RUBBER DAM

Presented by : Cheng Yung Yew P11132

Goals of Isolation

Moisture Control
Retraction and Access
Harm Prevention
Local Anesthesia

Definition - Rubber Dam

A small latex or non-latex sheet
used to isolate a tooth or teeth from the o
ral environment and to prevent migration
of fluids or foreign objects into or out of t
he operative field
providing a dry, visible and clean operativ
e field.

Rubber Dam Isolation

1864, New York City S.C. Barnum, introd
uced rubber dam
Ensures appropriate dryness of the teeth
Isolating one or more teeth from oral env
ironment
Prevent pulpal contamination from oral fl
uids

Advantages of Rubber Dam

1.
2.
3.
4.
5.

A dry, clean operating field

Improved access and visibility
Improved properties of dental materials
Protection of patient and operator
Operating efficiency

Disadvantages of Rubber Dam

1.
2.
3.
4.

Low usage among private practitioners

Time consuming
Patient objection
Conditions precluding use of rubber dam

Teeth that have not erupted sufficiently

Some third molars
Extremely malpositioned teeth
Patients with asthma (breathing difficult thru no
se)

Materials and Instrument

I. Rubber Dam Material
II. Rubber Dam Holder (frame)
III.Rubber Dam Retainer (clamp)
IV. Rubber Dam Punch
V. Rubber Dam Retainer Forceps
VI. Rubber Dam Napkin
VII.Lubricant
VIII.Modeling Compound
IX. Anchors

I. Rubber Dam Material

Dam material available in 5x5 inch or 6x6 inc
h sheets
Thicknesses or weights
o thin (0.15mm), medium (0.2mm), heavy (0.3mm),
super heavy (0.35mm)

Has a shiny and a dull side

o Dull side less light reflective placed facing th
e occlusal side of the isolated teeth

II. Rubber Dam Holder ( Youngs frame)

Maintains the borders of rubber dam in posit
ion
U-shaped metal frame
Small metal projections
An optional Neck Strap may be placed behin
d the patients neck attached to 2 hooks

III.Rubber Dam Retainer (clamp)

Consists of 4 prongs and 2 jaws, connected by
a bow
Used to anchor the dam to most posterior toot
h to be isolated
Used to retract gingival tissue
Available in different sizes and shapes
Wings provide extra retraction of rubber da
m
Disadvantage : interfere with placement of matrix
bands, wedges

IV. Rubber Dam Punch

A precision instrument having a rotating meta
l table (disk) with 6 holes of varying sizes, and
a tapered, sharp-pointed plunger
Plunger should be centered in the cutting hol
e avoid chipping of holes by plunger tip

V. Rubber Dam Retainer Forceps

Used for placement and removal of retainer f
rom tooth

VI. Rubber Dam Napkin

Placed between rubber dam and patients ski
n
Advantages :
Prevents skin contact with rubber to reduce possi
ble allergic reactions
Absorbs any saliva seeping at corners of mouth
Acts as cushion
Convenient method wiping patients lip on remova
l of the dam

VII.Lubricant
Applied in area of punched holes to facilitate
the passing of dam through proximal contacts
Cocoa butter, petroleum jelly applied to co
rners of mouth to prevent irritation

VIII. Modeling Compound

Sometimes used to secure retainer to tooth
Prevent retainer movement during operative
procedure

IX. Anchors (Other than Retainers)

Proximal contact may be sufficient to anchor
the dam on the tooth farthest from the post
erior retainer
To secure the anchor further, a waxed denta
l tape (or floss), or a small piece of rubber d
am material, can be passed through the pro
ximal contact.

Hole Size and Position

Holes must be punched by following arch
form
5-6 holes in cutting table of rubber dam p
unch
Smaller holes incisors, canines & prem
olars
Larger holes molars, posterior anchor t
ooth

 Guidelines in Positioning the Holes : 1. Punch an identification hole in upper left co

rner of rubber dam (optional)
2. When operating on the incisors and mesial
surfaces of canines, isolate from first premo
lar to first premolar.

3. When operating on posterior teeth, isolate a

nteriorly to include the lateral incisor on the
opposite side of arch from the operating sit
e.
4. Isolation of minimum of 3 teeth is recomme
nded except when endodontic therapy is in
dicated.
5. The distance between holes is equal to the
distance from the center of one tooth to the
center of adjacent tooth, measured at level
of gingival tissue prevents wrinkles of the
dam between teeth.

6. When a cervical retainer is used for isolatio

n of a Class V lesion, a heavier rubber dam
usually recommended for better tissue retr
action.
Hole for the tooth should be punched slightly fa
cial to arch form
The farther gingivally the lesion extends, the fart
her the hole must be positioned from arch form.
Hole should be slightly larger

7. When a thinner rubber dam is used, smaller

holes must be punched, because thin dam h
as greater elasticity to seal around the teeth
.
8. For inexperienced operator, a rubber stamp
that imprints permanent and primary arch f
orms on rubber dam is available.
9. A plastic template can be also used to mark
hole position.

Placement of Rubber Dam

Before placing the rubber dam dental c
hair adjusted for optimal patient comfort
Usually, administering anesthetic precede
s application of rubber dam
Rubber dam and retainer can be placed s
equentially provides maximal visibility
when placing retainer, reduces risk of imp
inging on gingival tissue

 Alternative placement :
y

Applying Dam and Retainer Simultaneousl

1. reduce risk of retainer being swallowed

2. this approach ease the passing of the dam over
a previously placed retainer

Applying Dam Before Retainer

1. There is no need of manipulate dam over retain
er
2. Reduction in visibility of underlying gingival tissu
e, which may impinged on by retainer

Application of Rubber Dam Isolation

STEP 1 :
acts
STEP 2 :
STEP 3 :
STEP 4 :
STEP 5 :
on
STEP 6 :
STEP 7 :
STEP 8 :

Testing and Lubricating the Proximal Cont

Punching the Holes
Lubricating the Dam
Selecting the Retainer
Testing the Retainers Stability and Retenti
Positioning the Dam over the Retainer
Applying the Napkin
Positioning the Napkin

 STEP 9 : Attaching the Frame

STEP 10 : Attaching the Neck Strap *(Optional)
STEP 11 : Passing the Dam Through Posterior
Contact
STEP 12 : Applying Compound *(Optional)
STEP 13 : Applying the Anterior Anchor
(If ne
eded)
STEP 14 : Passing the Septa Through the Conta
cts without Tape
STEP 15 : Passing the Septa Through the Conta
cts with Tape

 STEP 16 : Technique for Using Tape *(Opti

onal)
STEP 17 : Inverting the Dam Interproximal
ly
STEP 18 : Inverting the Dam Faciolingually
STEP 19 : Using a Saliva Ejector *(Optiona
l)
STEP 20 : Confirming a Properly Applied
Rubber Dam
STEP 21 : Checking the Access and Visibilit
y
STEP 22 : Inserting the Wedges

Removal of Rubber Dam Isolati

on
STEP 1 : Cutting the Septa
STEP 2 : Removing the Retainer
STEP 3 : Removing the Dam
STEP 4 : Wiping the Lips
STEP 5 : Rinsing the Mouth and Massagi
ng
the Tissue
STEP 6 : Examining the Dam

Factors affecting Rubber Dam Placement

Variation with Age
Errors in Application and Removal
1.
2.
3.
4.
5.
6.
7.
8.
9.

Off-Center Arch Form

Inappropriate Distance between the Holes
Incorrect Arch Form of Holes
Inappropriate Retainer
Retainer-Pinched Tissue
Shredded or Torn Dam
Incorrect Location of Hole for Class V Lesion
Sharp Tips on No.212 Retainer
Incorrect Technique for Cutting Septa

Reference

Sturdevants Art and Science of Operative

Dentistry, Fifth Edition; Theodore Roberts
on, Herald Heymaan, Ed Swift; Chapter 10
Rubber Dam Isolation; 10:463-86
http://www.youtube.com/watch?v=5e979
h67YVc

You don't have to brus

h your teeth - just the
ones you want to keep
.