Dentistry is a unique field. On one end we have straightforward day-to-day products such as a mirror, a probe, a tweezer, etc., and on the other end we have novel innovative products such as dental robotics, niche software, etc. What gets lost often in the MedTech space is the need to bring innovation to simple day-to-day products.

In today’s article we discuss the humble rubber dam product. It’s always poised as a “must-have” yet not everyone uses it. Why is that and who has taken it on their shoulders to improve the experience so that we have better adoption of this product? To understand this, let’s start with first understanding why we require isolation in dental procedures, what a rubber dam is and why we need improvement in this product line.

Keywords: Rubber Dam, Standard of care, Isolation systems, Improving patient care

Why is Isolation Needed?

Isolation of the operatory field is not only essential for patient safety but it also improves both access and visibility for the clinician. One major advantage of isolation is moisture control, which is especially important for adhesive materials sensitive to saliva that can reduce their bond strength. The best way to prevent this is by using a rubber dam for isolation, which is considered the gold standard. In today’s fast-paced dental landscape, traditional rubber dam isolation is being reimagined. Clinicians know that optimal moisture control, enhanced visibility, and patient safety are non-negotiable for successful procedures. Meanwhile, manufacturers are pioneering advanced, latex-free, and pre-framed solutions that promise to streamline workflows and elevate patient care.

Rubber Dam Isolation

A rubber dam is a thin sheet made of latex or non-latex material, featuring holes that allow only the targeted tooth to emerge, isolating it from saliva and bacteria. While the rest of the mouth is protected, the dentist is able to work in a clean environment.

Along with essential hygiene and disinfection protocols, the rubber dam provides notable safety benefits for both the clinical team and patients. The advantages of using a rubber dam include:

Control of moisture

Protecting the tooth and the tooth root from moisture and saliva during the procedure enhances the bonding of the restorative material and reduces the likelihood of infection or reinfection. This creates an optimal, contaminant-free field required for resin-based materials, thereby improving adhesive potential.2

Soft tissue retraction

Helps in creating an accessible field of work, which makes it easier for the clinician to access deep cavities.

Patient safety

Protects the patient from potentially harmful dental materials, chemicals (particularly sodium hypochlorite), and small instruments being swallowed into the gastrointestinal tract or, more critically, inhaled into the lungs.1

Prevention of infection transfer

A Acting as a barrier, the rubber dam essentially reduces the risk of infection transfer. It also provides an aseptic field during endodontic treatment, thereby preventing intracanal contamination by oral microbes.3

Issues related to Rubber Dam

There are several issues and challenges associated with its use that can affect both clinicians and patients.4 5 These include:

Clinician-Related Issues

Time-Consuming: Proper placement of a rubber dam can be time-consuming, especially for inexperienced clinicians or in complex cases.

Technique Sensitivity: Correct application requires skill and practice. Poor placement can lead to inadequate isolation or damage to surrounding tissues.

High cost: The additional cost of rubber dam materials and equipment may be a concern for some practices or patients.

Limited Access: In some cases, the rubber dam may restrict access to certain areas of the mouth, making procedures more difficult.

Interference with Emergency Procedures: In the event of a medical emergency, the rubber dam may need to be quickly removed, which can delay response time

Patient-Related Issues

Discomfort or Anxiety: Some patients may feel claustrophobic or uncomfortable with the rubber dam in place, especially if they are mouth breathers or asthmatic patients.

Allergic Reactions/Latex Sensitivity: Rarely, patients may have latex allergies, making the use of latex rubber dams problematic. Non-latex (nitrile-based) alternatives are available, though they may not be as commonly used.

Gingival trauma and pain: Use of metal clamps usually causes gingival tears and bleeding, making it a painful experience.

Difficulty in Application: Patients with TMJ Issues, limited mouth opening, malpositioned teeth, or extensive restorations may make rubber dam placement challenging.

Gag Reflex: Rubber dams can trigger a gag reflex in some patients, making the procedure uncomfortable.

Lack of Patient Understanding: Some patients may not understand the purpose of the rubber dam, leading to resistance or anxiety.

Alternatives Available in the Market

Whether you’re a clinician striving for precision and efficiency or a company at the forefront of dental innovation, join us in discovering how these advancements are setting new standards for isolation and infection control in modern dentistry.

DryShield Isolation System

These are intraoral devices that combine suction, retraction, and lighting to isolate the operative field. Brought to you by the leaders in this field, like DryShield, Solmetex, LLC, and more, they offer several benefits:

Advantages:

• Provides continuous suction and retraction, prevents pooling of saliva at the back of the throat
• Easy insertion and removal, as no clamp are involved
• Improves visibility, access and efficiency
• Reduces the need for additional assistants

Limitations:

• Can be bulky and uncomfortable for some patients
• Higher cost compared to traditional methods
• May not be suitable for all procedures or patients with small mouths

HandiDam Dental Dam Latex Free

A modern, latex-free pre-framed alternative to traditional rubber dam brought to you by Aseptico Inc., is particularly useful for patients with latex allergies or sensitivities, as well as for clinicians seeking a more user-friendly isolation system.

Advantages:

• Improved Patient Comfort: The lightweight, pre-framed design reduces pressure on the patient’s face and mouth.
• Time-Saving: Quick and easy to apply as the dam is pre-shaped and ready to use. Reducing chair time, making it ideal for busy dental practices.
• Enhanced Infection Control: Disposable and pre-sterilized, reducing the risk of cross-contamination.
• Transparent material: Provides excellent visibility of the operative field. ● Versatility: Can be used for a wide range of procedures, including restorative, endodontic, and paediatric dentistry.
• Adjustable Fit: Easily isolates a single tooth or groups of teeth for endodontics or other dental treatments.

Limitations:

• Cost: May be more expensive than traditional rubber dams due to its pre-framed and disposable design.
• Limited Reusability: Being single use, it may not be as cost-effective for practices with high patient volumes.
• Adaptability: While it is adjustable, it may not fit all clinical situations as precisely as a custom-cut traditional rubber dam.
• Availability: May not be as widely stocked as conventional rubber dams in some dental supply stores.

OptraDam Plus

Due to its anatomical shape and flexible three-dimensional design, OptraDam Plus by Ivolclar, differs significantly from conventional rubber dams.

Advantages:

• Preframed: Doesn ‘t require metal frame, resulting in greater patient comfort and easier placement
• Latex-Free Material: Made from synthetic, hypoallergenic materials, making them safe for patients with latex allergies.
• Ease of Use: Quick and straightforward to apply, ideal for busy practices and short procedures, improving workflow efficiency.
• Infection Control: Disposable and pre-sterilised, ensuring high standards of hygiene and reducing the spread of aerosols in the practice.
• Patient Comfort: Lightweight, flexible, and less bulky than traditional rubber dams, improving patient acceptance and comfort.

Limitations:

• Cost: May be more expensive than traditional rubber dams due to its pre-framed and disposable design.
• Limited Reusability: Being single use, it may not be as cost-effective for practices with high patient volumes.

Takeaway

The alternative isolation systems mentioned above offer significant advantages in terms of ease of use, patient comfort, and infection control. Although they may be more expensive than traditional rubber dams, their time-saving features and adaptability make them valuable tools for modern dental practices—especially for patients with latex allergies or those requiring quick and efficient isolation. It is time for cost-effective isolation systems to be more widely introduced in the market, raising the standard of patient care and reducing the risk of cross-contamination, which will encourage more frequent use of such systems.

The Global Dentists’ Pool – A New Way to Support Dental Innovation Progress

The Global Dentists’ PoolTM by NamNR Pro is an opportunity for both dentists, dental devices and technology companies to collaborate more closely and build solutions to maximise the efficiency of dental practices worldwide.

For dental companies –

With more than 180 dentists spread across 28 countries, this Pool supports dental companies by helping them.

(1) validate their design ideas by running surveys in a large global cohort of practitioners, KOLs and/or

(2) hire premium dental advisors to support various clinical, regulatory, marketing and sales projects.

These are all dentists with specialized MedTech expertise in different domains. The core focus is to avoid hiring multiple ‘non-dental trained’ freelancers and consultants and hire premium dental advisors instead, who are the perfect single substitute for multiple human resources, in the form of one highly specialized support person.

For dentists, surgeons –

The Global Dentists’ Pool provides both general dentists and specialists with opportunities to participate in dental projects without disrupting their clinical practice. The number of hours of engagement is flexible and dentists can upskill themselves by taking the “premium dental advisor program” which teaches how devices are made with medical device industry fundamentals.

If you would like to engage with us to support your project or advance your dental career, then reach out to us at contactus@namnrpro.org.

References

1. Nasser, A. Rubber Dam Isolation – When and Why to Use it? Part 1. BDJ Student 28, 40–41 (2021). https://doi.org/10.1038/s41406-021-0201-y

2. Miao C, Yang X, Wong MC, et al. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev. 2021;5(5):CD009858. Published 2021 May 17. https://doi.org/10.1002/14651858.CD009858.pub3

3. Cochran M A, Miller C H, Sheldrake M A. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. J Am Dent Assoc 1989; 119: 141-144. https://doi.org/10.14219/jada.archive.1989.0131

4. De Castro, Fabrício Luscino & Reges, Rogério & Campos, Bruno & Pazinatto, Flávia & Marra, Juliê & Bruno, Kely. (2013). Improving patient care: alternative rubber dam isolation methods. Revista Odontológica do Brasil Central – ROBRAC. 21.

https://doi.org/10.36065/robrac.v21i59.682

5. Ahmad I. A. (2009). Rubber dam usage for endodontic treatment: a review. International endodontic journal, 42(11), 963–972. https://doi.org/10.1111/j.1365-2591.2009.01623.x

Disclaimers

The opinions expressed in this article are the author’s own and not necessarily shared by NamNR Pro.

Author profile:

Dr Rija Asghar studied dentistry and graduated in 2019 with a distinction in Community Dentistry from Institute of Dentistry, CMH Lahore Medical College, Pakistan.

As an experienced clinician and as a Dental Machine Learning Annotationist, she’s currently working as a demonstrator in the department of Science of Dental Materials at IOD CMH LMC.

Dr Rija is also a Tongue Tie and Lip Tie Specialist having trained under the leading experts in the field and is aspiring to be a paediatric consultant in the future.

In her leisure time, Rija is a sports enthusiast with a true passion for tennis. She enjoys landscape and street photography & recently launched a perfume brand – from naming the perfumes to designing labels, mixing the oils to packaging, loves every aspect of it.