Rubber Dam

Question 1

what is a rubber dam?

Answer 1

it is a means of isolating teeth during restorative and endodontic procedures

Question 2

what type of restorative procedures require rubber dam?

Answer 2

• composite fillings (especially molar teeth)

- bonded restorations:
cores
veneers
quartz fibre posts
ceramic crowns
resin retained bridges

Question 3

what type of endodontic procedures require rubber dam? x3

Answer 3

• direct pulp capping
• emergency treatment that involves opening into the pulp chamber
• ALL root canal treatment

Question 4

why is rubber dam mandatory for root canal treatments?

Answer 4

• eliminate salivary contamination
• reduces risk of cross-infection
• protects oropharynx from aspiration or swallowing of instruments, irrigants, tooth, material debris
• improves access to operational area:
  retracts and protects soft tissues
  improves visibility, dry field, less mirror fogging
• relaxes patient
• reduces chairside time

Question 5

why should a rubber dam be used?

Answer 5

• medically and legally mandatory for all endodontic procedures
• essential for effective infection control: pulpal and periradicular disease

Question 6

what are the legal implications of not using rubber dam?

Answer 6

• instruments can be inhaled/swallowed -> negligence

- disregarding legal standard of care

Question 7

what are the materials and equipment required for rubber dam placement?

Answer 7

• rubber dam sheets: nitrile/latex
• punch
• clamps
• frames
• ancillary items: napkins, floss, wedjets, OraSeal

Question 8

reactions to materials: which 2 types are there?

Answer 8

• irritant contact dermatitis
• allergic contact dermatitis
• each can be acute or chronic

Question 9

true latex allergy: what type of hypersensitivity?

mediated by? what happens with successive exposures?

Answer 9

• type I hypersensitivity
• IgE
• becomes more severe

Question 10

latex allergy:

• risk factors?
• symptoms?
• treatment?

Answer 10

• eczema of hands, food allergies, prolonged exposure
• swelling, lightheadedness, oedema, itching, difficulty breathing
• assess and call patient ambulance, epinephrine, 100% oxygen (10 l/min)

Question 11

what are the 5 different types of clamp designs?

Answer 11

• winged
• wingless
• passive clamp
• active clamp
• anterior clamp

Question 12

winged clamps:

how are they placed?

Answer 12

placed with rubber dam attached to the clamp

Question 13

wingless clamps: how are they placed?

Answer 13

clamp has to be placed on tooth before applying rubber dam

Question 14

passive clamp: suits which teeth?

Answer 14

most molars with an intact crown

- not aggressive

Question 15

active clamp:
good choice for?
can traumatise which tissues?

Answer 15

• for tooth that is badly broken down, partially erupted or has no undercut
• aggressive clamp, do not use on porcelain crowns
• may traumatise gingival tissues

Question 16

anterior clamp:
particular feature?
what are its uses?

Answer 16

• very aggressive
• for teeth with minimal coronal tooth structure
• retraction of gingival tissues for placement of composite/GI cervically

Question 17

rubber dam frames: what are the 2 types?

Answer 17

• plastic nygaard-ostby

- metal frame

Question 18

why must dental floss/tape be tied around clamp?

Answer 18

to prevent clamp from falling into oral cavity in the event of accidental breakage
allows retrieval if it flies off or breaks

Question 19

what is oraseal caulk putty used for?

Answer 19

it prevents the seepage of saliva or irrigant through rubber dam

Question 20

location of hole in rubber dam?

Answer 20

hole should be made in a way where the rubber dam should protect the oropharynx by sitting above the patient’s upper lip
* however, it should not cover the patient’s nose

Question 21

factors in the choice of clamp?

Answer 21

• size of tooth (tooth type)
• active/passive clamp (tooth structure)
• winged/wingless (depends on technique of application)

Question 22

what could cause clamps to break?

how is dental floss threaded into the clamp?

Answer 22

• effect of sodium hypochlorite or autoclaving

- length of floss threaded through one hole, around the bow, and threaded through the other hole

Question 23

what are the 3 main methods of rubber dam application?

Answer 23

1. rubber dam attached to the clamp (winged), with or without frame
2. (winged or wingless) clamp is placed directly on the tooth, dam is then stretched over
3. dam stretched over tooth, then clamp is placed over

Question 24

broken down teeth/bridgework?

Answer 24

• cement orthodontic/copper band around tooth
• split-dam technique: clamps are placed on teeth mesial and distal to broken tooth
  dam stretched over 3 teeth
  requires extra protection from salivary contamination/leakage by using cotton wool rolls in the sulcus and salivary ejectors

Question 25

anterior isolation: how to carry out?

Answer 25

• punch a series of 8 holes,
• place topical anaesthetic over teeth being clamped.
• seat clamp on premolar tooth to ensure stability
• place dam over premolara-premolar

Question 26

advantages of anterior isolation?

Answer 26

clamps are placed well away from tooth being treated - will not obscure apex while taking radiographs
- dam can be placed prior to cutting access cavity: easier to follow long axis of tooth

Question 27

what type of radiographs are required during root canal treatment?
what equipment must be used?

Answer 27

• working length radiograph
• trial point radiograph
• endodontic film holder