Rubber Dam Application in Dentistry

• Operative dentistry must have controlled moisture to be properly executed.
• Moisture control means excluding sulcular fluids, saliva, and gingival bleeding from the operating field.
• Preventing spray and restorative debris from being swallowed or aspirated is part of moisture control.
• Rubber dams, suction devices, and absorbents can provide moisture control.
• Effective isolation is more important than the specific technique used.
• Isolating provides maximal exposure of the operating site.
• Patients maintain an open mouth and depressing or retracting the gingival tissue, tongue, lips, and cheek to give maximum retraction and access.
• Isolation prevents harm.
• Isolation prevents excessive saliva and spray, aspirating or swallowing instruments and debris, and tissue damage.

Isolation Techniques

• Defining the operating field requires isolating one or more teeth from the environment in the mouth, typically by using a rubber dam.

Rubber Dams

• The advantages include a dry, clean operating field, improved access and visibility.
• The advantages are potentially improved properties of dental materials, protection of the patient and the operator, and operating efficiency.
• Disadvantages include time consumption and patient objection.
• Rubber dams typically can be placed in less than 5 minutes.
• The advantages outweigh the time spent with placement.

Materials and Instruments

• Materials and instruments include rubber dam sheets, frames, retainers, forceps, punchers, napkins, and lubricant.

Rubber Dam Sheet

• Rubber dam sheets have a shiny side and a dull side.
• The dull side is less light reflective.
• The dull side is generally placed facing the occlusal side of the isolated teeth.

Light Rubber Dam

• Allows easier passage through the contacts, which is particularly helpful when the contacts are tight.
• Light rubber dams tear easily.

Dark Rubber Dam

• Advantages include maximum retraction, excellent contrast, and more resistance to tearing.
• Disadvantages are that perforations need to be precise and it is difficult to stretch.

Frame

• Is U-shaped with small metal projections for securing the borders of the rubber dam in position.
• Maintains the borders of the rubber dam in position.

Retainer

• Consists of four prongs and two jaws connected by a bow.
• A properly selected retainer should contact the tooth in its four line angles and prevent rocking or tilting.

Winged Retainers

• The wings are designed to provide extra retraction of the rubber dam from the operating field.
• Allows attachment of the dam to the retainer before applying the clamp.

Active Clamp

• Has prongs that are gingivally directed (inverted).
• Helpful when the anchor tooth is partially erupted or additional soft tissue retraction is indicated.

Retentive Clamp

• The retainer is used to anchor the dam to the most posterior tooth to be isolated.

Retraction Clamp

• Retainers are used to retract gingival tissue.
• The bow of the retainer (except the No. 212) should be tied with dental floss approximately 12 inches in length before placement into the mouth.
• The floss allows retrieval of the retainer or any broken parts if accidentally swallowed or aspirated.

Forceps

• Rubber dam retainer forceps are used for placement and removal of the retainer from the tooth.

Puncher

• Is a precision instrument with a rotating metal disk with varying sizes and a tapered, sharp-pointed plunger.
• Distances between holes that are excessive means dam material is excessive and wrinkles between teeth
• Too little distance between holes can cause the dam to stretch, resulting in space around the teeth and cause leakage
• Smaller holes must be punched to achieve an adequate seal around the teeth when a thinner rubber dam is used due to its greater elasticity.

Napkin

• A rubber dam napkin is placed between the rubber dam and the patient's skin.
• A napkin improves patient comfort by reducing direct contact of the rubber material with the skin.
• It absorbs any saliva seeping at the corners of the mouth and acts as a cushion.

Lubricant

• The lubricant is water-soluble and facilitates the passing of the dam septa through the proximal contacts.
• Alternatives to rubber dam lubricant are shaving cream.
• Cocoa butter or petroleum jelly may be applied at the corners of the patient's mouth to prevent irritation, however they are not easily rinsed.