The complexities of the oral environment are obstacles present to the restorative procedures starting from diagnosis till the final treatment is done. In order to minimize the trauma to these surrounding structures and to provide comfort to the patient, the clinicians need to isolate the tooth before moving forward with any dental surgical procedure. While performing any operative procedure, the isolation of the surgical site is imperative.
When any dental procedure is done without proper isolation, the dentist may face several issues as follows:
- The intervention of excessive saliva in the tooth
- Compromising the visibility of the operative field
- The intervention of blood and other oral fluids
- The poor setting of the dental cement
- Damage to the strength of the dental cement
- Inaccurate reading of the dental equipment due to saliva intervention
- The discomfort of the dentist and patients due to unwanted waiting time
- Soft Tissue injury
The solution here to avoid all the unwanted situations is a Rubber dam Kit. It is a flat thin sheet of latex or non-latex that is held by a clamp and a frame that is perforated to allow the teeth/tooth to protrude through the perforation while all other teeth are covered and protected by the sheet.
Advantages of A Rubber Dam in Dentistry:
- Provision of the dry clean operating field.
- Improvement of access & visibility by eliminating tongue, lip, cheeks & saliva from the operating field.
- Retraction & protection of soft tissues.
- Prevention of inhalation & ingestion of foreign bodies.
- Aid to cross-infection control by reducing the aerosol spread of micro-organisms.
- Minimization of mouth breathing during inhalation sedation procedures.
The armamentarium of Rubber Dam Kit:
- Rubber dam sheets
- Rubber dam clamps
- Rubber dam holders(frame)
- Rubber dam retainer forceps
- Rubber dam punch
- Rubber dam templates or stamps
Steps to Follow for placing the Rubber Dam Kit:
Step 1: Testing and lubricating the proximal contacts. Dental floss is used to test the interproximal contact and remove debris from the tooth to be isolated.
Step 2: Punching the holes
Step 3: Lubricate the dam in the area of the punched hole using a cotton roll or gloved fingertip to apply the lubricant. The lips and corners of the mouth may be lubricated with petroleum jelly or cocoa butter to prevent irritation.
Step 4: Selecting the retainer – The operator receives the rubber dam retainer forceps with the selected retainer and floss tie-in position. The free end of the tie should exit from the cheek side
of the retainer.
Step 5: Position the dam over the retainer with the forefinger, stretch the anchor hole of the dam over the retainer, and then under the jaws.
Step 6: Positioning the napkin – The assistant pulls the bunched dam through the napkin and positions it on the patient face.
Step 7: Attaching the frame
Step 8: If there is a tooth distal to the retainer, the distal edge of the posterior anchor hole should be passed through the contact to ensure a seal around the tooth.
Step 9: The properly applied rubber dam is securely positioned and comfortable to the patient. The patient should be assured that the rubber dam does not prevent swallowing or
closing the mouth when there is a pause in the procedure.
Step 10: Check to see that the completed rubber dam provides maximal access and visibility for the operative procedure.
Step 11: For the proximal surface preparations many operators consider the insertion of inter proximal wedges as the final step in rubber dam application. Wedges are generally round toothpick ends about half inch in length that are snugly inserted into the gingival embrasures from the facial or lingual embrasure.
Conclusion:
To achieve a proper isolation in the oral cavity, rubber dam kit is most useful. In dental clinics, it saves the time of the dentist in finishing the cases as many of the issues can be resolved, also it provides extra safety to the patient that avoids inhaling of foreign particles and unwanted swallowing of the oral fluids and dental debris.
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