Rubber Dam Isolation
In the interest of hygiene and safety, most dental procedures are carried out using a technique known as rubber dam isolation. This technique is routinely used at Gentle Dentistry to carry out all restorative work and enables you to feel more comfortable during treatment.
The rubber dam is a sheet of latex placed in the mouth to form a barrier between you and your teeth, in effect isolating them. This means that you can swallow and breathe normally, and prevents you from ingesting mercury from old fillings.
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RUBBER DAM TECHNIQUE AND THEORY - source: columbia.edu
The rubber dam (RD) should be applied whenever possible for restorative procedures. The dam is critical for services requiring moisture control, for procedures using small objects which may be easily swallowed (e.g. endodontic files and stainless steel crowns) and as a behavior management tool (e.g. restraining a "curious" tongue, preventing talking or closing). The plastic or nylon rubber dam frame is used to avoid accidental eye injury and to provide for radiology of the dam frame for endodontic procedures.
The rubber dam clamp is placed on the most distal tooth in the quadrant (clamp #27 for premolars, clamp 14A for 1st permanent molars and clamp 14 for 2nd primary molars). The rubber dam clamp must be ligated with a 20" length of waxed dental floss that should be tied to the patient's napkin clip. In the event of clamp slippage or breakage this will help to prevent aspiration. Floss ligated to lingual aspect of bow of clamp.
The rubber dam should be perforated near the center to keep the frame over the face. Usually one half is punched for each tooth, however the contiguous hole technique can provide acceptable isolation and speed rubber dam placement. Remember that primary teeth have a very low height of contour and newly erupted permanent teeth can often make RD isolation difficult or impossible. Most RD clamps we use aggressively impinge on soft tissue necessitating local anesthetics.
For isolation of posterior teeth, the rubber dam should be punched beginning near the center of the dam with one hole per tooth. The rubber dam can be anchored interproximally with dental floss or wooden wedges. For anterior procedure, in lieu of the 212 clamp two or more contiguous holes can be punched and the dam stretched over three or more teeth. Whenever using a clamp which aggressively impinges on soft tissue, consider the administration of local anesthetic.
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