(2) Another disadvantage has to do with its application. The rubber dam
cannot be applied to all cases for one reason or another. When this happens, only single
teeth should be restored.
(3) A psychological disadvantage associated with rubber dam use is the
reaction of a claustrophobic patient (fear of being shut up in a confined space).
(4) One of the major drawbacks to rubber dam usage is in the area of
occlusal checks. Once the dam is in place, occlusal checks are not possible. This
potential disadvantage can be overcome by doing a thorough preoperative inspection of
the patient's record before using a rubber dam.
c. Communication with Patient. Rubber dam placement begins with an
explanation to the patient of what you are going to do. You must tell the patient what a
rubber dam is and the advantages of its use.
d. Preoperative Mouth. A mouth inspection should be done. This preoperative
examination will enable the operator to anticipate most problems before they arise.
During this examination, you should check the number of teeth present in the operative
area, the alignment of the teeth, and the contact area. The contacts should be examined
with floss to see if the dam will clear these areas. If there are any problem areas, you can
call them to the attention of the dentist so modifications can be made.
e. Isolation Procedure. After you have performed your preoperative inspection,
the planned isolation is performed (see figure 2-1 for rubber dam equipment). The proper
clamps are selected (Bi Nap, molar [number 8], anterior [number 9], W14A). With an
indelible pencil, mark the location of each hole to be punched in the rubber dam. Holes
are usually punched for at least one tooth on either side of the one to be prepared. Holes
should be marked to conform to the arch arrangement of the teeth and located on the
dam so that the dam will be centered on the face with its upper edge lying just below the
nose. Usually, dams are premarked with printed dots indicating tooth location. Gauze
pads or napkins are fitted around the patient's face to provide ventilation to the skin and to
prevent irritation. The patient's lips are coated with a lubricant (such as Vaseline) to
prevent them from drying. The dental specialist then selects the appropriate rubber dam
clamp for the tooth most distal to the tooth being prepared. He attaches a ligature of
dental floss to the clamp and secures the clamp to the rubber dam at the most distal hole
punched. He secures the rubber dam frame to the dam and inserts the clamp forceps
into the clamp. The dam is then placed in the patient's mouth and the clamp anchored to
the appropriate tooth. The remaining dam is secured around the teeth by fitting the
septum of the dam interproximally with a strand of dental floss. The dam is then inverted
with a placing instrument, such as a stellite numbers 1-2, by forcing the dam material to
turn over or invert around the neck (the cervical portion) of each tooth. (The air syringe
may also be used to help invert the rubber dam.) The saliva ejector is inserted under the
dam and the clamp ligature wound around one of the small posts of the frame to keep it
from entering the operative field. Depending on the location of the tooth, the dentist may
request that a bite block be inserted for patient comfort.