dam Templates

Sometimes it is hard to know where to cut the holes on the rubber dam. This is where a dam template is handy. The dam template and stamp inkpad allow the assistant the exactly where to place the holes if the teeth are out of the arch form.

Dam Forceps

Dental Forceps are used to place and remove the dental dam clamp. The beaks of the forceps fit into the holes on the jaws of the clamp. The handles have a spring action that allows the forceps when squeezed to open up and fit over the tooth. When the handles are released, the clamp is let go.

Dam Clamps

A dental dam clamp is used to stabilize the dental dam. The dam clamp holds the dental dam secure on the end nearest the tooth that is being treated. Clamps can be ligated for security and safety of the patient from swallowing if the clamp becomes dislodged during treatment.

Selection of Clamps

  • Anterior Tooth: Use a double bowed clamp ()
  • Pre-Molar: Use a small, flat-jawed clamp()
  • Mandibular Molar: Use a flat-jawed clamp ()
  • Maxillary Molar: Use a clamp with a curved jaw ()
  • Partially Erupted: Use a clamp with sub-gingival designed

Different Dams to Choose From

Traditional Dental Dams

  1. Coltene Whaledent
  2. Zirc
  3. Roeko
  4. Ivory by Heraeus Kulzer
  5. Hu-friedy
  6. Ultradent

Conventional Dental Dams

  1. Optidam by Kerr
  2. Optradam by Ivoclar Vivadent

Placement of the Traditional Dam

  1. The dental dam and supplies are ready for use
  2. Determine the operating field.
  3. Mark and punch the hole positions.
  4. Select the correct clamp and ligate.
  5. For Posterior Isolation, Always go one tooth distal to the tooth (teeth) being treated and extend to the midline. Anterior Isolation include pre-molar to pre-molar.
  6. Position the clamp over the tooth with the lingual jaws of the clamp first, then the facial jaws. During the placement, you may need to keep your finger on the clamp to keep the clamp from coming off before it is properly seated on the tooth.
  7. Stretch the Dental Dam that has been punched over the anchor tooth.
  8. The ligature (floss) should be exposed and easy to grasp if needed.
  9. Position the frame over the dam and slightly pulling the dam to catch on the prongs of the frame.
  10. Fit the last whole of the dam over the last tooth to be exposed at the opposite end of the tooth that is anchored.
  11. Using your index fingers stretch the dam over the clamp. For more difficult interproximal contacts, use the waxed floss such as Glide by Proctor and Gamble or wedjets by (). The lingual end of the floss is looped over and inserted into the contact, while caring down more dam with it. Remove floss by pulling both ends buccally without disturbing the dam.
  12. Using a black spoon HuFriedy (), tuck the edges of the dental dam into the gingival sulcus.
  13. If the patient is having problems breathing, cut a small u shape just under the nose so the nasal passage is not blocked, and the patient can breathe easy.

Conclusion

Placement of the rubber dam should not be a nescience or an option. With today’s new systems Practice and Placement makes perfect.