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What Is A Dental Dam Used For

Written By Monday, April 25, 2022 Add Comment Edit

A thin, rectangular sheet used in dentistry to isolate the operative site

A dental dam or rubber dam is a sparse, half dozen-inch (150 mm) square canvass, normally latex or nitrile, used in dentistry to isolate the operative site (one or more teeth) from the rest of the mouth. Sometimes termed "Kofferdam" (from High german), it was designed in the United States in 1864 by Sanford Christie Barnum.[1] Information technology is used mainly in endodontic, stock-still prosthodontic (crowns, bridges) and general restorative treatments. Its purpose is both to prevent saliva interfering with the dental work (e.g. contamination of oral micro-organisms during root culvert therapy, or to keep filling materials such as composite dry during placement and curing), and to prevent instruments and materials from being inhaled, swallowed or damaging the mouth. In dentistry, utilise of a rubber dam is sometimes referred to as isolation or wet control.[2]

Dental dams are also used for safer oral sex.[3] [iv] [5]

Dentistry [edit]

Background [edit]

Safety dam isolation of upper left second premolar, held in place with a rubber dam clamp during endodontic therapy.

The technique used to use the dental dam is selected co-ordinate to the tooth requiring treatment. Several techniques tin can be used including unmarried molar isolation, multiple tooth isolation or split dam technique. The dental dam is prepared by punching ane or more holes in the dental dam sail to enable isolation of the advisable number of teeth required for the dental process. The dental dam is then applied to the tooth, anchored into place using a metal or flexible plastic clamp (chosen according to the molar and area it volition be applied to). The clench 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.[ citation needed ] Individuals may feel subjective discomfort due to the tight sensation of the dam clamp, therefore topical anaesthetic (liquid or gel) may exist applied to the gingiva at the operators discretion prior to applying the dental dam.[6]

History [edit]

Prior to the use of the rubber dam isolation method, many dental procedures had a high risk of contagion from saliva and bacteria infiltrating the tooth during a procedure. This can lead to the failure of the treatment being undertaken which tin result in farther interventions or the loss of a tooth. Dr Sanford C. Barnum was the original designer of the dental dam as a mode to keep the operation site articulate from saliva. Information technology was in 1882 that Dr S. S. White improved the design farther by adjusting the hole punched into the canvas. In spite of these changes, it was found to exist difficult to stabilise the dam around the tooth until Dr. Delous Palmer adult the metallic clamps which anchors the dam around the selected tooth. These clamps are available in diverse shapes and sizes which are designed to fit different molar structures and morphology.[7]

Current practice [edit]

At that place are several treatments where dental dam can be applied; dental restorations, endodontic treatments including root culvert therapy, scissure sealants, training of dental crown, dental implant and some veneer placements.

There is an ongoing controversy with the use and efficacy of rubber dam amidst dental practitioners.[viii] Some practitioners may routinely employ its use, for others it may only exist practical during selective treatments whereas many others will avoid its awarding altogether. Although the use of rubber dam is considered a standard of care, studies showed that a large number of dental practitioners practice not utilise it during procedures. The standard is defined by reasonable standard supported with current bear witness. [ clarify ] [9]

Armamentarium [edit]

The ready of a condom dam has many elements and involves the apply of specific tools and accessories which ordinarily consist of:

  • Rubber dam sheets
  • Clamps or hooks
  • Frame
  • Forceps
  • Dam Punch
  • Dental floss

Other materials that may exist used to help with the setting upwardly of safety dam are:

  • OralSeal[10]
  • Wooden wedges
  • Wedjets[11]

Prophylactic dam application [edit]

The dental dam sheets are predominantly made from condom materials such as latex or nitrile and tend to be 15 cm by 15 cm in length and width. The thickness of each dam canvas is approximately between 0.xiv mm and 0.38 mm but the size, shape, color and material that the dam sheet is made from can vary with differing manufacturers. Most manufacturers will likewise make dental dam canvass alternatives that are suitable for patients with allergies to materials such as latex and some may even make alternatives that tin can be autoclaved.

The dental dam is anchored around the crown of the molar using a metal clamp to seal and secure the safe dam sheet to the molar or teeth that are receiving handling during the dental procedure. The clamps come up in a variety of shapes and sizes which suit the beefcake of the different teeth in the mouth. Earlier placing the dam in the mouth dental professionals may cull to secure dental floss around the clamps; this acts as an anchor to prevent aspiration or swallowing. It tin can also provide a point of reference for the clinician to exist able to visualise and retrieve the clench if it dislodges from the tooth or the dam forceps.[12]

The purpose of the safety dam frame is to keep the dam sheet taut around target areas; this volition ensure that a clinician tin work effectively on the tooth without the dam sheet obstructing vision and becoming entangled in dental instruments during the procedure. There are several types of dental dam frames which have an assortment of purposes. The frames are fabricated from stainless steel, polypropylene or other polymer plastics. Irrespective of the material the dam frame is fabricated from, the frame will always take modest pins on the outer edges which human action to secure the dam canvass to the frame. The plastic dam frames are predominantly used in the case where dental radiography is planned as they are less radiodense, ensuring the frame appears radiolucent to avert superimposition of the frame in the radiograph.

The dam punch is a tool used to perforate holes of various sizes into the dental dam sheet. When punching holes in the rubber dam prior to a process the size and spacing of the teeth to be isolated should be taken into consideration. In multi-tooth isolation, the holes should correspond to the curve of the dental arch. The safety dam armamentarium can exist ready in a diverseness of ways; this usually depends on clinician preference and pedagogy.[13]

In difficult clinical cases, the standard dental clamp need to be adapted. 1 efficient method is using the carved gypsum bandage equally described by CAZACU NCE[xiv]

Advantages [edit]

Using a rubber dam for dental procedures can provide multiple advantages. A rubber dam can provide a clean and dry operating field away from substances such as saliva and blood. This is important for dental procedures every bit the bonding ability of adhesives and cements is heightened in a clean and dry field away from possible contagion, in guild for maximum adhesive strength between the restorative materials, dentin and enamel. If the surroundings is contaminated leading to poor bonding of the materials, the success and longevity of the restoration is shortened.[fifteen] [ needs update ]

When using the rubber dam, it is able to isolate one or more teeth. By doing this the clinicians visibility of the tooth is greatly improved, due to the increase in dissimilarity with the rubber dam around the tooth or teeth. Whilst at the same time it retracts the soft tissues such as the lips, tongue, cheeks, and reduces mirror fogging, allowing the clinician to focus solely on the restorative site which can lead to the procedure also existence more fourth dimension efficient.[16] [17] Fifty-fifty though it is commonly said condom dam takes too much time to apply in many means it can reduce the fourth dimension needed for the process, every bit non only does information technology merely isolate the tooth, it reduces the ability for the patient to communicate with the clinician. This is most benign for the over talkative patients which can sometimes hinder the efficiency of treatment and can instead allow more fourth dimension for the clinician to focus on the task at hand in order for the process to have less time.[ citation needed ]

A Cochrane review in 2021 suggests that the use of condom dam as an isolation method provides a adventure for dental restorations to final longer. Disregarding the fact information technology is depression quality evidence, there is still proof that over a ii-year period, comparing restorations washed using rubber dams versus cotton fiber roll isolation, the safe dam grouping had a lower take a chance of failure with a risk ratio of 0.lxxx compared to cotton wool roll isolation at 1.19, however, further inquiry is needed on varying restorative treatments.[18]

Additionally, a safe dam can human activity as an infection control barrier and reduce the chance of cross-contamination and infection. In example the patient may have a contagious disease the rubber dam decreases the hazard of the splatter of microbial content if the patient were to cough or the spread of microbes being caused past the pressure from the triplex, which is a tube or syringe used to evangelize air or h2o under force per unit area.[19]

A rubber dam can also protect patients' airways. Information technology does non eliminate the risk but decreases the possibility of the patient accidentally swallowing or inhaling restorative instruments, tooth fragments or debris. [10] It has happened in the past and should this occur, the patient must always be admitted into hospital every bit a chest 10-ray is necessary in order to discover where the inhalant may be and whether it may potentially need to exist removed on the operating table or not. As it has potential to be life-threatening if ignored.[xx]

Not but tin it be instruments or debris, chemic materials used in dental procedures such every bit acrid etch, seals, and constructing can have harmful effects. In endodontic procedures, corrosive irrigants are contained such as sodium hypochlorite (bleach).[21] Without the protection of a condom dam, there is an increased risk of this chemical damaging the soft tissues of the mouth and be more harmful if swallowed. Another case is during constructing restorations, amalgam contains the chemical element mercury, and if ingested during the placing of constructing tin cause potentially harmful side effects if not treated. All the same amalgam later on being placed safely, bear witness does suggest the exposure to mercury is at a level non harmful and rubber to the human torso.[22] [23]

Sealing agent used on a patient to fill in some gaps between the prophylactic dam and gingiva, afterwards a tear was caused in the rubber dam

The rubber dam tin also offer additional protection of the soft tissues of oral mucosa from sharp instruments, acting as a barrier between the instrument and the soft tissue. Additionally, associated with rubber dam is a caulking adhesive, caulking in definition is a material used to seal joints, in this can be used to fill in gaps between the prophylactic dam and gingiva every bit it adheres to the wet rubber dam or mucosal tissues, acting as another mode of protection.[24]

A big issue surrounding the rubber dam is its use equally part of a legal obligation. In some parts of the earth, the employ of a rubber dam is obligatory for procedures such every bit endodontic treatment. The reason for this is that if an injury was to occur or possible cantankerous-contamination and the result could have been prevented by rubber dam, this situation is regarded every bit md-legally indefensible. Meaning the clinician will not be able to defend themselves in court due to the duty of care falling nether negligence of the patient.

Lastly, some patients, in fact, prefer using the prophylactic dam as being told and understanding the risks they instead feel more than comfy knowing they are safer with than without information technology as well as feeling dissociated from the noises happening around them such every bit the drilling. Additionally, some patients tend to be more comfortable as they may prefer the feeling of not having h2o and suction running within their mouths.[25]

Disadvantages [edit]

Although there are many advantages of rubber dams during dental handling in that location are also associated risks and disadvantages. The rubber dam can take extra fourth dimension to apply; notwithstanding, with consistent practise and utilise by the dental practitioner, this may non have an effect on the length of the appointment. Bereft preparation and the inconvenience of application tin besides exist a deterrent for its use and can too contribute to lost time.[26] The cost of dental dams is an expense to the dental practice and could also be a disincentive. Although the rubber dams are inexpensive to purchase, initial costs for the armamentarium can exist high.

At that place is a risk of safety dam clamps breaking during application due to the chemical furnishings of sodium hypochlorite, an antimicrobial solution used during root canal treatments, repeated stresses of clinical use,[27] or autoclaving,[28] all of which tin potentially weaken the material. To avoid swallowing or aspiration of broken clamps, the dental practitioner should place floss around the clamp to allow its retrieval if it snaps or springs off during a procedure.

As the dental dam clamp is placed forth the gum line, this tin cause some discomfort or pain (peculiarly in a patient who does not require local amazement), bleeding from the gums, impairment 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.[29]

The dental dam is placed over the oral cavity, effectively blocking off the airway, which means the patient must be able to comfortably breathe through their nose. This is a trouble for patients with nasal airway obstacle such as the cold, a cleaved nose, adenoids, recurring sinus issues, or those who habitually breathe through their mouths. Patients can also find that advice is reduced between the dental practitioner and themselves, which may result in feelings of claustrophobia, vulnerability, and anxiety. Those decumbent to dental phobia and individuals who have learning difficulties, disabilities or special needs may find the utilize of dental dams incommunicable and intolerable.[30]

To an extent, the use of a dental dam may pb to visual distortion of molar morphology since the other teeth and the residual of the oral cavity are hidden from view. This may atomic number 82 to perforation if an admission cavity is incorrectly angled during root canal therapy. For this reason, endodontists may routinely begin their access crenel before applying the dam. This will ensure the correct orientation prior to commencing removal of the claret vessels, nerve tissue and other cellular entities from the molar.

The rubber dam, which is usually brightly coloured (blueish or green), may alter the apparent colour of the tooth, which tin can lead to incorrect pick of shade, e.g. during placement of a dental blended during a restorative procedure. For this reason, dental practitioners should select the appropriate shade of textile prior to the awarding of rubber dam.

Equally the rubber dams are primarily made of latex, patients may feel reactions which range from uncomfortable (allergic contact dermatitis, allergic contact cheilitis, allergic contact stomatitis) to life-threatening (anaphylaxis). Nitrile versions are bachelor for those with latex allergies and agin reactions can be avoided by patients informing dental practitioners of latex allergies prior to treatment or adverse reactions after rubber dam application.

Oral sex [edit]

Repurposing of a condom into a dam.

Flavoured dams packaged for sale as a safer sex production.

Dental dams are sometimes suggested for use as a physical barrier against the exchange of body fluids during cunnilingus and anilingus, especially for women who have sex with women to protect against sexually transmitted infections (STIs).[31] However, they are rarely used for this purpose,[31] [32] [33] and there is no good evidence that their use reduces the risk of STI transmission, including the risk of HIV infection.[33]

After lubrication with a water-based lubricant, an unpunctured dental dam may be held over the vulva or anus, assuasive oral stimulation of these areas without transmission of actual fluids or direct physical contact. Plastic cling wrap, condoms (repurposed by cut off the tip and band and cutting them lengthwise) or latex gloves (cut open up longitudinally) tin can be used for STI protection in a similar fashion equally a dental dam, past providing a physical bulwark to encompass the vaginal or anal areas during oral sex and these alternative barrier methods are more affordable and readily bachelor than dental dams.[31] [34] [35] Dental dams were initially promoted in the 1980s in some safer sexual practice campaigns every bit a barrier to forestall transmission of STIs during oral sexual activity.[31] They were introduced for utilize in some women's prisons in Canada and Australia (in the jurisdictions of New South Wales, the Australian Capital Territory, Western Australia, and South Australia) in the 1990s every bit a course of sexual barrier protection later on the Earth Health Organization (WHO) recommended that female prisoners should take admission to dental dams.[31] [34] Inmates take reported numerous problems with dental dam use, including the dam being too thick, lack of availability, poor gustation, and reduced sensations when used for oral sex. Dental dams are often reappropriated by prison inmates for other uses, such as hair elastics, placemats or shoelaces.[34] They are relatively expensive and difficult to obtain outside of the prison system.[36] Rubber dams are not manufactured, marketed, registered, tested or evaluated for their effectiveness every bit a STI prevention aid, and no studies currently exist on their permeability to STI pathogens.[37]

References [edit]

  1. ^ Elderton, R. J. (1971-02-01). "A modern arroyo to the use of rubber dam--one". The Dental Practitioner and Dental Record. 21 (6): 187–193. ISSN 0011-8729. PMID 5278933.
  2. ^ Luca Martinelli, The prophylactic dam technique, Academia.
  3. ^ "What's a dental dam?". www.plannedparenthood.org . Retrieved 2019-07-05 .
  4. ^ Summary of safety and effectiveness for Sheer Glyde dams
  5. ^ How to use a dental dam
  6. ^ Madrati, Ahmed; Abid, S; Tamimi, F; Ezzi, A; sammani, A; Shaar, Grand; Zafar, M (September 2018). "Dental-Dam for Infection Command and Patient Condom during Clinical Endodontic Treatment: Preferences of Dental Patients". International Journal of Environmental Research and Public Health. xv (ix): 2012. doi:10.3390/ijerph15092012. PMC6165332. PMID 30223521.
  7. ^ Martinelli, Luca. "THE Safety DAM TECHNIQUE". Academia . Retrieved six June 2019.
  8. ^ Feierabend, SA; Matt, J; Klaiber,B (2011). "comparison of conventional and safe dam systems in dental do". Operative Dentistry. 36 (iii): 243–250. doi:10.2341/09-283-C. PMID 21740241.
  9. ^ Yen, P; Huang, Southward; Chi, S (Nov 2014). "The Effect of Rubber Dam Usage on the Survival Rate of Teeth Receiving Initial Root Canal Handling: A Nationwide Population-based Study". Periodical of Endodontics. 40 (11): 1733–1737. doi:10.1016/j.joen.2014.07.007. PMID 25175849.
  10. ^ "OraSeal™ - Ultradent Products, Inc". www.ultradent.com . Retrieved 21 June 2019.
  11. ^ Duggal, Monty; Cameron, Angus; Toumba, Jack (2012-eleven-28). Paediatric dentistry at a glance. Wiley-Blackwell. p. 22. ISBN978-1-444-33676-four . Retrieved 8 May 2019. [ permanent dead link ]
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  13. ^ Scheller-Sheridan, Carmen (2013-05-20). Bones guide to dental instruments (2nd ed.). Wiley-Blackwell. ISBN9781118713587 . Retrieved 9 May 2019. [ permanent expressionless link ]
  14. ^ Cazacu, NCE (2014). "Dental dam clamp adaptation method on carved gypsum cast". Periodical of Medicine and Life. 7 (4): 499–506. ISSN 1844-122X. PMC4316126. PMID 25713609.
  15. ^ Wang, Yan; Li, Chunjie; Yuan, He; Wong, May CM; Zou, Jing; Shi, Zongdao; Zhou, Xuedong (2016-09-20). "Safe dam isolation for restorative treatment in dental patients". Cochrane Database of Systematic Reviews. nine: CD009858. doi:10.1002/14651858.cd009858.pub2. PMC6457832. PMID 27648846.
  16. ^ Cochran, K. A.; Miller, C. H.; Sheldrake, 1000. A. (1989-07-01). "The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment". Journal of the American Dental Clan. 119 (1): 141–144. doi:x.14219/jada.archive.1989.0131. ISSN 0002-8177. PMID 2760346.
  17. ^ Reid JS, Callis PD, Patterson CJ (1991). Safe Dam in Clinical Practise (1st ed.). London: Quintessence Publishing.
  18. ^ Miao, Cheng; Yang, Xiaoyu; Wong, May Cm; Zou, Jing; Zhou, Xuedong; Li, Chunjie; Wang, Yan (2021-05-17). "Rubber dam isolation for restorative treatment in dental patients". The Cochrane Database of Systematic Reviews. 2021 (5): CD009858. doi:10.1002/14651858.CD009858.pub3. ISSN 1469-493X. PMC 8127531. PMID 33998662.
  19. ^ Harrel, Stephen K.; Molinari, John (2004-04-01). "Aerosols and splatter in dentistry: a brief review of the literature and infection command implications". Journal of the American Dental Association. 135 (4): 429–437. doi:10.14219/jada.archive.2004.0207. ISSN 0002-8177. PMC7093851. PMID 15127864.
  20. ^ Tiwana, Karen K.; Morton, Teresa; Tiwana, Paul S. (2004-09-01). "Aspiration and ingestion in dental practice: a 10-year institutional review". Journal of the American Dental Clan. 135 (ix): 1287–1291. doi:10.14219/jada.archive.2004.0404. ISSN 0002-8177. PMID 15493393.
  21. ^ Cohen, S.; Schwartz, S. (1987-04-01). "Endodontic complications and the law". Journal of Endodontics. 13 (4): 191–197. doi:10.1016/S0099-2399(87)80139-5. ISSN 0099-2399. PMID 3471843.
  22. ^ Kremers, L.; Halbach, S.; Willruth, H.; Mehl, A.; Welzl, G.; Wack, F. X.; Hickel, R.; Greim, H. (1999-06-01). "Effect of safety dam on mercury exposure during amalgam removal". European Journal of Oral Sciences. 107 (three): 202–207. doi:10.1046/j.0909-8836.1999.eos1070307.x. ISSN 0909-8836. PMID 10424384.
  23. ^ Halbach, Southward.; Vogt, South.; Köhler, W.; Felgenhauer, Due north.; Welzl, M.; Kremers, L.; Zilker, T.; Melchart, D. (2008-05-01). "Blood and urine mercury levels in developed amalgam patients of a randomized controlled trial: interaction of Hg species in erythrocytes" (PDF). Environmental Research. 107 (1): 69–78. Bibcode:2008ER....107...69H. doi:ten.1016/j.envres.2007.07.005. ISSN 0013-9351. PMID 17767927. [ permanent dead link ]
  24. ^ "OraSeal*". CLINICAL RESEARCH DENTAL. Archived from the original on 2018-05-27. Retrieved 2018-05-27 .
  25. ^ Stewardson, D. A.; McHugh, E. S. (2002-10-01). "Patients' attitudes to rubber dam". International Endodontic Journal. 35 (10): 812–819. doi:10.1046/j.1365-2591.2002.00571.10. ISSN 0143-2885. PMID 12406374.
  26. ^ Hill, Edward Eastward.; Rubel, Barry Southward. (2008-10-01). "Do dental educators need to improve their approach to instruction safe dam use?". Journal of Dental Educational activity. 72 (10): 1177–1181. doi:10.1002/j.0022-0337.2008.72.ten.tb04596.ten. ISSN 0022-0337. PMID 18923098.
  27. ^ Chhabra, Mudrika; Greenwell, Ann 50 (2018). "Effect of Repeated Sterilization on the Tensile Strength of Rubber Dam Clamps". Pediatric Dentistry. 40 (3): 220–223. PMID 29793571.
  28. ^ Sutton, J.; Saunders, W. P. (1996-09-01). "Upshot of various irrigant and autoclaving regimes on the fracture resistance of safe dam clamps". International Endodontic Periodical. 29 (5): 335–343. doi:10.1111/j.1365-2591.1996.tb01394.10. ISSN 0143-2885. PMID 9206417.
  29. ^ Wakabayashi, Hajime; Ochi, Kouichi; Tachibana, Hitoshi; Matsumoto, Koukichi (1986). "A clinical technique for the retention of a safety dam clamp". Journal of Endodontics. 12 (9): 422–4. doi:10.1016/S0099-2399(86)80078-4. PMID 3463649.
  30. ^ Soldani, Francesca; Foley, Jennifer (Jan 2007). "An assessment of rubber dam usage amongst specialists in paediatric dentistry practising within the United kingdom". International Journal of Paediatric Dentistry. 17 (1): 50–6. doi:10.1111/j.1365-263X.2006.00796.x. PMID 17181579.
  31. ^ a b c d eastward Richters, J; Prestage, G; Schneider, Thou; Clayton, S (Jun 2010). "Practice women use dental dams? Safer sexual practice practices of lesbians and other women who take sex with women". Sexual Health. 7 (2): 165–9. doi:10.1071/SH09072. PMID 20465981.
  32. ^ Yap, L; Richters, J; Butler, T; Schneider, M; Kirkwood, K; Donovan, B (Jun 2010). "Sexual practices and dental dam use among women prisoners--a mixed methods study". Sexual Health. seven (2): 170–vi. doi:10.1071/SH09138. PMID 20465982.
  33. ^ a b Jonathan Zenilman, Mohsen Shahmanesh (2012). Sexually transmitted infections : diagnosis, direction, and treatment. Sudbury, Mass.: Jones & Bartlett Learning. p. 330. ISBN9780763786755.
  34. ^ a b c Yap, L; Richters, J; Butler, T; Schneider, K; Kirkwood, K; Donovan, B (June 2010). "Sexual practices and dental dam use among women prisoners - a mixed methods report". Sexual Health. 7 (ii): 170–6. doi:10.1071/SH09138. PMID 20465982.
  35. ^ "Dental Dam Use". www.cdc.gov. Centers for Disease Control and Prevention. Retrieved 2018-09-eighteen .
  36. ^ Stevens, P; Hall, J (July 2001). "Do women employ dental dams? Safer sexual practice practices of lesbians and other women who have sex with women". Journal of Obstetric, Gynecologic & Neonatal Nursing. 30 (4): 439–447. doi:10.1111/j.1552-6909.2001.tb01563.x. PMID 11461028.
  37. ^ Richters, J; Clayton, S (June 2010). "The applied and symbolic purpose of dental dams in lesbian safer sexual activity promotion". Sexual Health. 7 (2): 103–106. doi:x.1071/SH09073. PMID 20648734.

What Is A Dental Dam Used For,

Source: https://en.wikipedia.org/wiki/Dental_dam

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