A dental dam or rubber dam (sometimes termed “Kofferdam”—from German), designed in the United States in 1864 by Sanford Christie Barnum, is a thin, 6-inch (150 mm) square sheet, usually latex or nitrile, used in dentistry to isolate the operative site (one or more teeth) from the rest of the mouth. It is used mainly in endodontic, fixed 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 canal 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, use of a rubber dam is sometimes referred to as isolation or moisture control.
However, it seems that it is still not being universally applied in general practice. The most recent study examining the use of rubber dam and reported in the British Medical Journal5 showed that less than half of the sample of 1,490 American dentists were routinely using a rubber dam every time.
Now, a widely reported6 accident in the UK, in which a file fell into a patient’s airway and pierced the patient’s stomach, highlights well the important role of the rubber dam in protecting the airway. Publicity of this kind is not what the profession needs.
Some years ago the Chief Dental Officer mandated single patient use of endodontic instruments to support cross infection control. Perhaps the procedural use of rubber dam should now be mandated to prevent further calamitous consequences?
In an era when forums provide resources and the opportunity for the sharing of information, it should not be argued that rubber dams are not tolerated. Well-informed patients can see the logic of isolating a tooth for both clinical and safety reasons.7
There is no better way of demonstrating that we put patients’ interests first than by only operating according to best practice. The message should be no rubber dam, no root canal treatment.