No dam, no endo!on 19th August 2019
Is it necessary?
Yes – a rubber dam is an absolute must for any root treatment procedure. This was assumed knowledge during your studies. Once you step into general practice, you will see many clinicians performing root treatments without a rubber dam. There are many historical X-rays with no radiographic evidence of a clamp and these teeth have survived for many years. However, the question you need to ask yourself is, are you prepared to take that risk?
For many UK dentists, the use of a rubber dam is unnecessary, a waste of time and does not make much difference. For those clinicians whom routinely use a rubber dam, do not be influenced by often more experienced colleagues who consider a rubber dam a redundant part of your armamentarium. What if the tooth is badly broken? What if the clamp is making mid treatment radiographs difficult? What if the patient doesn’t like it? There is not a situation that warrants performing root treatment without a dam. If the patient is not prepared to have a rubber dam, you should not be prepared to offer the treatment.
Risks and complications
If your patient aspirates an endodontic file and ultimately needs a chest X-ray, you can be assured they are not going to be pleased. You can also have a very serious situation arising in your chair if your patient swallows bleach. In today’s society, the tabloids will find any story to publish. By keeping the tooth isolated and dry, you are inevitably keeping out the same bacteria you are trying to eliminate with your procedure. Cotton wool rolls are not a viable alternative! Your indemnity providers will have a difficult job trying to defend a clinician that was too lazy to place a rubber dam.
Benefits and techniques
- Improved access and visibility
- Reduced operative time
- Improved standard of cross infection
- Containment of irrigants
- Safely secures the airway and GI tract
- Reduced stress for the dentist and patient.
There is no correct method to placing a rubber dam, if it works for you then continue with your technique. If it doesn’t work, then seek advice and support from your peers to learn a different technique. The more regularly you use a rubber damn, the faster, more efficient and easier it will become for everyone. Find a technique that works for you and get good with it.
For those extra 30 seconds it takes to place the dam, it will only make your life easier. There are many advantages to the rubber dam, allowing you to focus on your task of providing high quality endodontic treatment in a timely and efficient manner.
The best means of operating in your patient’s best interest is implementation of best practice. You should take the time to educate your patients about the necessity and reasoning of a rubber dam. There are no circumstances that justify proceeding without a rubber dam, no matter how you try and justify it. Simply put, no dam, no endo!