Ever since Sanford Christie Barnum introduced the idea of dental isolation during dental procedures in 1964, and subsequent developments in 1882 by SS White, it has become an essential element of everyday dental procedures. This blog is your complete guide to dental isolation - if you want to learn about the advantages, disadvantages, instruments and materials of dental rubber dams in the dental practice.... Read on!
To begin with, let's talk about the advantages and disadvantages of using dental rubber dams in dentistry procedures:
- Mostly, dental dams are used in procedures that require bonding or the use of irritating chemicals. The barrier created between the hard surface of the tooth and the soft tissues, lips and tongue by the dam not only ensures that the patient does not experience tissue damage from chemicals and adhesives, but also keeps the oral area free of fluids or debris that compromise the effectiveness of adhesives.
- Recently, the COVID-19 pandemic has made isolation more important than ever. As we mentioned in our blog on reducing aerosols in the dental practice, it is really important to use dams to mitigate the risk of viral spread in procedures that use turbines.
- Another benefit of using dental dams is that they avoid the risk of the patient swallowing or choking on any dental tools or instruments that the dentist uses.
- The final major benefit of using dental dams in dentistry is that they greatly increase the visibility of the work area for the dentist. This means that human error is reduced and the duration of the procedure can be minimised to make the practice more efficient and avoid any possible discomfort for the patient.
However, that said, there are a few things that dental professionals should be aware of when deciding to use dental isolation techniques:
- Make sure the patient does not suffer from latex allergies, as many dental dams contain latex. Some dental dams, such as those from VIDU, are low in protein, which is the main cause of allergic reactions in latex-containing products.
- The dentist must also be careful with the placement of the dam. In some cases, the use of a dam restricts breathing - this is easily resolved by trimming the rubber dam around the nose and ensuring that the patient has unrestricted breathing before starting the procedure.
- There is a possibility that the dental clamps used on the tooth could become dislodged and be swallowed, read on for a solution to this risk.
- Finally, if the clamp is not placed correctly on the teeth, it can damage the soft tissues around the base of the tooth. Remember that the clamp should not cause extreme pain to the patient. If they experience severe pain, the clamp is most likely too close to the tissues, and you'll need to adjust it.
Next, it'll help to clarify the whole process of dental isolation, from preparation to safe removal. Let's go through the different instruments you will need to start using this technique in your own practice.
The most important bit: The rubber dam:
Rubber dams may look very similar to each other, but there are some really important differences to take into account when stocking the clinic.
- Thickness: Dams are available in various thicknesses to suit different needs. All brands do not offer all thicknesses, but as a general rule, there are 5 thicknesses: Thin, Medium, Thick, Extra Thick and Specialised Thickness.
- Size: Almost all rubber dams are 6" x 6" in size. For children and patients with smaller oral cavities, you can get 5 x 5 inch dams.
- Colour: The choice of dam colour is entirely up to the dentist. The dams are usually brightly coloured, such as blue, green and pink so that the white teeth stand out against the gum and maximise visibility.
Although rubber dams must be disposable and are rarely recyclable, as they are not made of sterilisable material and carry a biohazard risk, this doesn't mean they can't be used environmentally consciously. In collaboration with The Gravity Wave, we have created VIDU's rubber dams, which compensate for the weight of plastic used in their manufacture. Plus, they come in recyclable packaging so you can be sure that your practice isn't harming the planet.
Blue Powder-Free Rubber Dams (36 pcs)
- Available in different thicknesses - medium and thick
- Size: 6" x 6" (152 x 152 mm)
- Tensile Strength: 24.0 Mpa (min)
- Box of 36 units
These VIDU rubber dams are low in protein, which drastically reduces possible allergic reactions in patients. They have high elasticity, allowing for quick and comfortable placement and guaranteeing a 10-fold expansion in size. They are blue to contrast with the colour of the patient's teeth and, thanks to their high tolerance to tearing, provide easy clamp fixation.
*Medium thickness is also available in green to suit individual dentist's preferences.
The Dental Dam Puncher
Another key instrument in the isolation process is the dam puncher. When the dams arrive at the clinic, they are simply a square of rubber. The dentist must use a dam puncher to mark and punch holes in the dam tailored to each patient's mouth and tooth structure. Each punch has a rotating disc that allows the dentist to select the size of hole required, which typically ranges from 2mm holes for molars to 1.5mm holes for anterior and smaller teeth. The following diagram helps to conceptualise the operation of the puncher.
You can take a look at all dam punchers on Dentaltix in their specific category.
Clamps
The next vital pieces of equipment in dental isolation are clamps. There are several standard types, all specifically designed for use on different tooth shapes and in different situations.
There are several variants of the clamps including:
- Serrated or smooth - serrated clamps tend to give a stronger grip on the tooth.
- Distal arch - This creates a space around the entire tooth to provide unrestricted access to the teeth, for example, allowing instruments to reach cavities.
- Clamp with gingival retraction - keeps all soft tissues compressed and allows better access to the base of the tooth
- Winged - these clamps come with a small metal extension on each side to allow the dentist to fix the dam before placing the clamp on the tooth and means less intraoral positioning is required and improves patient comfort
- Wingless - sometimes it's not possible to position the dam before inserting it into the mouth, so a wingless clamp can be used and then the dam can be placed on top once the clamp is attached to the tooth
WARNING! It is recommended that you tie a piece of dental floss to the clamp and secure it before inserting it into the mouth. This prevents the patient from suffocating or swallowing the clamp in the event of it becoming detached from the tooth.
There is an entire blog created specifically about clamps and their classifications that will help you pick the ones you need in your practice.
Clamp forceps
The last important instrument in a dental isolation procedure is the clamp holder for inserting the clamp.
- They have arms with a small tip that fits into the clamp hole, which means they will not come loose or cause damage to the soft tissues of the mouth when inserted.
- The clamp handles have a sliding ring that slides up and down on the shaft of the handle, allowing the dentist to control its movement and can be used for both insertion and removal of the clamps.
- The clamp handles have a spring-loaded hinge, which means they can stretch the clamp over the tooth and then allow the clamp to grip gently over the tooth.
They are essential for the correct and safe placement of the clamps. They are specifically designed for this procedure for the following reasons:
There is a specific section of our site that allows you to view, compare and read reviews of Clamp holders from the best brands.
Other tips to remember
There are a few more things you may need to carry out absolute isolation, and it depends on how you like to carry out this procedure as to whether you find them useful. Either way, here are a few things that dentists use to make the process easier:
- Water-based lubrication in the corner of the mouth to avoid irritation to the patient's skin.
- Dental floss, used as a safety measure to prevent the clamp from being swallowed or the patient from choking, and is also used to help the dentist to push the dam securely between the teeth.
- Dental dam Arch or Young's Arch - a piece of metal or plastic bent into a U-shape, used to stretch the dam and facilitate access to the isolated teeth.
- Plastic clamps - are sometimes used because they are non-metallic and therefore do not interfere with radiography. However, it has been observed that they are not as strong as metal clamps and, therefore, are less commonly used.
- Wedges - They can be used to further stretch the dam to ensure that it is securely attached to the tooth base. They are also used to provide clearance for the teeth and to attach a matrix if necessary.
Today, absolute isolation is a widely used procedure in many specialties of dentistry, especially in endodontics and aesthetic adhesive dentistry. You will find all the products we have already mentioned in the 'Endodontics' category, which is the specialism where all these materials are traditionally used.
Let's see how the professionals do it...
Now that we've gone over the main reasons to use dental insulation and the tools you'll need, the best way to understand how the process is done is to see how a professional does it.
Before you go, there's something we want to tell you!
If you want to try an isolation method that isn't so time-consuming and easier to insert and use on a daily basis, take a look at Optradam dental dams. It's a newer innovation to traditional methods and is preferred by some dentists, as it is a single unit that is inserted into the mouth with a single movement. It can also come with a pre-marked dental arch, which means that all the dentist has to do is drill the holes, lubricate and insert the dam around each tooth.
Here is one of the Optradam dams we have at Dentaltix. Let us know what you think and if Optradam is your preferred method of dental isolation!
OptraDam Plus: Rubber Dam (50 pcs)
- Automatic adaptation and total isolation of the two sets of teeth.
- Perfect for different dental treatments.
- Small size model (small) for adults.
- Box of 50 units.
OptraDam Plus is based on the innovative three-dimensional technique that establishes a completely dry working field. The anatomically shaped and flexible three-dimensional design makes it completely different from conventional rubber dams.
Go to Ivoclar Vivadent OptraDam Dams
There you have it! A comprehensive and concise guide to everything you and your practice need for dental isolation. It may seem like a long and arduous process, but it gets much easier over time and soon you'll be using it every day. It is a proven way to increase the efficiency of procedures, reduce human error and patient discomfort. What are you waiting for?
Any questions or suggestions? Keep in touch with us and let us know how you are getting on through our social media channels linked below.
Good luck!