Some of my patients are surprised when they see a rubber dam for the first time. It is something that I use for nearly all of my treatments that involve using "dental glue" (adhesive treatments) or where I want to keep the zone of work as germ free as possible. The rubber dam has been around for a long time but certainly is being used more and more for dental procedures and especially during the Coronavirus pandemic, it has been recommended for all aerosol procedures where possible. With that in mind, this post is about what it is and what to expect.
The rubber dam itself is a sheet that goes over your tooth or teeth and isolates them from your mouth. It looks a little strange, but it stops all of our materials going into your mouth, including the water spray, and it stops your saliva, blood and plaque getting in the way of your treatment.
When we put a rubber dam on, it can be a little fiddly, but in most cases it only takes a minute or so to place. The dam comes in different colours and we aim to use latex free where possible. Most importantly, it will not stop you being able to breathe at any point!
The right sized holes are punched into the sheet to allow your tooth or teeth to poke through. Then floss can be used to ease the dam over the teeth and down between the tight contacts where your teeth touch together. Sometimes a clip or clamp is used over one of the teeth to hold it down tightly and this is applied using a special forceps. In some cases some local anaesthetic might be used to make this more comfortable because in order to get tooth as dry as possible the gum might need to be squashed down by the clip or floss. It will be a little uncomfortable afterwards for a few days but will recover quickly. Once the dam is nicely positioned then a frame is used to hold it away from your nose and mouth for comfort and to stop the edges getting in the way of the treatment.
Most of my patients tolerate the rubber dam really well. Some really like it because it gives a feeling of being separated from the procedure and stops all the water splashing around. Some even fall asleep! It is useful in patients where they gag, as once it is in place it stops instruments, suction and materials irritating the palate and tongue.
There are a few patients who find it uncomfortable because it makes them feel scared or worsens a gag. In those cases, where the dam is still really important we sometimes consider sedation to support treatment.
So what does it look like to the dentist when it is in place? I saw a young patient today for a filling in her top molar. I was granted permission to use the photos of the treatment here. I put the rubber dam on because I was putting a white composite filling in and this material likes to be dry when it is placed. When it is in place I get a really nice view of the tooth that is being treated and the tongue and cheeks are protected and out of the way of the tooth. The photos taken show the tooth nearly cleaned out, just after the filling is placed and then when it has been polished and the rubber dam has been taken off. By having the rubber dam in place, I am able to see the edges of the tooth more clearly, make sure that the deep parts of the filling set properly and spend more time over the grooves and contours of the tooth to make it as natural as possible. You can see the gum gets a little squashed by the clamp in the final picture, however this will heal really quickly over the next week or so, and the advantage to using the rubber dam is that this filling will last much longer for this patient.
The rubber dam is a really good tool and in some cases absolutely mandatory to ensure that the dental treatment is of a good enough standard. I certainly would find many procedures much harder without it. I still get the "wide-eyed look", from patients who are new to me when I show this to them for the first time but when explain what it is, it is nearly always ok and the general feedback I get is that it makes everything more comfortable. Especially once the patient has chosen their favourite music to play!
If you need adhesive treatment and want to talk to me about rubber dam then do get in touch, but I promise it is not as scary as it first appears and it will allow you to have first class, long lasting treatments.
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