Why a dental dam is a must for endodontic treatments

Potential challenges

During root canal treatment, dental dam isolation is considered the gold standard of care because it provides the patient and practitioner with so many advantages. However, it’s still not commonly used among all dental clinicians, with less than 19% placing dental dams during root canal treatment and 45% reporting that they never use one.[ii] This may be due to minor issues such as inconvenience of application, increased cost, and prolonged treatment time.[iii] However, it’s important to understand the wide-ranging benefits that dental dams could offer to improve clinician safety, the safety of their patients, and their treatment outcomes.

Benefits for patients and clinicians

Using a dental dam significantly reduces splatter when compared to when a dental dam is not used.[iv]Reducing contamination, especially following the impact of the pandemic, is essential for minimising the risk to your team. When using a dental dam, bacterial contamination from AGE has been shown to reduce by 70-98.9% – a particularly useful tool in managing the risk of contamination.ⁱ

Alongside this, one of the most obvious reasons for using a dental dam is that it provides a physical barrier for protecting the patient’s airway from accidental aspiration or swallowing of instruments, irrigants and debris. From a legal point of view, it would be difficult to defend reasons for not using a dental dam in the instance that a patient were to ingest or inhale a dental instrument, like an endodontic bur. Over the last ten years endodontic files, filling materials, implant screwdrivers, prostheses, and scaler tips have been amongst the most common instruments or materials to be accidently swallowed or inhaled. The Dental Defence Union recommend using a dental dam to minimise this risk.ⁱ

Dental dams also ensure the isolation of the tooth or teeth undergoing treatment. This is especially important in endodontics as the outcomes of treatment are reliant on preventing re-infection from the oral cavity. It’s also beneficial to achieve sterility of the exposed dentine-pulp complex prior to sealing with cement. When carried out using a dental dam, endodontic treatment resulted in higher rates of success.ⁱ

The use of dental dams during treatment also help to improve workflows. When dental dams are applied, surrounding soft tissues are retracted, providing the practitioner with easier access to the treatment site. The barrier also means that saliva is unable to contaminate the treatment site and fog up the mirror, making treatments easier, more efficient, and less stressful to carry out.ⁱ

Informed patients for improved acceptance

It’s important that both practitioners and patients fully understand the benefits of using a dental dam during treatment. Patient reluctance to accept the use of dental dams may also be a hindrance, with discomfort and rejection preventing dentists using the dental dam.ⁱⁱⁱ This makes effective communication with patients vital for maximising acceptance. The use of a dental dam is extremely beneficial, and can protect the health of your patients, and your dental team, as well as protecting you legally should things go wrong.

The HySolate Latex Dental Dam range from COLTENE is low-protein and powder-free, for a reduced risk of hypersensitivity, and provides you with an enhanced dental dam solution which is ideal for use in endodontic and restorative treatment. The HySolate range of dental dams is available in a wide array of scents, thicknesses and colours to meet the specific needs in each case. For example, the lighter colours help to naturally illuminate the operating field, whereas darker colours are useful for creating a visual contrast. Consider the HySolate Black Edition which provides the ultimate contrast – perfect for photographs, and pre-printed to reduce your working steps.

Inform patients of the advantages of using a dental dam to help improve treatment acceptance. Be sure to discuss the advantage of preventing accidentally swallowing of a file, for example. Instrument inhalation is a life-threatening accident, and not necessarily uncommon if a dental dam is not used; 36% of instrument ingestion cases require hospitalisation as a result. Patient safety is vital, and dental dams are an excellent tool for treating endodontic patients. They also offer the additional benefit to the dental team of acting as a barrier for spreading infection.ⁱⁱⁱ

For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.

Author: Mark Allen, General Manager at COLTENE

[i] Patel, Shanon, and Samantha Hamer. “A simple guide to using dental dam.” British Dental Journal 230.10 (2021): 644-650. https://www.nature.com/articles/s41415-021-3016-x

[ii] Anabtawi, Mona F., et al. “Rubber dam use during root canal treatment: findings from The Dental Practice-Based Research Network.” The Journal of the American Dental Association 144.2 (2013): 179-186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563093/

[iii] Madarati, Ahmad, et al. “Dental-dam for infection control and patient safety during clinical endodontic treatment: preferences of dental patients.” International journal of environmental research and public health 15.9 (2018): 2012. file:///Users/officeone/Downloads/ijerph-15-02012.pdf

[iv] Dahlke, William O., et al. “Evaluation of the spatter-reduction effectiveness of two dry-field isolation techniques.” The Journal of the American Dental Association 143.11 (2012): 1199-1204.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093867/