The Endo Archive

Article from Endodontic Specialists of Madison, S.C.

Rubber Dam Isolation

The use of the rubber dam is considered mandatory in root canal treatment and is the standard of care. (1,2,3,4) Procedural mishaps can occur during the treatment of a root canal. Iatrogenic perforations, instrument breakage, hypochlorite accidents, and anesthesia issues all have the potential to impact the outcome of treatment or the patient’s perception of treatment. Many problems can occur that are beyond the dentist’s control. However, with the use of the rubber dam, certain issues can be reduced or eliminated altogether.

With proper use of the rubber dam, both the patient and clinician are protected from the issues associated with aspiration or swallowing of instruments, tooth debris, or irrigating solutions. A surgically clean operating field is isolated from saliva, minimizing risk of bacterial recontamination during the cleaning and shaping of the root canal system. Increased visibility into the canals will enhance efficiency and potentially increase success by allowing the dentist to locate accessory anatomy. Although allergy to latex would be a contraindication to its use, a nonlatex rubber dam is available. (5)

In spite of the advantages of the rubber dam, it is underutilized in some parts of the world. (6,7) In a survey of Irish general dentists, the rubber dam was never used by 26% when performing root canal treatment on molar teeth. (8) Use of the rubber dam for endodontic treatment in New Zealand was evaluated by a national survey of general practitioners and it was used routinely by only 57%. (9) However, less than universal use of the rubber dam is not only an issue in foreign countries. In a recent practice-based research network survey (729 dentists) in the United States, the rubber dam was used for all RCTs in 44% of the cases and 15 percent never used it during RCT. (10)

Because the rubber dam can and must be used in every endodontic case, procedural issues with swallowed dental instruments will be limited to treatments in which use of the rubber dam is not an option.

Rubber dam in place to provide isolation and to prevent bacterial contamination during treatment. The rubber dam also ensures no instrument can be aspirated or swallowed.

Abdomen radiograph 30 minutes after swallowing instrument, showing file in lumbosaccaral region of intestine. Hrushikesh P. Saraf, Pradnya P. Nikhade, and Manoj G. Chandak. Accidental Ingestion of Endodontic File: A Case Report. Case Reports in Dentistry, Volume 2012.

In spite of the advantages of the rubber dam, it is underutilized in some parts of the world. (6,7) In a survey of Irish general dentists, the rubber dam was never used by 26% when performing root canal treatment on molar teeth. (8) Use of the rubber dam for endodontic treatment in New Zealand was evaluated by a national survey of general practitioners and it was used routinely by only 57%. (9) However, less than universal use of the rubber dam is not only an issue in foreign countries. In a recent practice-based research network survey (729 dentists) in the United States, the rubber dam was used for all RCTs in 44% of the cases and 15 percent never used it during RCT. (10)

Because the rubber dam can and must be used in every endodontic case, procedural issues with swallowed dental instruments will be limited to treatments in which use of the rubber dam is not an option.

 

 

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REFERENCES

1) American Association of Endodontics position statement- available at aae.org
2) Cochran MA, Miller CH, Sheldrake MA: The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc 1989; 119:141.
3) Cohen S: Endodontics and litigation: an American perspective. Int Dent J 1989; 39:13.
4) Cohen S, Schwartz SF: Endodontic complications and the law. J Endod 1987; 13:191.
5) Kosti E, Lambrianidis T. Endodontic Treatment in Cases of Allergic Reaction to Rubber Dam. J Endodon. 2002;28:787-89.
6) Ahmad IA. Rubber dam usage for endodontic treatment: a review. Int Endod J. 2009 Nov;42(11):963-72.
7) Susini G, Pommel L, Camps J. Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population. Int Endod J 2007; 40(8):585-9.
8) Lynch CD, McConnell RJ. Attitudes and use of rubber dam by Irish general dental practitioners. Int Endod J. 2007 Jun;40(6):427-32.
9) Koshy S, Chandler NP. Use of rubber dam and its association with other endodontic procedures in New Zealand. N Z Dent J. 2002 Mar;98(431):12-6.
10) Anabtawi MF, Gilbert GH, Bauer MR, Reams G, Makhija SK, Benjamin PL, Williams OD. JADA Continuing Education: Rubber dam use during root canal treatment: Findings from The Dental Practice-Based Research Network. JADA. 2013 144(2): 179-186.