Return of the Rubber Dam
Isolation has bounced back during COVID-19, but there’s more to gain than the reduction of aerosols
Novel coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020, due to the speed and scale of the transmission of the disease. Immediately, our profession began to investigate ways to protect our patients and our teams from infection. This approach involved the careful assessment of and improvement upon our current infection control procedures. Many institutions dedicated webinars to providing specific information regarding the use of masks, surface disinfectants, fogging techniques, preprocedural mouth rinses, protective barriers, and surgical air purifiers. But what about the use of rubber dams?
In its algorithm for treating emergency patients during the COVID-19 pandemic, the American Dental Association has included rubber dam use with a high-volume evacuator as a strategy to help reduce the spread of the highly contagious virus. Cochran and colleagues found that the application of rubber dams during restorative procedures could significantly reduce the amount of airborne particles within an approximately 3-ft diameter of the operational field by 70% or more. This reduction in airborne particles reduces the risk of COVID-19 transmission and keeps our teams safe during patient care. But should this be the primary reason why clinicians are employing rubber dam isolation?
According to the results of a 2010 study that included the United States and Scandinavia, approximately 63% of the dentists did not use a rubber dam for any restorative procedure despite its proven importance in maintaining a dry field during adhesive dentistry, and a 2007 survey of US dentists found that the most common reason respondents gave for neglecting to use a rubber dam was "inconvenience." For many of the procedures that we have learned to perform in our careers, we were not nearly as fast or proficient in our first attempts as we were after years of experience. Rubber dam application is no different. There are many online and in-person courses available regarding rubber dam placement. I firmly believe that with the proper education and experience, rubber dam application can be completed in 3 to 4 minutes or less, proving that it does not take too much time to incorporate.
Should the need to reduce aerosols for COVID-19 be the only reason for the return of the rubber dam? In my opinion, the answer is an emphatic no. Adhesive dentistry is an integral part of our day-to-day restorative dental treatments. Indeed, adhesives are involved in almost every procedure that we perform. Composite resins, all-ceramic restorations, fiber posts, core build-up materials, and even metal restorations all include an adhesive component in their delivery. Numerous studies have demonstrated that a surface free of contaminates such as saliva, blood, and crevicular fluid is required for successful long-term bonding. It also has been shown that the best way to achieve and maintain a clean restorative surface is with absolute isolation using a rubber dam.
In recent years on social media, we have seen an explosion of rubber dam posts with a never-ending sea of blue photographs. With this came improvements in the techniques for the placement of rubber dams. These techniques include the use of accessory clamps, floss ligatures, and cross arch stabilization-all of which allow the provider to achieve unparalleled isolation and better visualization for nearly any imaginable restorative procedure, including crown and veneer preparation and cementation.
Although there is no doubt that the use of rubber dam isolation provides another form of safety as it relates to the spread of COVID-19, it is also clear that it offers many other benefits in our day-to-day procedures. We may have seen a spike in rubber dam usage since the return to elective practice following the shutdown; however, the evidence shows that clinicians should have been using them all along.
About the Author
Adamo E. Notarantonio, DDS, is a fellow of the American Academy of Cosmetic Dentistry and a clinical instructor in the Aesthetics Honors Program at the New York University College of Dentistry. He maintains a private practice in Huntington, New York.